In any form of medicine, a successful patient outcome depends on compliance: how willing or able a patient is to adhere to medical recommendations. In the United States alone, it’s estimated that half of human patients do not subscribe to their doctor’s advice.1 Nearly 40% of patients don’t take prescriptions correctly, if at all, and almost twice that ignore advice to exercise or adjust their diet.1,2
Compliance in veterinary medicine presents its own unique challenges because dogs and cats themselves cannot act on recommendations from the veterinary team. They—and we—must rely on pet parents to follow through. When pet parents fail to hold up their end of the bargain, it’s easy for the veterinary team to question their commitment and wonder why they aren’t listening.
Client shortcomings in compliance with preventive medicine recommendations are especially concerning: In a major study of veterinary client compliance conducted by AAHA in 2003, pet owners’ adherence to recommendations on core vaccines, heartworm testing and prevention, and dental prophylaxis was much lower than healthcare providers had predicted.3
Yet how much are our clients to blame? What are the responsibilities of the veterinary team when it comes to follow-up? In the AAHA study, more than a third of surveyed clients claimed they would be more likely to act on recommendations if the veterinary team took the time to check in.3 And while 78% of clients in that study said they expected post-appointment follow-up, 52% actually received callbacks.3
Can veterinary teams more specifically tailor their follow-up strategies with clients so that their practices find greater success in (1) meeting consumer needs and (2) improving compliance?
Asking clients to fill in the blanks
We recently conducted an online survey via Facebook and LinkedIn through advertising that met Institutional Review Board approval at Midwestern University in Glendale, Arizona. Participation was anonymous and voluntary, without financial incentive. One hundred veterinary clients completed the survey, the majority of which were female (89%).
Participants were asked if they expected post-appointment follow-up after:
- their pet’s first visit to a new practice
- routine wellness visits
- acute, sick or emergency visits.
Participants who answered in the affirmative were asked a series of follow-up questions to clarify their expectations regarding time frame and whom within the veterinary team they expected to follow up.
Study data were collected and managed using REDCap (Research Electronic Data Capture) at Midwestern University. REDCap is a secure, web-based application designed to support data capture for research studies.4
Client expectations regarding post-appointment follow-up
According to our results, 51% of clients who are new to a veterinary practice expect to receive post-appointment follow-up. Once clients have established themselves at a practice, their expectation of post-appointment follow-up hinges on the reason for presenting the patient to the clinic. After a routine wellness appointment, only 18% of clients expect follow-up, compared with 90% of clients who present on emergency (see Figures 1-3).
Timing of follow-up matters, particularly after emergent situations. Of those who expected to hear from the veterinary team after an acute or sick visit, the majority (63%) agreed that follow-up should take place within 24 hours of the office visit. By contrast, 44% of those who expected follow-up after a wellness exam extended the time frame to 72 hours after the visit (see Figures 4 and 5).
Clients have clear preferences for how they want the veterinary team to follow up: 65% preferred that communication take place via telephone, 20% via email and 15% via text messaging (see Figure 6).
Who within the veterinary team reached out to contact the client did not matter to 36% of survey respondents. However, 19% had clear-cut preferences: Of these, 90% (17 of 19) expected to hear from the veterinarian, and 11% (two of 19) expected to hear from the technician. None would have been satisfied if a customer service representative had reached out to check in (see Figures 7 and 8).
Forty-five percent of respondents acknowledged that their preference for who followed up with them depended on the clinical scenario: For instance, respondents had a tendency to accept callbacks from support staff when the news to be shared was “normal” or “good” test results. Here are some verbatim comments from respondents:
“If it is negative test results, [then hearing from] tech or office staff is fine.”
“If tests are routine and do not require change [to the treatment plan], then a technician following up would be fine.”
“Bad news: doctor. Good news: doesn’t matter who.”
Situations that more preferentially called for the veterinarian to reach out included abnormal test results and extended medical discussions about changes in treatment plans:
“If it is bad news, then I want the vet to call.”
“If new treatment is required or further diagnostics … then I prefer to speak directly with the veterinarian.”
“If the situation was life-threatening or potentially life-ending, … I would prefer the vet that provided care to make the follow-up call.”
“If it’s reasonable to expect that I’ll ask follow-up questions and/or have to make a potentially difficult decision, I think a veterinarian (preferably the one who most recently saw my pet, and certainly one with some familiarity with me and my pet) should call me, so s/he can answer my questions as necessary.”
Clients who felt strongly that the veterinarian should be the one to follow up were upfront with their reasoning:
“I’d rather be contacted by someone who knows the entire situation.”
“I would prefer to talk to the vet just in case I have questions.”
“The person following up should have the knowledge to speak to the situation.”
Clients did not want to run the risk of having questions for support staff, only to have those questions not addressed or lost to follow-up when support staff failed to pass them along to veterinarians, who in turn never called back. Clients wanted to feel that “the veterinary team is responsive to me and my pet’s needs.” From the client perspective, the best way to do that is to be selective about who calls and for what reason so that “if I have questions, I will get the appropriate answers.”
How does voicemail fit into the picture?
Clients unanimously wanted to receive a voicemail from the veterinary team if they could not be reached. However, they were split as to the level of detail they expected in a message (see Figure 9).
When asked to rate the level of detail they thought a message from the veterinary team should contain on a scale of 1 to 10, 36% selected “10,” indicating they wanted to receive the most detail possible. These individuals equated words with value:
“If I paid $150 for bloodwork, I do not think that a brief message devoid of details is sufficient. Telling me ‘the bloodwork was normal’ doesn’t help. I want to know that there was value to the tests that were run. I want to know if there are any values that are normal but perhaps nearing the high or low range that we need to watch. I need to know what the next steps are. I want an action plan.”
“Everything is important. I have paid for it.”
Respondents who appreciated detailed voicemails also explained that more information leaves less room for interpretation and worry:
"I especially dislike messages that leave no information—because then I am left to invent concerns in my own mind until I hear back from the clinic.”
“Vague responses can create needless confusion or fear. Specific, clear information is best.”
“I hate messages that are vague: ‘I’m sorry that I couldn’t reach you; I will try again tomorrow.’ Those kind of brief messages are stressful. I want to know and I want to know now.”
The second most popular choice was a “5,” at 18%, indicating the need for the veterinary team to exhibit moderation when leaving a voicemail:
“I don’t need to know every measurement or other detail, but the message should tell me enough so that I know the ‘big picture.’”
Respondents who requested the least amount of information on voicemail mainly did so out of fear that bad news would be relayed:
“If it’s something like cancer, I don’t want that on a message.”
“I do not want them to give me any bad results over the phone.”
“If it’s upsetting news, I would want to hear it in real time.”
Respondents who feared bad news delivery were very specific about what the veterinary team could do to ease the process:
“If there’s a potentially serious problem, the message should prepare me for that news.”
“I would appreciate if the doctor left a date and time to be reached so that when I attempt to call, I can actually talk with them.”
Would providing a written discharge statement help?
Several clients acknowledged that being provided with a copy of the visit summary might lessen their need for follow-up. Sixty-nine percent of clients expected to be given a written statement for every visit. An additional 18% felt that a visit summary could be beneficial, particularly after hospitalization or a surgical procedure or when home care instructions were extensive. One respondent admitted that “not everyone retains what they hear,” so it’s helpful to have instructions in writing. Several respondents agreed:
“It’s hard to take all the information in when you are in a crisis situation. Having something to refer to when you get home is very helpful.”
“Information can be missed when transmitted verbally.”
“Written words prevent misunderstanding.”
“I’m forgetful and like to revisit the information and instructions from the visit.”
Another stressed that medication instructions are must-haves “so I don’t do the wrong thing and make [the situation] worse.”
Another emphasized the importance of postoperative instructions, saying that when done well, these “reduce repeat calls to the vet office and answer questions about ‘what to watch for’ during recovery.”
One participant provided an important reminder to the veterinary team that not every client is hearing, emphasizing the importance of having a visit summary available: “I’m deaf so when it’s written down, [the] directions are clear.”
In addition to using the visit summary as a means to clarify home care instructions, 17% of respondents admitted to wanting a copy for their own personal records. These individuals stressed the importance of maintaining a file at home for each pet “in the event we ever change vets” or because “we move a lot.”
Likewise, breeders expressed the importance of retaining files on individuals:
“I keep records of each kitten/cat. Since I own a cattery, if I need to refer to a specific office visit in the future, there isn’t any way for me to remember EXACTLY what happened if it is not clearly stated.”
Should we be providing copies of test results?
An even greater percentage of clients (74%) wanted to be provided with copies of all test results. An additional 11% felt that copies of selective test results could be beneficial, particularly if abnormal values were detected and could prove important in an emergency or after-hours setting.
One respondent acknowledged that having a copy of test results facilitated her at-home attempts to research the pet’s condition more extensively. Another respondent expressed a similar mindset:
“I’m heavily into evidence-based medicine, which appears to have penetrated veterinary medicine less than two-legged medicine. I want ALL results including original x-rays and lab results. … Any questions I have would be directed to the vet after I review results.”
Moving forward, what can we do to better serve our clients?
This survey’s results are in agreement with the 2003 AAHA compliance study that clients value their connection to and ability to communicate with the veterinary team: Clients expect to be contacted by their practice.4,5 Yet there are so many means of engaging with clients today—telephone, patient portals, apps, email, texts and social media platforms—that it’s easy to inappropriately make assumptions about clients and lump them into one category.6 The challenge is to recognize that one client is not synonymous with all clients: Each has their own identity and preferences when it comes to both the communication medium and the message.
Rather than jumping onto the next trend, the veterinary team should invest time in exploring what the individual client wants. One respondent put it best when she wrote, “Perhaps the vet could ask the client at the end of the visit who they would like to hear from.”
If we leave it up to guesswork, then we have a 50-50 shot at getting it right. But if we ask the client from the onset, we’re sending a message loud and clear: (1) We respect the client as an individual, and (2) we are committed to meeting their needs even if it means adapting ours.
1. Roter D, Hall JA. Doctors talking with patients/patients talking with doctors: Improved communication in medical visits. Westport, Connecticut: Auburn House, 1992.
2. DiMatteo MR, Giordani PJ, Lepper HS, et al. Patient adherence and medical treatment outcomes: a meta-analysis. Med Care 2002;40(9):794-811.
3. The path to high quality care: practical tips for improving compliance. Lakewood, Colorado: American Animal Hospital Association, 2003;4-25.
4. Harris PA, Taylor R, Thielke R, et al. Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. Jour Biomed Informatics 2009;42(2):377-381.
5. Ackerman LJ. Blackwell’s five-minute veterinary practice management consult. 1st ed. Ames, Iowa: Blackwell Publishing, 2007;xvii, 654.
6. Mortensen P. Communicating with patients? Follow their preferences, not yours. MobiHealthNews, Aug. 24, 2015. Available from: www.mobihealthnews.com/news/communicating-patients-follow-their-preferen....