Profession hazy on client compliance

Apr 01, 2003
By dvm360.com staff

Most veterinary practices don't measure client compliance. Instead, a whopping 83 percent of compliance estimates are based largely on feel and, consequently, overestimated.

That's according to preliminary statistics cited in a compliance study spearheaded by the American Animal Hospital Association (AAHA). The results of the study were released at AAHA's national convention in Phoenix in late March.

"Most (veterinarians) have the impression compliance is better than it really is," says Link Welborn, DVM, president of AAHA. "They give it their best guess, which is usually an overestimation."

That rings true for Dr. Philip Smith, of Indian Hills, Ala., who says he "feels pretty good" about client compliance, although he readily admits he'd probably be "totally shocked" if he knew the real numbers.

Welborn says part of the problem is that compliance isn't a term commonly used within veterinary medicine. The study aims to change that by not only defining the barriers to compliance in practices, but emphasizing how measuring client compliance improves quality of care.

Broad in scope

The study, funded by Hill's Pet Nutrition, analyzes compliance data from the animal and human health and pet food industries, and gleans insight from on-site interviews in veterinary practices and pet owner research. Based on findings, study authors have generated a list of healthcare recommendations for veterinarians.

The study focuses on six areas of compliance: vaccinations, heartworm prevention, nutrition, dental care, lab screening and senior care.

For example, surveyed practices estimated an average of 74 percent complied with heartworm preventative recommendations. However, measurement of actual compliance showed they were averaging only 48 percent compliance.

Smith, of Indian Hills Animal Hospital, is not surprised. "It's the busy lifestyle everybody leads nowadays," he says. "Everybody gets pulled in so many directions - family, lifestyle. I've got three kids ­ it's hard enough for the veterinarian to remember the heartworm preventative. I feel like I do a good job of it, but it's not easy."

Confirming Smith's experience, a nationwide survey of dog owners conducted in 2000 revealed that more than 80 percent had failed to give their dogs the monthly heartworm preventive on the exact day as instructed; one-third said they missed an entire month and 20 percent of those who missed eventually quit the preventive altogether.

While veterinarians digest such data, industry is responding.

Industry action

One major player in the animal health industry, Merial, is targeting compliance by mailing a single dose of heartworm protection monthly to clients on behalf of prescribing veterinarians. The incentive, dubbed "Compliance in a Box" is designed to make it easier for clients to remember to comply with the veterinarian's recommendations.

Another company, Fort Dodge Animal Health, now provides veterinarians with the option of a six-month dose of heartworm protection for canines.

Whether veterinarians prescribe to such services, Dr. Kathleen Neuhoff, immediate past president of AAHA, says the real message is for veterinarians to view compliance as a means to better pet health.

"If we know we can improve pet health by making certain that our patients are receiving appropriate heartworm medication or are having appropriate diets dispensed, we have an obligation to do all that we can to be sure that clients follow through on our recommendations," she says.

Little things count

Take, for example, Dr. Jessica Heard of Braelinn Village Animal Hospital who welcomes the trivial nuances of her customers; like, when they claim their pets prefer tuna-flavored compounded medications over liver-flavored ones.

By catering to her customers, Heard hopes they'll not only schedule a return visit but comply with her discharge instructions.

But she's realistic.

"All veterinarians, including us, overestimate how much compliance we get," says Heard, of Peachtree City, Ga. "We do these things to increase our compliance because we know it's not very good. It makes it easier for (clients) to keep up with medications long-term."

Responsibility factor

Other veterinarians concentrate on educating clients to achieve compliance, but if they're still not listening, some believe it's up to the pet owner to shoulder the responsibility from that point.

For instance, at Dr. René Carlson's AAHA-certified clinic, doctors stress owner education and provide good recommendations, but aren't afraid to draw the line.

"We do not feel it is our job to enforce compliance," says Carlson of Chetek, Wis. "I understand the liability if it is not documented, so our records contain our recommendations (but) the responsibility rests with the owner, not the veterinarian, to get the care for that animal, unless it is just sheer negligence and a severe welfare issue for the animal.

"We have been trying to transfer that monkey off our backs for a long time, and I don't want it back based mainly on the need to expand our services performed at the hospital," Carlson says.

"Compliance is not difficult to achieve if we do our jobs, and the owners are good pet owners," Carlson adds.

Dr. Jon Redfield of Fredonia Animal Hospital, New York appears to follow suit. Other than a follow-up call to clients who receive medications, the clinic relies on the client to inform them of any compliance complications.

"We're hoping they're forthcoming if they do have any problems," he says, adding that there are clients who comply and those who ignore everything you say. "Other than our communicating with the client, short of going to the house and giving it to them, it's hard to (know)," says Redfield.

Broken record

While Welborn admits certain clients will never comply, at his small animal and exotics practices in Tampa, Fla., he and staff attempt to drill home the compliance message repeatedly to all clients during their visit in hopes many will listen.

"Hearing the same message multiple times and in multiple forms from the whole practice team tends to be effective," says Welborn, who served on AAHA's compliance taskforce.

"Clearly, health care recommendations are of no benefit unless clients comply with or follow through on the recommendations," he says.