Profession hazy on client compliance

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

That's according to preliminary statistics cited in a compliance studyspearheaded by the American Animal Hospital Association (AAHA). The resultsof the study were released at AAHA's national convention in Phoenix in lateMarch.

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

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

Welborn says part of the problem is that compliance isn't a term commonlyused within veterinary medicine. The study aims to change that by not onlydefining the barriers to compliance in practices, but emphasizing how measuringclient compliance improves quality of care.

Broad in scope

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

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

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

Smith, of Indian Hills Animal Hospital, is not surprised. "It'sthe busy lifestyle everybody leads nowadays," he says. "Everybodygets 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 conductedin 2000 revealed that more than 80 percent had failed to give their dogsthe monthly heartworm preventive on the exact day as instructed; one-thirdsaid they missed an entire month and 20 percent of those who missed eventuallyquit the preventive altogether.

While veterinarians digest such data, industry is responding.

Industry action

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

Another company, Fort Dodge Animal Health, now provides veterinarianswith 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 veterinariansto view compliance as a means to better pet health.

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

Little things count

Take, for example, Dr. Jessica Heard of Braelinn Village Animal Hospitalwho welcomes the trivial nuances of her customers; like, when they claimtheir pets prefer tuna-flavored compounded medications over liver-flavoredones.

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

But she's realistic.

"All veterinarians, including us, overestimate how much compliancewe get," says Heard, of Peachtree City, Ga. "We do these thingsto increase our compliance because we know it's not very good. It makesit 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 ownerto shoulder the responsibility from that point.

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

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

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

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

Dr. Jon Redfield of Fredonia Animal Hospital, New York appears to followsuit. Other than a follow-up call to clients who receive medications, theclinic 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 everythingyou say. "Other than our communicating with the client, short of goingto 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 smallanimal and exotics practices in Tampa, Fla., he and staff attempt to drillhome the compliance message repeatedly to all clients during their visitin hopes many will listen.

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

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