The importance of compliance in small animal practice

07/08/2020

There are many factors which can affect the therapeutic success of a particular treatment. Even if both the correct diagnosis was made and the most appropriate treatment prescribed, the clinical outcome may not be optimal if the owner does not follow the prescribed instructions or if the animal does not accept the medication.

Poor compliance can have an adverse effect on the patient, can cause failure of antimicrobial therapy and can even have signifi cant public health implications. A poor treatment outcome may also make pet owners feel that their veterinarian’s skills and knowledge are defi cient. This can lead to pet owners seeking a second opinion, maybe even from a neighbouring practice. Compliance is particularly important when prescribing long treatment courses and especially when treatment continues beyond the resolution of clinical signs and apparent recovery e.g. canine pyoderma where minimum treatment durations are 3-6 weeks. A number of studies have shown that veterinarians are not able to predict which pet owners will be compliant.

Potential consequences of poor compliance

Inadequate response to treatment
Development of bacterial resistance
Recurrent infections
Side effects associated with the discontinuation of some drugs
Toxicity if owners try to catch up on missed doses
Increased cost to pet owners
Creation of doubt about a drug’s effectiveness
Creation of doubt about the veterinarian’s competence

Barriers to good compliance

Administering treatment more than once or twice daily
Administering multiple medications
Remembering to give the medication
Difficulty getting the pet to take the medication
Long duration of treatment
Not able to give the medication with food
Lack of understanding about the disease being treated and/or medication prescribed
Lack of client satisfaction with time spent with veterinarian
Lack of client participation in treatment decisions
Client unwillingness to ask questions
Pet owner’s busy lifestyle

How to improve compliance

Recognise that you cannot predict which pet owners will be compliant – treat them all as potentially non compliant
Choose treatment regimes which suit each pet owner’s lifestyle
Ensure clients know how to administer the medication
Consider dispensing the formulation that best suits the needs of the pets and owners
Consider the palatability of the medication
If possible give the medication with food as linking pill administration to an activity such as feeding can increase compliance
Ensure your instructions are clear and support verbal instructions with written instructions
Give dose instructions in hours rather than frequency/day
If possible avoid medications which need to be given more than twice a day
Involve veterinary nurses in enhancing client communication e.g. administration techniques

References
1. Maddison JE, Medication compliance in small animal practice, Veterinary Ireland Journal 2011; 64 (1); 39-43
2. Adams VJ, Campbell JR, Waldner CL, et al. Evaluation of client compliance with short-term administration of antimicrobials to dogs. JAVMA 2005; 226(4):567-574.
3. Barter LS, Maddison JE, Watson ADJ. Comparison of methods to assess dog owners’ therapeutic compliance. Aust Vet J 1996; 74:443-446.
4. Haynes RB, McKibbon KA, Kanani R. Systematic review of randomised trials of interventions to assist patients to follow prescriptions for medications. Lancet 1996; 348:383-386.