Better compliance: better outcomes

01 April 2010, at 1:00am

BRONWEN DAVIES discusses ways of reducing the divergence between client behaviour and veterinary expectation.

ANTIBIOTICS are commonly prescribed in small animal practice and it is important they are given according to instructions. 

Animal owners often find it difficult to understand what is wrong with their pet and why they are being given medicine. It is the clinician’s responsibility to explain not only the problem with their cat or dog but also how and why the recommended treatment should be given in a particular way.  

It is also important they indicate what the likely outcome will be and give a reasonable estimate of the expected treatment costs. Assuming that adequate explanation is given on these matters, then the client is far more likely to act in accordance with advice given by the veterinary surgeon concerned.1 

If antibiotics are not given correctly (the right drug at the right time and the right dose), several events might occur including, for example, failure of the animal to get better, resistance to the antimicrobial concerned and the possibility of intractable and recurrent infection.  

Clients will often blame the veterinary surgeon for an apparent inability to diagnose and treat the condition2 and may, as a result, seek a second opinion elsewhere. This is not a good advertisement for the practice but there are many ways that the likelihood of such an outcome can be minimised.

Starting point 

Communication and understanding between clinician and owner is a good starting point in increasing client compliance with treatment.3 

The higher level of compliance within referral practices is generally explained by the longer consultation times allowed, combined with the greater degree of explanation given regarding the condition of the animal under review.4 

Obviously, increasing time spent with each client is impossible within a busy general practice but greater delegation to nursing staff concerning explanation of treatment options will help understanding in this regard. 

Simplification of treatment options also helps augment the number of clients willing to give medication correctly. Clients will be more inclined to administer regular doses if only one or two daily doses are required and the animal is more likely to receive its full treatment course.5

If, however, antibiotics need to be given three times a day, or more, then the probability of a correct treatment regimen being followed declines dramatically.6 This may be due to owner work commitment or can be the result of forgetfulness in a stressful life.7 

It is important, therefore, to choose a drug that can be given once, or at the maximum twice, a day, in order to give the animal the best chance of improvement. 

Often, if an animal is to receive the correct dose of medication it might be necessary for the clinician to dispense tablets of different strengths. This can be confusing for the client and may become a further cause of compliance issues.

Simplify administration   

On the other hand, a single tablet, which can be broken easily into several equal parts to achieve the correct dosage level, will simplify administration for the client and, correspondingly, increase the percentage of animals receiving the complete dose of medication. 

Many animals do not like taking medicine! Cats, in particular, are frequently troublesome. Owners will get frustrated if they have difficulty giving tablets to their pet.

Although it is sometimes possible to mix tablets with food, this is not always appropriate. In some cases the pet may refuse to eat what it sees as contaminated food. Additionally, a number of antibiotics should not be given with food as it can delay, or even prevent, absorption of the active ingredient.  

It is important, therefore, that drugs should be given according to instructions.  To this end, the advent of tablets that an animal will take voluntarily, with or without food, will increase the number of animals being given their treatment correctly.  

If it is possible to dose a dog or cat without effort, then it becomes increasingly probable that the owner will complete the course of treatment given for the pet.

When administration of medication is difficult, numerous owners will be tempted to discontinue tablets as soon as their animal appears to have recovered. Premature cessation of treatment, for whatever cause, can occur before all bacteria are destroyed and recurrent problems for the owner and pet may ensue.  

Palatable tablets 

It can be seen from the above that the recent advent of palatable tablets in the dispensary would be expected to go a long way towards improving compliance levels in general practice. 

Treatment expense is another contentious issue. Many owners seeking initial treatment may be reluctant to continue if costs are felt to be too high. 

A large number of antibiotics come in capsule form or as tablets that are difficult to break. This can result in higher doses being dispensed than strictly necessary which, although not harmful, will increase overall treatment cost significantly when given over a period of time.  

Tablets that can be split easily into four, rather than two, portions make more accurate dosing possible. This could reduce the quantity of pills dispensed for treatment, decrease treatment costs and increase compliance as a result. 

Finally, compliance levels, and thus treatment outcomes, indicate the divergence between client behaviour and veterinary expectation. The gap is wide if compliance levels are low and narrow or absent if they are high. 

All veterinary surgeons are able, by the use of a few simple steps, to virtually eradicate the discrepancy in the following ways: by ensuring the client’s understanding of treatment options, simplifying treatment regimens, facilitating tablet administration by dispensing drugs in palatable form, and reducing treatment costs by using tablets that can be easily broken into several equal parts. 

Additionally, a new eight-point plan for the responsible use of antimicrobials has recently been launched by the British Veterinary Association. The main thrust of its argument is aimed at reducing the overall utilisation of antibiotics unless absolutely necessary for specific treatment regimens. 

Points two and three in the plan, which emphasise the importance of correct administration of the correct antibiotic for the presenting condition, relate directly to the force of the argument towards improving compliance by the administration of palatable tablets that can be easily broken into several equal parts.

  1. News and Reports (2006) Veterinary medicines and owner compliance. Veterinary Record 9: 792-793. 
  2. Ibid 
  3. Humphries, J. P. (2008) Client communications for good compliance. Proceedings of the 33rd World Small Animal Veterinary Congress, pp479-482. 
  4. Fn1 supra. 
  5. Barter, L. S. et al (1996) Owner compliance with short-term antimicrobial medication in dogs. Australian Veterinary Journal 74 (4): 277280. 
  6. Griffith, S. (1990) A review of factors associated with patient compliance and the taking of prescribed medicines. British Journal of General Practice 40: 114-116. 
  7. Fn1 supra; fn3 supra.