Page 40 - Small Animal Clinical Nutrition 5th Edition

40 Small Animal Clinical Nutrition

interviews with practice teams. More than 1,000 pet owners
VetBooks.ir Box 3-4. Compliance in Human Medicine. were surveyed about the care they provided for their pets, their
desires relative to the information and care provided by their
Several types of noncompliance exist. Initial noncompliance veterinarian and their compliance with health care recommen-
occurs when a patient receives a written prescription or calls a dations. Furthermore, data were gathered from the medical
pharmacy, but doesn’t wait or return to pick up the filled pre- records of almost 1,400 cats and dogs. These data were used to
scription. Patients who fail to present a prescription are also quantify compliance and the opportunities that practices had to
initial noncompliers.Varying compliance is used to describe the improve pet care by improving compliance (AAHA, 2003).
process of taking a prescribed medication at a level less than The study quantified compliance in six areas:
recommended. Hypercompliance occurs when a patient takes • Heartworm testing and prevention
a medication at a level above that prescribed. The term “white • Dental prophylaxis
coat compliance” is used to describe behavior in which a • Therapeutic foods
patient who has been noncompliant takes medication at or • Senior screenings
above the prescribed level around a recheck appointment. • Canine and feline core vaccinations
Accordingly, both the physician and the patient may incorrect- • Preanesthetic testing.
ly believe the patient is receiving therapeutic benefit.“Drug hol-
idays” refers to the behavior in which patients repeatedly and Only dogs and cats seen by their veterinarian at least once
abruptly discontinue and resume taking their medication. during the past 12 months were included in the study; extrap-
Studies have shown that the amount of information forgot- olation accounts for 51 million dogs and 44.2 million cats
ten by patients is a linear function of the amount presented and falling into this category (AVMA, 2002).The AAHA compli-
is correlated with the patient’s medical knowledge, anxiety ance data do not include 10.6 million dogs and 22.7 million
level, and possibly age, but not with intelligence. Therefore, a cats that were not seen at a veterinary practice during the pre-
phased approach is preferable in patient education. Both oral vious year.
and written information should be provided (e.g., patient edu- More than seven million dogs were not in compliance with
cation booklets, medication cards, etc.) and special materials their veterinarian’s protocol for heartworm testing. Almost 21.5
should be developed to instruct patients with low literacy (e.g., million owners did not give their dog’s heartworm preventive
picture schedule). Formal evaluation of patient education is medication at all, failed to give medication for the number of
imperative.
Failure to attend appointments is often one of the first signs days recommended by their veterinarian, or (and maybe most
that a patient is not complying with his or her treatment. Given alarming) were never dispensed an adequate amount of preven-
the difficulty of monitoring compliance directly, health care pro- tive in the first place, or were never notified by the practice to
fessionals may want to monitor patients’ attendance at clinic purchase follow-up doses. In endemic areas, compliance for
appointments as a proxy measure. testing and preventive medication was 83 and 48%, respective-
Asking patients to complete diaries about medication use ly. The American Heartworm Association reported that more
has the advantage of providing details about how and when the than 244,000 dogs tested positive for heartworms in 2001
product was taken. However, whether diaries improve compli- (AAHA, 2003).
ance hasn’t been proven. The AAHA Compliance Study found a dental prophylaxis
compliance rate of 35% for dogs and cats with grade 2, 3 or 4
The Bibliography for Box 3-4 can be found at dental disease. Compliance was only 15% for those pets with
www.markmorris.org.
grade 1 disease. The study concluded that almost 15.5 million
dogs and cats with grade 2, 3 or 4 dental disease had not
received dental prophylaxis. Based on chart review, 23% of
The American Animal Hospital Association those owners of pets with grade 2 or higher dental disease (3.6
Compliance Study million pets) did not receive a recommendation for treatment.
The American Animal Hospital Association conducted the Millions more cats and dogs had grade 1 disease. Interestingly,
largest, most significant compliance study in veterinary medi- no grade was reported for 19% of the patients. The lack of a
cine, which was funded by a substantial educational grant from reported dental grade may indicate that no exam was given or
Hill’s Pet Nutrition, Inc. Results of the study were reported in poor medical record keeping (AAHA, 2003). The American
the book The Path to High-Quality Care: Practical Tips for Veterinary Dental College defines quality dental health care as
Improving Compliance in 2003. This comprehensive study completing a dental prophylactic procedure on any pet with
showed that millions of dogs and cats did not receive the best grade 1 to 4 dental disease. Veterinary health care teams failed
care they could have. Although most practice teams thought to adhere to these recommendations in a great many cases,
compliance with recommendations was high, few practices which has resulted in less than the best care for many patients.
actually measured compliance and the level of compliance in Compliance with feeding a therapeutic food for six canine
almost all cases was significantly less than what practice teams conditions (i.e., kidney disease, bladder stones or crystals, food
believed; 78% of veterinarians indicated that they were satisfied allergies, chronic GI disease, acute GI disease and obesity) and
with the levels of compliance in their practices (AAHA, 2003). seven feline conditions (i.e., the same six canine topics plus
Researchers visited 52 practices and/or conducted in-depth feline lower urinary tract disease) was included in the survey.