Page 42 - Small Animal Clinical Nutrition 5th Edition

42 Small Animal Clinical Nutrition

pliance (AAHA, 2003). owners during more than 90% of visits. Only 18 to 22% of pet
The AAHA study lists several follow through components
VetBooks.ir to augment recommendations. These include: scheduling pro- owners recalled such discussions. Reasons cited for lack of
client follow through include:
cedures and follow-up appointments when the recommenda-
• Unclear diagnosis or need for follow-up care
tion is made, providing clear instructions for at-homecare and • No one told me about the need for follow-up
recheck exams (Almost 80% of pet owners indicated they • Follow-up appointment not made or was too difficult to
wanted verbal and written instructions.), sending reminders (In make
the AAHA study, compliance was highest for core vaccina- • No reminders were sent.
tions, a service for which virtually every practice sends As an example, client acceptance of dental recommendations
reminders. Few practices send reminders for medication or doesn’t depend on the degree of dental disease or the cost of the
food refills. Sixty-five percent of pet owners said they would procedure. Clients cited these reasons for lack of compliance:
welcome multiple reminders by phone, mail, e-mail or a com- • Not enough education provided about the need for the
bination. Seventy-two percent said they would like to receive a service (45%)
phone call if they were overdue for a recommended treatment • Follow-up visit not scheduled (15%)
or preventive service.) and making follow-up phone calls. More • Veterinary health care team didn’t tell me about it (8%)
than 82% of the pet owners surveyed indicated that they want- • Pending appointment (5%)
ed to be able to discuss feeding and homecare instructions with • Unclear diagnosis (5%)
other members of the health care team, not just the doctors. • Cat was too wild to catch (5%)
Practices that consistently followed-up with clients whose pets • Other (7%).
were fed a new food reported a much higher percentage of Several other sources bear consideration for improving com-
patients staying on the new food and a much higher compli- pliance (Table 3-3).
ance with recommended feeding guidelines (AAHA, 2003).
The AAHA Compliance Study identified six steps to Conclusion
improving compliance and patient care: It is obvious that adequate health literacy is a major obstacle to
• Measure current compliance delivering optimal health care in human medicine. By exten-
• Involve the entire health care team (and establish protocols sion, this issue is no less dramatic in veterinary medicine, and
that are agreed upon) the processes for improved communications and health literacy
• Set compliance goals cited in this chapter have direct relevance to pet care.
• Implement new protocols The health literacy issue is coupled to that of
• Measure and track results compliance/adherence. As defined in the AAHA Compliance
• Celebrate success. Study,compliance in veterinary medicine is defined as,“the pets
The AAHA Compliance Study found that a major cause of in your practice are receiving the care that you believe is best for
veterinary care providers’ failure to make health care recom- them.”That is; if you, the attending veterinarian, believe specif-
mendations was their misjudgment of the clients’ willingness to ic products and services are important for a particular pet’s care,
take action. The following represent reasons veterinarians cited does your health care team effectively communicate your beliefs
for noncompliance (AAHA, 2003): to the client in order for her/him to decide the next steps for
• Cost (60%) the pet’s care? Not all clients will take our recommendations,
• Communication and client education (55%) but research suggests that better communication improves
• Client time or convenience (40%) medical care.
• Perceived value (25%) Health literacy, the degree to which individuals have the
• Process error at practice (15%). capacity to obtain, process and understand basic health infor-
Despite these perceptions 75% of pet owners agreed or mation and services needed to make appropriate health deci-
strongly agreed that their veterinarian made recommendations sions (Ratzan and Parker, 2000; Healthy People 2010) cannot
that were good for the pet. Only 10% of pet owners agreed or be assumed. Effective communication is paramount to practic-
strongly agreed that their veterinarian’s recommendations were ing great medicine (Silverman et al, 2005; Cornell et al, 2007).
motivated by a desire to make money. Cost wasn’t a major bar-
rier to adherence in the AAHA Compliance Study. However,
lack of an effective recommendation and lack of reinforcement REFERENCES
by the veterinary health care team were cited by clients as
important barriers to compliance. For example, veterinarians The references for Chapter 3 can be found at
claimed that they discussed nutrition and pet food with pet www.markmorris.org.