Consensus on Compliance Essential, Not Optional

• Consensus on Compliance Essential, Not Optional (199.0 KB)

In 2002, Hill’s Pet Nutrition and the American Animal Hospital Association (AAHA) joined forces to investigate compliance in veterinary medicine. Data were published in 2003 and for the past 7 years, the word compliance has taken on significant meaning within the worldwide veterinary profession. But for many of us, several questions remain:
• What is compliance?
• Why is it important?
• How can the concept of compliance be leveraged to better provide for the pets and people we serve?

Compliance Defined
When discussing compliance, an incredibly important word is often trivialized: care. As Rick DeBowes notes in this month's "Letter From the Editor," care is defined as “watchful attention.” Compliance in veterinary medicine exists when a pet receives the watchful attention you believe best. Seems simple enough. When asked, 78% of veterinarians indicated they were satisfied with the level of compliance in their practices—even though, in reality, almost none measured compliance.¹ Once a practice investigates the number of pets that receive a product or treatment versus how many should, based on their own parameters, alarming statistics begin to emerge.

To illustrate, let’s talk about a fictitious health care team that believes that every dog with grade II/IV periodontal disease would benefit from prophylactic dental therapy. This clinic, like many if not most practices, has the means to perform or send out laboratory work for a preanesthetic work-up; has radiographic, anesthetic, and dental equipment; and at least one trained veterinary technician or nurse to perform the procedure. They examined 100 dogs last month that fit their criteria, and of those, conducted or scheduled a dental for 20. This team thought they were doing a pretty good job of caring for this group of patients, but in fact, their compliance on dentistries was just 20%, even lower than the national average of approximately 40% to 50%.²

Why? Part of the reason (excuse?) lies in the fact there is a disconnect between what pet owners want and what veterinarians believe they are willing to pay. The 2003 Hill’s and AAHA3 study, along with a 2008 AAHA compliance study conducted in association with Pfizer², shed valuable light on understanding why compliance shortfalls exist in veterinary medicine.

CRAFT
Figure 1 details how once a condition is diagnosed, compliance depends on the art and science of communication. Compliance = Recommendation (by the veterinarian), Reinforced by the health care team, + Awareness and Acceptance by the pet owner, + Follow Through (facilitating therapy) to ensure the service was completed and/or products were continually provided. This translates into better patient and pet owner care, and as a result, a more enjoyable and productive work environment for the health care team.

(Figure 1)

Pets Are Family
Every scientific survey of pet owners since 1995 found that the vast majority of pet owners think of their pets as members of the family and are willing to incur the expense of keeping them healthy.⁵ Pet owners are usually quite willing to pay for veterinary care if they realize the value of what is being offered.

Simply stated, Value = Benefits/Price. The better the health care team communicates the benefits to a pet of proposed products and services, the more likely a pet owner will agree. It is critical that all members of the health care team believe this!

In our dental example, how well do the team members take care of the own pets’ periodontal health? Do they believe the benefits are worth the cost? Can they communicate with confidence, competence, and conviction on the benefits of oral care to clients? Unfortunately, many veterinarians (and sometimes practice staff) are overly influenced by the fewer than 10% of clients for whom cost is an issue rather than focusing on the 90% who want the best care for their pets.⁶

To close the “recommendation gap,” everyone, particularly the doctors, must agree to consistently recommend in accordance with the practice’s protocols, without prejudging the client’s level of interest in providing the best care or willingness to pay.⁷

Communicate for Compliance
The six most important communication practices to improve adherence (according to pet owners) are:
• Demonstration
• Length of appointment
• Written information
• Follow-up calls
• Chronic medication reminders
• Continuity with the veterinarian.⁸

Consider the simple examples of dental care, internal and external parasite control, and weight management. Does your practice have succinct, convincing, and consistent ways to communicate the importance of overseeing these issues to a pet’s health and longevity? Almost 60% of pet owners agreed or completely agreed that their pet’s health care provider did not always make the importance of their recommendations clear.⁹

Investing time in preparing scripts, checklists, and protocols, and then ensuring they are used effectively by the entire team can pay huge dividends in improved care, pet owner satisfaction, and practice productivity.

Align for Achievement
Is every individual in your practice committed to providing the best care for each pet, every time? If so, you know how enjoyable practice can be, and that continuous improvement is paramount, regardless of the economic climate. Both of the above-mentioned AAHA compliance studies have insightful steps on improving compliance and patient care, and all health care teams will be well served in adapting such measures. In addition, many other resources exist to help practices develop and implement plans for measuring and achieving higher levels of compliance.¹⁰

Commit to Compliance
Compliance is a quality-of-care issue. If you as a veterinary care professional have the knowledge, skills, equipment, medicines, and diets available to maintain wellness and restore health, yet fail to recommend appropriate care and take reasonable steps to ensure client acceptance, you have not achieved the highest-quality outcome possible for your patient.¹¹ Owners and pets depend on you to be an advocate; don’t abdicate that responsibility. Enhancing compliance (care, watchful attention) is essential to providing the best medicine we can.

Portrait of a Successful Veterinary Health Care Team

Veterinary health care teams that maximize the benefits of compliance share these traits:

1. A solid understanding of what compliance means.

2. Agreement that compliance fits with the practice’s philosophy to provide quality care.

3. Insight into research regarding what pet owners and veterinary health care team members believe about effective compliance.

4. Proven processes, protocols, and tools that can be modified and adapted to increase compliance.

5. Commitment by each team member to improve, including goals set to measure progress.

References
1. The Path to High-Quality Care, Practical Tips on Improving Compliance. AAHA Press, p 14, 2003.
2. Compliance: Taking Quality Care to the Next Level. AAHA Press, p 11, 2009.
3. The Path to High-Quality Care, Practical Tips on Improving Compliance. AAHA Press, 2003.
4. Compliance: Taking Quality Care to the Next Level. AAHA Press, 2009.
5. The Path to High-Quality Care, Practical Tips on Improving Compliance. AAHA Press, p 17, 2003.
6. The Path to High-Quality Care, Practical Tips on Improving Compliance. AAHA Press, p 83, 2003.
7. The Path to High-Quality Care, Practical Tips on Improving Compliance. AAHA Press, p 32, 2003.
8. Compliance: Taking Quality Care to the Next Level Executive Summary. American Animal Hospital Association, 2009.
9. The Path to High-Quality Care, Practical Tips on Improving Compliance. AAHA Press, p 81, 2003.
10. Veterinary Nutritional Advocate, vna.hillsvet.com, 2009.
11. The Path to High-Quality Care, Practical Tips on Improving Compliance. AAHA Press, p22, 2003.