5 steps to success: Client compliance


Create 'maximum opportunity' to follow doctor's orders; confused clients can't comply

Have you ever gone into a store to ask a simple question and gotten barraged in a techno-babble response that overwhelmed you?

To save face, you may have nodded politely and bee-lined it for the exitthe first chance you got. You still had your simple question left unansweredand now the start of a massive headache.

Well, some of your clients may feel this same way without you knowingit. Scarier still is the fact that even if you, your staff and all of yourcolleagues are 100 percent perfect in your verbal and written client communications,you may still have a compliance problem when it comes time for the pet ownerto follow your directions.

Over the edge

It's not always the medical talk that sends clients over the edge whenit comes to understanding and complying with your prescribed therapy. Sometimesclient emotions interfere with what you're saying. Other times they maystill be processing problems from work or home and only get half of whatyou tell them.

Simple distractions such as children in the exam room can also affectthe client's ability to hear, understand and comply with your prescribedtherapy.

I see and talk with your clients when they've just left your practiceand need a prescription compounded. Often they are confused about theirpet's diagnosis and/or the prescribed treatment. Their questions typicallyfall into the "What do I do now?" category. "Impossible!"You say. You detailed it three times. Guess what? It didn't "take."

* Five practical suggestions

To address this common scenario and elevate the compliance levels inyour practice, I've put together the following five practical suggestions.I hope you'll find this useful, or at the very least, a quick refresherof what you may already know.

Before I begin, keep this in mind: Confused clients cannot comply. Regardlessof why clients leave your practice with questions unanswered or incompleteinformation, it is essential to the pet's health and your practice to interveneand help ensure that a maximum opportunity for compliance is established.This "maximum opportunity for compliance" involves you, everydoctor in your practice, your staff, and yes, the client.

So client compliance begins withyou guessed it you.

1. Doctor, heal thyself. Okay, not literally, but the first step towardsincreasing compliance levels at your practice is to audit yourself. Thinkabout your most recent day at the practice and see if the following statementsare true for every client who left with a therapy regimen for their pet:

Did you:

* Summarize the pet's condition in words you know for sure theyunderstood?

* Provide them with some written information about their pet'scondition?

* Share with them insights on any Web sites that could providefurther details?

* Say any prescribed dosing aloud at least twice along with thedosing interval?

* Point out that the dose and dosing interval are printed righton the bottle?

Gently quiz the client to ensure they heard, e.g., "So you knowhow much of the medicine to give, correct? Wait for a reply. "And howoften?"

Consider calling them in a few days to check in on how they're doingand be available to answer additional questions, especially if this is acase involving long-term therapy.

As tedious as this all sounds, know that increased compliance will positivelyaffect your patient's care so it is worth it in the long run.

Keeping up-to-date

A second part of auditing yourself is to ensure that you are continuallyupdated on current treatments and monitoring guidelines.

Read voraciously. Clip and file. Keep current article reprints on handto help you detail current strategies for managing and treating common conditionsand diseases. New drugs and therapies are coming out all the time. Stayon top of the monitoring parameters. Many of the of the common disease statessuch as thyroid, cardiac, neurological disorders can be effectively treatedwith pharmaceuticals, but you need to be aware of the recommended monitoringfor each drug as well as various physiological perimeters before initiatingtherapy.

2.Educate your colleagues and staff. Share your self audit outcomes ­or even just the fact that you did one ­ with the other doctors on staffto encourage them to do the same. See if your office management softwarecan give you information about (a) the top medical conditions in your practiceand (b) all pets on long-term medications. Study this. Share it. Educateall staff members on the practice's common conditions, the correspondingtreatment regimen, possible side effects, monitoring requirements. Practicepossible answers to commonly asked questions on each of these conditions.

Educated receptionists and technicians can be your best ambassadors forincreasing compliance ­ and they are sometimes a lot more availableto the client. An educated staff will know when blood monitoring has tobe done and will realize when there may be issues arising from ongoing therapy.Their ability to ask good questions and generate additional informationfrom clients can play an important role in client compliance. While staffmembers should never be considered the final decision- makers when it comesto practicing veterinary medicine, they can act to alert you to a potentialproblem and play a pivotal role in protecting the pet's health.

Another compliance area your staff can handle is drug monitoring.

Check that notices on appropriate monitoring go out when needed. Makesure your staff understands and can "sell" pet owners on the importanceof keeping an eye on the blood levels of certain drugs or the physiologicalmarkers that indicate whether the therapy is or isn't successful. If ownersdon't buy into the concept of monitoring ongoing therapy, then a major pieceof the compliance pie will be missing.

Now I realize that 120 percent of your time is typically taken up providingcare to patients. All this staff education can chew up a big chunk of time.Look for additional ways to educate your staff that may not require lotsof your own time. There are an increasing number of software programs outthat enable staff members to look up a drug or retrieve appropriate laband drug data. If your practice isn't set up to allow staff access to acomputer terminal, make sure you have the latest editions of Handbook ofVeterinary Drugs, Plumb's Veterinary Drug Handbook, the AAHA Formulary andthe Physicians' Desk Reference, Drug Facts and Comparisons or Drug InteractionFacts.

3.Team up with a veterinary compounding pharmacist. Another keyresource to invite onto your medical team is your veterinary compoundingpharmacist.

Establishing a relationship with your veterinary pharmacist can saveyou time and money as well as contribute to the enhanced care for your patients.

A veterinary compounding pharmacist can help your practice in three keyareas:

* By being a good reference for your medical team as well as yourclient. You don't really read every word from every drug company on allthe new medications available, do you? With hundreds of new medicationscoming onto the market each year, it can help to have a specialist on yourteam who is up to speed on each of them. Keep in mind that a pharmacistis trained to understand potential issues from chronic drug therapy. Weare exposed to cases involving complicated drug interaction every day.

* By reinforcing your medical therapy message; you know, the oneyou said three times and the pet owner still doesn't recall? Your veterinarypharmacist can help educate the client about the prescribed therapy andreinforce the need to continue to monitor their pets' progress and responseto treatment. The veterinary pharmacist can also be helpful in asking theowner about any side effects the pet may be having that may require a dosageor medication change.

* By enhancing compliance directly via making the medicine easierto take. Turning a giant-sized, foul-tasting pill into a "treat"that is easy to give and even easier to swallow can make compliance levelssoar.

Client aspect

Okay, so now that you have your full medical team on board and primed,you're ready to take the leap into the client aspect of compliance. Knowthat there are as many excuses for not complying with your therapy regimenas there are clients, but don't despair. There are some means of alleviatingmany (excuses that is.)

4.Educate the client. Let's look at some common pitfalls. Avoidthese and your compliance is sure to escalate.

Too much or too technical. Unless your client is a doctor, nurse or othermedical professional, assume that they know nothing about anatomy and areunfamiliar with medical terminology. Resist the urge to sound importantand knowledgeable with the use of big words. Substitute clear, non-technicalwords instead. Use language you would use for a typical teenager, that wayyou'll not only use simple words, you'll be already tuned in to a personwho is only half listening!

Too little. "Your dog has amelanotic malignant melanoma, any questions?Great. Have a good day." Wrong! Right after you give the technicaldiagnosis, launch into a layman's version of what the condition is, whatcauses it, and what can be done about it. Then, just when you're sure you'vebrilliantly imparted every tidbit of wisdom there is on the subject, considergiving the client a client-friendly handout. You might also direct themto an appropriate Web site, loan them a video on the subject, or share withthem one of those clippings you've been diligently cutting out and filingfor just this occasion.

Keep in mind that some clients learn best from the spoken word (auditorylearners); some will only digest the information fully if they can readit, and others still will need both methods. Don't short-change them. Givingthem information in a manner that doesn't connect directly to their learningmode will be as effective as trying to watch your favorite football gameon the wrong channel.

Using different communications to relay your message will increase yourclients' likelihood of understanding the situation at hand, and directlylink to higher compliance with your prescribed treatment regimen.

Forgetting to explain the need for follow-ups and lab monitoring. Partof any long-term drug program should be monitoring of drug levels and monitoringof blood perimeters if indicated. Many of the drugs used for long-term diseasesrequire monitoring to determine if there is any underlying harm being doneto body systems as a result of chronic exposure to a drug. There are manyresources available (software as well as reference books) that can helpyou explain to clients both the need for monitoring and the frequency.

Implement a system where clients are scheduled for follow-up labs ona regular basis. The problem of follow-up labs and how often tests needto be done is a touchy issue. It is important to have a system in placethat is not too onerous for the client but still allows you to keep an eyeon the patient's condition. If a lab is scheduled to be repeated too often,the owner will think this is just another revenue stream for the practiceand not relate to monitoring the pet's therapy.

Explain it to them. Tell them of the drug manufacturers' recommendationsand why it's necessary to monitor. Have the staff help in continually educatingclients on the importance to keeping an eye on the appropriate labs to determinehow the therapy is progressing and more importantly that the therapy isnot resulting in any harm.

5.Prescribe a regimen that is easy and affordable. Short term,an educated pet owner who understands the situation can comply with justabout any therapeutic regimen you can devise. Here the emphasis is on "short."Most clients will be able to afford a short course of expensive medicationor treatments. And the majority of clients will find a way to administerthe medication if it is needed more than twice daily- even those every oneto two hour doses of forioxuridine ophthalmic drops can be juggled intoa schedule-for a short period of time. When prescribing long-term or lifelongtherapy, however, know that it's a different story.

It is very clear in the pharmaceutical world that that there are inverserelationships with dosing interval, drug cost, and patient compliance.

That is, with decreased frequency of dosing comes increased compliance.In addition, with decreased cost of medication there is an increase in compliance.It is very clear with all of the different human medications being formulatedas once a day or even once a week dosing that the less intrusive a drugtherapy is the better the chances are that it will be adhered to. Thereis no reason to believe that this will not be true when pet owners needto give medications to their pet.

Easier to swallow

When prescribing medication, consider calling your veterinary pharmacistto ask if there are other drug forms available. Making a drug flavorfulor easy to give can increase the compliance factor dramatically.

I don't know how many times I've had pet owners come into the pharmacyafter using a flavored medication and give me an unsolicited testimonialas to how their relationship with their pet has greatly improved since theystarted giving a medication that was easy to administer and enjoyable forthe pet to take. These types of clients are very consistent in reorderingtheir pets' medications, which results in the pet having therapy that isoptimal because of the owners' excellent compliance. These are also thesame owners who will also make every effort to have routine labs performedif given appropriate reasoning to do so.


Another compliance factor that your veterinary pharmacist can help withis cost.

Ask if there are less expensive options for the medication you wish toprescribe and hear what is available. If you can find a less expensive alternative,you may have just increased client compliance on this factor alone.

A final word on prescribing for better compliance: Avoid prescribinga medication where the client must give different doses at different timesof the day. There is usually very little need for this complication. Moreover,the complication itself tends to breed non-compliance.

Don't lose sight

As healthcare professionals, we sometimes lose sight of how little thegeneral public knows about medicine, physiology, pharmacology and diseasestates.

In general, the level of knowledge is low. If your clients are not properlyeducated about the disease being treated, the chances of their followingthough with your prescribed therapy or lab monitoring is minimal. So weneed to continually check our own communications, update and refresh knowledgebanks for ourselves and the entire staff and take steps to ensure that weare doing everything we can to increase the client's understanding of theirpet's condition.

With this higher level of communication on our part, comes a higher levelof understanding on the client's part-and ultimately a higher level of complianceto ensure that the pet's health is optimal.

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