Researchers ask: Why is pet owner compliance so dang low?
Dr. Natalie Stilwell provides freelance medical writing and aquatic veterinary consulting services through her business, Seastar Communications and Consulting. In addition to her DVM obtained from Auburn University, she holds a MS in fisheries and aquatic sciences and a PhD in veterinary medical sciences from the University of Florida.
Noncompliance with recommended treatment is a common concern in veterinary medicine, but existing literature provides few clues to its causes.
Pet owner compliance with home treatment recommendations can have a significant effect on patient outcome. Human medical literature estimates an average patient compliance rate of 50%, with similar rates presumed in veterinary medicine.
Why they did it
Expressing the need for a greater understanding of the many factors contributing to veterinary client noncompliance, investigators in the United Kingdom recently compiled available evidence from peer-reviewed studies to examine which factors are most at play.1
What they did
The investigators searched three databases (Medline, CAB Abstracts, and Google) to identify relevant peer-reviewed veterinary studies. Only publications focusing on at-home administration of veterinarian-prescribed therapies to pet dogs and cats were included. Then, they rated each study's quality of evidence using the 2011 Center for Evidence-Based Medicine (CEBM) grading system.
What they found
Eight veterinary studies matched all of the inclusion criteria. Seven of these studies directly examined pet owner compliance with treatment recommendations; one study focused on drug efficacy but also included information on compliance. At-home treatments included short-term antimicrobials, allergy hyposensitization injections and treatments for neoplasia.
Seven of the studies evaluated compliance in dog owners, and one study targeted cat owners. Compliance with recommended treatments was reported using a variety of methods, including owner self-reporting, pill counting, electronic monitoring and review of medication refill orders.
The following four factors reportedly affected owner compliance in at least one study:
- Type of disease
- Frequency of medication dosing (e.g. once vs. three times per day)
- Consultation time with the veterinarian
- Health risk to the pet if untreated.
Interestingly, none of the studies found associations between pet owner compliance and route of drug administration, treatment outcome, pet owner's working schedule or extent of the pet owner's understanding of the treated disease.
More rigorous studies needed
Overall, conflicting results and unclear methods reported in the studies frustrated the investigators. The studies all used different designs, variables and study populations, making side-by-side comparison of their results difficult. Compliance rates depended heavily on the method of reporting used, and the investigators suggested that the use of owner self-reporting likely led to biased results.
Also, none of the studies met the highest level of CEBM criteria for study design and quality. Many were either funded by pharmaceutical companies or failed to report key details on statistical analysis or sample size. Despite being common in medical literature, oversights in reporting can dramatically alter a study's reliability, according to the authors. Thus, the literature review failed to find a consensus on reasons for pet owner noncompliance.
To increase compliance, veterinarians must be able to recognize and address a client's potential reasons for not following through with recommended at-home treatment. This article's authors declared the existing literature on this topic to be “scarce and of poor quality,” providing inconsistent results and little helpful data. They stated that future studies should focus on providing practitioners with actionable intervention steps to manage and prevent noncompliance.
1. Wareham KJ, Brennan ML, Dean RS. Systematic review of the factors affecting cat and dog owner compliance with pharmaceutical treatment recommendations. Vet Rec 2019;184:154.