the Dog’s Blog: Giving a dose of medicine – what do we know about pet owner compliance?

Giving a dose of medicine – what do we know about pet owner compliance?

One of the factors affecting the likelihood of success of a treatment is the degree to which a pet owner complies with the vet’s treatment recommendations. In humans it’s thought that between a third and a half of all medicines prescribed for longterm conditions are not taken as recommended. Do we know that people are any better at giving medicines to their pets?

A research group at the Centre for Evidence-Based Veterinary Medicine in Nottingham aimed to discover what is known about compliance with drug treatments among pet owners. The results of their research were published earlier this year (Wareham et al 2019). Incidentally the lead author of the report is Kathryn Wareham, a member of Veterinary Prescriber’s editorial team. 

The research involved conducting a systematic review of the published literature. The group found eight relevant studies (six tested factors affecting compliance while two proposed factors that potentially affect compliance). All but one directly examined owner compliance and the factors associated with owners’ compliance with therapeutic recommendations for dogs and cats in a small animal practice setting. The remaining study was a drug efficacy trial that also assessed compliance. The studies mainly involved short-term therapy with antimicrobials; other treatments studied were chronic allergen injection therapy and therapy for mammary neoplasia. 

Factors that were found to have affected compliance in at least one study were: 

  • one vs. three times daily dosing and twice vs. three times daily dosing (although the effects on compliance were inconsistent); 

  • discussion of the dosing regimen in light of the owners’ circumstances; 

  • the consultation time spent with the vet;

  • the disease condition being treated; 

  • the month of the consultation or treatment; 

  • and physical and social risk. 

Factors that appeared not to affect compliance included:

  • route of administration of the medication,

  • treatment outcome or effect of treatment; 

  • owners’ employment in relation to the dosing regimen;

  • and whether the owner knew what disease was being treated.

There were methodological problems with all the trials, including differences in the ways of measuring and defining compliance and no accepted definition of a compliant client. The variation meant that it was not possible to reach an overall conclusion about the data. There was only one study in cats and none looked at polypharmacy or multimodal therapy. Overall it’s a limited amount of evidence and indicates that we know relatively little about pet owner compliance or what to do to improve it.

Should we even be talking about pet owner compliance? No one talks about ‘compliance’ any more in human medicine; instead the term ‘adherence’ is used, including in relation to the treatment of children. Compliance suggests passively following a prescriber’s recommendation whereas adherence presumes an agreement with the prescriber about the recommendations and implies that a person is able and willing to abide by a prescribed regimen. Unintentional non˗adherence occurs when the person wants to follow the agreed treatment but is prevented from doing so by barriers that are beyond their control, for instance difficulties in understanding the instructions, problems with using the treatment, or inability to pay for the treatment. Intentional non˗adherence occurs when the person decides not to follow the treatment recommendations because of beliefs and preferences that influence the person's perceptions of the treatment and their motivation to start and continue with it. 

As many of the factors that can affect human patient adherence can also affect the likelihood of a pet receiving a treatment, it seems to me that adherence is a more appropriate term to use in veterinary medicine too. And it would more accurately reflect what is already happening in practice because clearly some treatment decisions are being made that take into consideration pet owner factors, but to what extent, I don’t think we know.

References

Aronson JK. Editor’s view. Compliance, concordance, adherence. (2007) Br J Clin Pharm 63: 383-4.

National Institute for Health and Care Excellence. (2009) Medicines adherence: involving patients in decisions about prescribed medicines and supporting adherence. Clinical Guidelines [CG 76] [online]. https://www.nice.org.uk/guidance/cg76

Wareham KJ, Brennan M, Dean R. (2019) Systematic review of the factors affecting cat and dog owner compliance with pharmaceutical treatment recommendations. Vet Rec 184: 5: 154.

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Veterinary Prescribercompliance, veterinary medicines, adherence, pet owners