Drugs don’t work unless we can get them into our patients. It sounds simple, but that premise is one of the core challenges in veterinary pharmacy. This is not limited to just finding the best route of administration or palatable flavorings for your pet. Owner compliance is just as, if not more, important.
At the forefront of a pharmacist’s mind each day is medication adherence. Failure to follow a medication regimen can lead to treatment failure, serious adverse reactions and poor patient outcomes. It’s true in human pharmacy and the same applies to our pets.
At Realo, we use a variety of tools to improve patient compliance. There is significant evidence to support using the techniques below and I have personally seen the effectiveness of each one. The most important thing to remember is that persistence is key. You must continually encourage clients and may need to institute a multidisciplinary approach with your local veterinary pharmacy.
Difficulty administering medications can affect adherence. Your practice can sample different dosage forms and flavorings to find the form that your patient takes with the most ease. Oral suspensions, medicated treats or transdermal gels may be a better option than capsules or tablets. It may even be possible to combine some medications in a capsule or suspension – check with your pharmacist to determine what is possible.
Applying medicated ear drops daily (sometimes twice daily) can be difficult for even the most dedicated pet owners. Otic gel packs can be invaluable for improving treatment outcomes. Usually applied in the office, these gels stay in place for 10-14 days, being slowly absorbed over that duration. For your busy vacationers, these otic gel packs make compliance during summer travel much more attainable.
In addition to drug formulation, dispensing containers can hinder drug administration. Owners who struggle with physical dexterity can use devices designed to ease application of topical preparations, eye drops and injecting medications like insulin.
Good habits require routine. Give your owners a specific time(s) of day for administering their pets’ medications and avoid their guesswork. Owners are more likely to remember to give their pets a medication before meal time or before going to bed. Incorporating the practice into daily life means it is less likely to be forgotten.
There are a variety of adherence aids available to help owners organize their pets’ medications (e.g. pill boxes) and remember dose times (alarms and mobile applications). Ask your local pharmacist for recommendations.
Pet owners may misinterpret common instructions. Repeated instructions can help ensure proper understanding. Partnering with a local veterinary pharmacy can also serve as another communication avenue. Pharmacists can offer back-up counseling to make sure the client understood your directions. Medication monographs and administration guides should always be included with prescriptions as an additional reference tool.
While communication with the pet owner is key, it’s essential to have open communication with other healthcare providers that care for your patients. This becomes very relevant when your patient sees multiple specialists or has been under the care of an emergency clinic.
Collaborating with a local pharmacy can help you detect nonadherence. Through monitoring refills, pharmacists are an excellent source for ensuring an owner is continuing to administer medication. Also, by virtue of multiple client touch points, pharmacists can regularly check for adverse effects. Any unpleasant side effects can be a primary reason for abruptly discontinuing medication.
Pets are members of our families. Many owners go to great lengths to provide optimal care for their animals. When a pet owner understands the importance of the medication, they are more likely to remain compliant. Again, providing supplemental literature, like drug monographs, can help convey reasoning behind drug selection choice.
“Medication sync,” as it is often referred to in pharmaceutical practice, is an excellent tool for improving patient adherence. With synchronization, the pharmacy coordinates medication refills with the patient (or client in this case) to set a pick up at the same time each month (their “sync” date). With compounded medications especially, this practice can prevent interruptions in therapy. Better yet, the pharmacy can increase convenience for the entire family by syncing everyone’s medications for the same sync date each month.
Pharmacists will often encourage more “difficult” patients to participate in a comprehensive medication review (CMR). These patients are often those with complex medication regimens, significant prescription drug expenses and those struggling to remain compliant. Working with a qualified veterinary pharmacist, an interactive pharmacist-to-client meeting could assist your practice with providing enhanced patient care and with uncovering adherence issues.
Financial limitations can be the largest barrier to patients not receiving their medications. Prescription drug costs can be more pronounced in veterinary patients since they are most often not covered by drug insurance. A pharmacist, with a knowledge of veterinary pharmacotherapy, can help you find suitable alternatives that are more economically feasible for your clients.
Again, not all of these options will work. Encourage pet owners to try different approaches to find what works best for them. It’s imperative we remain aware of owner compliance to improve outcomes in our veterinary patients.