Client compliance with ocular and oral medications is a constant challenge and an essential component of any veterinary treatment plan. Most clients can adhere to a brief regimen of drug administration for their pets. However, persistent administrations of medications for months to years can be problematic. Typically, client compliance decreases as additional medications are added to a regimen, or as their frequency of administration is increased. There are a number of strategies for increasing compliance especially for clients administering multiple chronic medications to their pets.
Medication adherence or (compliance) is defined as the degree to which a person’s behavior corresponds with the recommendation of their health care provider. This differs from medication persistence which is defined as the time period from initiation to discontinuation of a therapy. In humans the administration of chronic medications has an adherence rate between 48 and 78%. Humans are known to consistently overstate their compliance with their medical providers to relieve their sense of guilt. In addition, humans tend to be most compliant within 5 days of a doctor’s visit and 5 days before any re-examination.
A good example of medication compliance can be appreciated in humans with chronic glaucoma. Medication refills requested by glaucoma patients has not been correlated with their age, gender, ethnicity, severity of glaucoma, or level of education. However, their medication persistence is strongly correlated with their level of health literacy (simplified information regarding their condition and what their medications do). Therefore, clinicians which increase health literacy tend to have more compliant patients.
In veterinary ophthalmology many effective therapies require strict compliance for long periods of time. For effective ocular drug compliance clients must obtain prescribed medications, and then successfully administer them to their pet’s eye (or eyes) at appropriate times each day.
Many clients assume that their veterinary specialist can directly provide their pet’s medications. This may be convenient, but is also typically the most expensive option. This can lower compliance as clients struggle with financial burdens. Less expensive and often just as convenient options include filing prescriptions with their referring veterinarian, a local pharmacy, or a compounding pharmacy that delivers to their home.
Once obtained, it can be particulary difficult for clients (or evened seasoned veterinary professionals) to administer medications to the eye of a fractious animal. With docile pets, owners still require good coordination, manual dexterity, and good vision to successfully administer medications to the eye. Some owners may lack some or all of these traits. Following a demonstration, a veterinarian can often gauge their client’s abilities by watching them administer a medication to the eye of their pet. A client’s abilities, and preferences, for the application of ocular ointments vs. the instillation of eye drops can also be determined at this time.
A veterinarian’s rhetoric when referring to drug compliance is also important. For example, asking an owner if their “pet is allowing them” to administer a medication is preferable to asking if the owner has administered a medication to their pet. This shifts any guilt associated with non-compliance from the owner to the pet, and often results in a more honest assessment of compliance.
Compliance with ocular medication regimens decrease with increased frequencies of daily administrations. For example, human compliance decreases from 92% to 64% when self-administered anti-glaucomics are shifted from BID to TID. It is helpful to explain to veterinary clients that even a TID regimen is attainable for their pet. Administrations every 8 hours can be simplified to an owner as a first dosage during their pet’s breakfast, a second after the owner gets home from work, and a third at bedtime. In this way a client understands that their veterinarian has reasonable expectations. A daily dosing chart may also assist, and simplify, these dosage regimens (Figure 1).
Medication persistence is dependent on an owner understanding what their pet’s medications are for. Daily adherence can be problematic especially when diseases do not immediately present symptoms when a dosage of a drug is skipped. Owner’s may then interpret this as a sign that a drug is no longer necessary and stop a medication without consulting their veterinarian. Frequent examination of pets undergoing long-term medical therapy can be used to explain to an owner the subtler changes they are not appreciating, and can be a time for re-emphasizing the importance of maintaining a drug regimen. The importance of medication persistence can also be emphasized to an owner through a pictorial history showing the subtler changes in their pet’s welfare.
Typically, owners immediately stop administering any ocular medications that they feel are harming their pet. Owners are acutely aware of, and are concerned about, complications routinely associated with ocular drug administration including stinging, blepharospasm, periocular discharge, or pawing at the eye. Many of these are transient side effects that are not of significant medical concern. Post-surgical hyperemic conjunctiva, injected sclera, and/or inflammation are also sometimes misinterpreted by clients as side-effects of subsequent medications. Communication between a veterinarian and an owner will be crucial in these cases to maintain medication compliance.
A veterinarian’s empathy, clear communication, and positive re-enforcement of an owner’s medication compliance can increase that compliance. Understanding the limitations of an owner’s ability to medicate their pet should also be appreciated by their veterinarian. Increased medical compliance is associated with better outcomes of long-term therapies.
If you have any further questions regarding ocular medication compliance, please feel free to consult with a veterinary ophthalmologist.
Noelle La Croix, DVM, Dip. ACVO
The Veterinary Medical Center of Long Island
75 Sunrise Highway
West Islip, New York 11795
(631) 587-0800, fax (631) 587-2006
Figure 1. A drug log kept by the owner of a 7-year-old castrated male Shih Tzu suffering from keratoconjunctivitis sicca.