OSTEOARTHRITIS (OA) AFFECTS AN ESTIMATED 20% of dogs older than one year of age and is the most common form of arthritis in dogs and cats.
The disease may have profound effects on canine and feline quality of life, causing chronic pain, decreased mobility and increased stress. The financial and emotional burden on pet owners resulting from disease management can also be significant and impacts on owners’ willingness to continue with treatment strategies.
Optimising compliance with regard to osteoarthritis treatment therefore increases the likelihood that a management strategy will be adopted long-term by the pet owner. At most, 50% of people with chronic disease comply with their doctor’s recommendations so in short, the easier we make our owners’ lives the more likely they are to follow our guidance.
In the human field, the term “compliance” has been superseded by the term “adherence” to reflect the extent to which a patient’s behaviour with respect to taking medication corresponds with the agreed recommendations from their healthcare provider.8 This change in terminology illustrates the importance of client/patient engagement.
Animal health clinicians should adopt a multimodal approach to the management of OA, ideally including all or a combination of pharmaceutical agents, dietary supplementation/modification, lifestyle changes, surgery or other complementary strategies where appropriate. So multimodal management leads to better clinical outcomes, but we must be sensitive to the added complexity it adds to our clients’ lives.
Various strategies can be employed to optimise the compliance of clients managing chronic diseases such as osteoarthritis in their pets…
Less is more
Multiple studies confirm that the prescribed number of doses of treatment per day is inversely related to compliance, hence we should aim for once-per-day treatments wherever possible and look for ways to combine treatments, e.g. reach for multi-ingredient preparations where they exist.
Allow owners to trial different presentations, e.g. tablets/capsules/ liquids to find the form that works best for their pet. Every pet is different and owners appreciate being offered options.
Opt for oral medications and supplements with high levels of acceptance as determined by strict palatability testing and design. This can limit the likelihood of rejection and hence the stress of administration, aiding compliance. This is especially true in the management of chronic diseases, e.g. osteoarthritis.
Choose treatments optimised for bioavailability to allow for maximum benefit from dosing and reach for treatment options supported by clinical data, to avoid under/overdosing.
A tablet which is simple for a vet/nurse to administer can prove impossible in the hands of an owner, so reach for treatments tailored to aid compliance, e.g. species/breed-specific sizing. As not every oral treatment can be given mixed with food, choose your treatment options/sizes with care.
Education, education, education
Compliance levels significantly rise when we as vets take the time to explain our treatment regimens to our clients, so make use of product literature and client leaflets to engage with pet owners.
Providing clients with simple dosage charts and treatment scorecards can also help to encourage them to comply with our often complicated treatment strategies!
Encourage owners to share their experiences of using products with you, to allow you to help when things are not going to plan. Ensure any issues with compliance are reported to the manufacturer as not only will their support team assist you in the short-term, recurrent compliance issues may lead to product improvements in the long-term.
Slowly does it
Ask owners to gradually introduce new management strategies, e.g. new exercise regimes, over days to weeks to desensitise pets to novel treatments. Desensitisation reduces the risk of rejection, meaning owners have a positive, not a negative experience, and are more likely to persevere with treatments.
In short, modern medical advances mean the treatment options open to our patients are better than ever, but this is an empty victory if we do not ensure our clients are totally engaged with their pets’ clinical journeys and offer them the support they need to carry out their care plans.
- Johnston, S. A. (1997) Osteoarthritis. Joint anatomy, physiology, and pathobiology. Vet Clin North Am Small Anim Pract 27: 699-723.
- Innes, J. F. (2012) Arthritis. In: Tobias, K. M. J., S. A. (ed), Veterinary Surgery: Small Animal. Missouri, Saunders, pp1,078-1,111.
- Bloom, B. S. (2001) Daily regimen and compliance with treatment. BMJ 323: 647.
- Grave and Tanem. Compliance with short-term oral antibacterial drug treatment in dogs. JSAP 40 (4): 158-162.
- Claxton, Cramer and Pierce. A systematic review of the associations between dose regimens and medication compliance. Clin Ther 23 (8): 1,296-1,310.
- Litster et al. Clinical Efficacy and Palatability of Prado oxacin 2.5% Oral Suspension for the Treatment of Bacterial Lower Urinary Tract Infections in Cats. JVIM 21 (5): 990-995.
- Thombre, A. G. Oral delivery of medications to companion animals: palatability considerations. Advanced Drug Delivery Reviews 56 (10): 1,399-1,413.
- World Health Organization (2003) Adherence to long-term therapies: evidence for action.