HAVE you ever stood in front of your vast array of drugs and reached for the medication with which you feel most at ease? It could be the drug you have used for years; the tablets whose dose rate you could recite in your sleep; the tablets you know the “little old lady” will be able to afford?
Clearly it can prove challenging when attempting to introduce a new or alternative drug into practice, despite the fact that newer medicines often mean better efficacy and pet owner satisfaction.
Where there is evidence to suggest that a particular drug offers greater benefits, then why is it sometimes perceived as challenging to alter the behaviour of vets and get them to reach for the new drug of choice? There are, however, ways to make this whole process easier and unite members of the practice in the decisions they make.
A recent initiative, “Previcox in Practice”, demonstrates how the introduction of a recently-developed drug can be a positive experience for business, staff and clients alike. The scheme helped practices across the UK introduce the NSAID, Previcox, considered by participating vets to offer new benefits to patients suffering from osteoarthritis (OA).
However, initiatives driven by drug companies are not the only solution to the challenges faced when introducing an alternative drug. After all, not every new drug that is brought to market will have supportive initiatives to ease its introduction into practice. It takes time and commitment to ensure the whole process is as positive as possible for both staff and clients.
Here we look at an example of the “Previcox in Practice” initiative in action, and also an independent practice approach, and hopefully give some direction to other practices which are also willing to take on the sometimes daunting challenge of introducing a new drug into practice.
In total, 49 practices took part in the “Previcox in Practice” initiative and 246 dogs were included in the scheme. Vets prescribing the product for the first time, in either existing or new cases of OA, were asked to monitor patients by a series of evaluations.
Vets were required to evaluate the patient at days 0 and 28, and owners were asked to make their own evaluation at days 14, 28 and 56. The latter was achieved by completing an owner assessment form and giving verbal feedback to either vets or VNs within the practice.
Menna Morgan, principal partner at St David Veterinary Centre in Cardiff, explains why she was keen to participate in the scheme. “Although we had used a small amount of Previcox, we found it challenging to alter our vets’ standard routines and utilise it on a frequent basis. We required a structured approach that would practically demonstrate the benefits of the treatment and convince staff this is a drug worth reaching for.
“Newly diagnosed cases of OA, and existing cases not responding well to previous medication (following an appropriate wash-out period), were entered onto the scheme. As cost is of secondary importance to our clients using NSAIDs on a long-term basis, the introduction of a new drug did not raise any concerns at all.
“Completion of the vet assessment form was easily achievable within a consultation. All questions could be answered from examination of the patient and a general discussion with owners. As we had to complete the assessments within a certain time-frame, this scheme, more importantly, provided the motivation and discipline to communicate with our clients on a regular basis – an opportunity not to be missed.”
Menna believes that this not only increased client compliance but helped to enhance client relationships, confirmed by positive feedback gained from staff and clients. “This scheme has provenareal success and we would happily participate in further initiatives which help introduce drugs of choice into the practice,” she adds.
Independent practice approach
Robert Hill, owner of the The Barn Veterinary Practice near Ipswich, didn’t wait for the trial. As owner of a seven vet companion animal practice, Robert explains how he has grown his business by being open with clients when it comes to the medicines they prescribe.
“My wife and I originally built the surgery in 1986 and we had aimed to establish a two-man practice. We focused on the service we provided to our clients and eventually formed a large client base which was established mostly through ‘word of mouth’ rather than any other form of advertising. We now have seven vets which, with veterinary nurses and receptionists, takes the total number of staff to over 20,” he says.
With this service-led focus in mind, Robert has always used products that he feels offer the best care to his clients. When Previcox was launched, Robert felt the COX story was a particularly interesting development and wanted to explore the benefits further.
“Initially we set up our own trial with all vets within the practice prescribing the product for 8-10 days in dogs which were not doing as well as expected on their current medication. All these patients were then reexamined. The vets within the practice could see the positive effects of the drug, which was vital for instilling confidence in the product.
“After this successful assessment, a decision was made to use Previcox in all appropriate cases of OA, either in new cases or as a replacement to a more traditional NSAID. All our vets were on board with this approach, especially as they had seen such positive responses.
“Resistance from owners to alter their dogs’ current medication was cited as an area which could be potentially challenging. However, we are a practice which believes in making positive recommendations to our clients on the basis of informed discussion, which means managing client expectations and providing the facts.
“We made a real effort to explain to owners how the treatment works and the benefits we felt it offered their pet. Ultimately, we encountered very little resistance from owners and gained a lot of positive feedback.
“In most cases, cost was also not an issue. With some dogs it does cost more than the alternatives, but in these instances almost all owners were prepared to pay as they could really appreciate the improvement seen in their dog’s quality of life.
“We also encouraged the nurses to playaproactive role in the initiatives used to introduce this new drug. The nurses are often at the forefront of the positive reports received by clients about their dog’s improvement. They will often see cases back in geriatric or weight clinics and can see the benefits reaped from both the drug and their supporting management advice.
“Although nurses cannot prescribe NSAIDs, it is important that everyone in the practice is on board with its use – and this was certainly achieved by the nurses seeing the positive effects of the drug through their clinics and client interaction,” adds Robert.
Overall, whatever approach your practice takes to introduce a new drug, the key is to be 100% focused on the benefits that drug offers and the reasons behind its choice. All members of the practice should be involved and where possible the positive aspects of the drug demonstrated practically through a short study either supported by a drug company or independently.
Finally, in explaining the benefits of an alternative drug to clients, vets may be pleasantly surprised by the lack of opposition. All in all there is no reason why introducing a new drug into practice cannot be a positive experience for all involved.