Getting pets to take their medication often calls for a team effort
By Laura Thill

It may not take a village to raise healthy pets, but it often takes a team. Particularly when it comes to getting pets to take their medications, the veterinarian, the client and even the sales rep can all play an important role. There are no solid numbers pointing to the rate at which pets adhere to taking their medications, according to John Albers, DVM, executive director, the American Animal Hospital Association (AAHA). “Recent studies have found a 60 percent adherence rate for heartworm medications, but there are [not many] studies for adherence to other medications,” he says.

The AAHA distinguishes between compliance and adherence. Compliance refers to the extent to which pets receive treatments, screening or procedures according to standard veterinary practices. Adherence refers to the extent to which patients take their prescribed medications.

Getting clients to take their pets to the veterinarian is the first obstacle to overcome with regard to adherence to medication, according to Lee Cahalan, brand manager, Novartis (Greensboro, N.C.). A 2008 survey by the AAHA found that a third of veterinarians reported a drop in visits from the first half of 2007 through the first half of 2008, largely due to the economic downturn. The study indicated that revenues dropped for about 28 percent of the 550 respondents during that time period. “We have seen pets become more important in people’s lives, but it appears we still have a ways to go to get pets the care they need,” says Cahalan. “Among those pets that do visit the veterinarian, we see that adherence with monthly heartworm and parasitic products is pretty good. And, we see greater adherence with oral medications, probably because pet owners think of topical products as as-needed products.”

A prime example is heartworm vs. flea and tick medications, Cahalan points out. “We see vets communicating well that pets must take heartworm products regularly, and pet owners understand that heartworm is the No. 1 threat. But, for flea and tick [issues], pet owners often believe they can administer the product after they see fleas or ticks.” Some companies have addressed this to some degree by combining flea and tick medications in one product, he adds.

Barriers to adherence
Bernadine Cruz, DVM, a member of the American Veterinary Medical Association (AVMA), finds that between half and two-thirds of her clients give the medication she prescribes to their pets, but fall off after about six months. “In spite of their desire to help their pets maintain a high quality of life, they tend to have a low adherence rate,” she says. In fact, clients stop giving their pets certain medications as quickly as five or six days, she notes.

“Often their pet looks better, so they believe it is cured. Out of sight, out of mind,” she says. But, in the case of a bladder or ear infection, where the animal is supposed to stay on medication for 21 days, the infection returns and the owners become upset, she points out. And with regard to medications that need only be given once a month, it can be difficult for pet owners to remember to do so. “I tell them to pay the mortgage and give the medication at the same time,” says Cruz.

Indeed, it can be downright dangerous for pets that, for whatever reason, do not adhere to medication regimes, she continues. “In the case of a cat with an overactive thyroid, the owner may think it looks and feels great [after taking its medication for a short period],” she says. “Then the cat may start vomiting and lose weight. We warn the owner the cat may become hypertensive (secondary to hyperthyroidism), with internal retinal [detachment] that can lead to blindness. Or, seizures can occur when the owner is not around.”

In addition to owners forgetting to administer medication to their pet or developing a false sense of their pet’s well being, a number of other issues may arise that lead them to abort a prescribed medication. One of the biggest barriers preventing clients from giving their pets prescribed medications is inexperience, according to Albers. “One of the biggest issues [with regard to lack of adherence] is that veterinarians hand out prescriptions but don’t show clients how to administer them,” he says. “Veterinarians are so used to giving medications, they sometimes forget that some clients are less experienced at this.”

Other reasons for poor adherence involve clients not believing the medication is working, notes Albers. In other cases, a drug can cause uncomfortable side effects, which concern the pet owner. Or, when medications taste bitter or unpleasant to animals, they may fight taking it, leading the pet owner to eventually give up trying.

Compounding and flavoring
Animals are no different than humans when it comes to swallowing bitter-tasting medication. Getting them to take it can be challenging for owners, according to Kelly Rowe, marketing director, FLAVORx Inc. (Columbia, Md.). Indeed, companies such as FLAVORx are finding ways to sweeten the pot – or the pill – for pets. “Large, bitter tasting pills or capsules that become slimy are very difficult to get down a pet’s throat, especially for a new and inexperienced pet owner,” says Rowe. Sometimes, pet owners are embarrassed to ask their veterinarian how to administer the medicine, and eventually they discontinue it, she adds, and this can work against the practice. “If a client is not giving the medicine and the patient does not get better in the first couple of days, often the client will go to another veterinarian,” she points out. “Adherence helps ensure client loyalty.”

FLAVORx provides a formulary (syrup and solutions) to flavor medication on a per-species basis, Rowe continues. “We offer just under 20 flavors, all species-specific,” she says. “Basically, the veterinarian can get any liquid, capsule or tablet off the shelf and use our formulary to flavor it [to the animal’s liking]. We provide exact ratios for mixing, [which is essential] with compounding. For instance, cats foam or regurgitate [substances] that are too salty.”

By flavoring medications on site, the veterinarian can ensure patients receive their medication immediately, she explains. “If the veterinarian outsources the prescription to a lab for flavoring, the patient may not get its medication until the next day – or longer if it’s a weekend,” she says. “Then the client must pay the cost of having the medication compounded, plus the veterinarian often adds a dispensing fee. It costs the veterinarian about $3 to flavor a medication [in-house], whereas the client pays between $12 and $23 for medications outsourced to a lab for flavoring.” Some veterinarians flavor medications free of charge to attract more patients, says Rowe. “Especially with the economy being as it is, this can be a huge bonus for the practice,” she says, and sales reps should point this out to their customers.

Some veterinarians, like Cruz, raise concerns that not all compounded medications are as effective as the original medication. “Sometimes the purity of a product can be compromised by the compounding [process] and the medication may not be as strong,” she points out. “For instance, after a chew tablet is compounded, it may be down from 100 mg to 75 mg. Can the vendor say the compounded medication will be as effective as the original one?”

It can be very effective, according to Rowe. “All of our flavors are FDA-regulated,” she says. “They are water-based and the main ingredients are natural and artificial flavorings. We use a natural sweetening enhancer (root extract) for particularly bitter medications. And while we do use some sugar in the syrup, we offer a dietetic version as well.” But, the bottom line is that pets look forward to taking their flavored medication, and veterinarians appreciate this benefit, notes Rowe.

The rep’s role
No matter how busy a practice they run, veterinarians must take time to communicate with clients to ensure patients get the right care. By working closely with their customers to remind them of this, sales reps can provide their customers with some value-added service.

Ensuring pets take their medication should be a shared responsibility, according to Rowe. “Veterinarians can get backed up,” says Rowe. “By the time they are prescribing the medication, they often are moving on [to the next patient].” In fact, sometimes it falls on the receptionist to make sure clients are comfortable giving their pets medication, she notes. “But many receptionists don’t know, for example, that certain medications can’t be taken with dairy.” And, while the technicians may have a more in-depth understanding of various medications, they often are too busy to provide instructions. So, it’s imperative that the veterinarian and the client take time to communicate, she adds.

Distributor reps should remind their veterinarian customers of three important points, says Albers: communication, demonstration and convenience. “Reps should remind [their customers] of the need to communicate to clients why animals need their medication,” she says. “They must remind veterinarians to demonstrate to clients how to give the medicine. And, veterinarians should be aware that pet owners are sometimes willing to pay a premium for medications that are easier to dispense.” Indeed, in the AAHA 2008 compliance study, 22 percent of responding clients said they would pay 50 percent more for medication that is easier to administer; 18 percent said they would be willing to pay a 100 percent premium; and 20 percent said they would pay 200 percent more, he says. “So, distributor reps should always remind their veterinarian customers to offer clients easier solutions,” he points out.

Doing your homework
Sometimes the simplest things offer the best solutions. Cahalan has found that one of the best tools for veterinarians to offer clients is a fool-proof reminder to give their pets their medications. “We provide a compliance wheel and stickers,” he says. “The pet owner can check off days on the wheel and place a sticker on [his or her] calendar to see that [he or she] has administered the pet’s medication.” Other approaches by Novartis include online reminder notices, personalized to the pet, and text messaging.

“Reps should do their homework,” says Cruz. Particularly in the case of compounded medications, “they should make sure that the company they work with can ensure the purity of the product.” And, it would be helpful if reps offered flavored blanks for pets to try such that clients can determine their pets’ likes and dislikes.

In addition, distributor reps can remind veterinarians to show clients how to administer topical or oral medications. “Reps should give them pointers,” notes Cruz. It can make their job easier and possibly increase adherence, she adds.

Finally, veterinarians and their clients want medications that can be dispensed the least number of times, Cruz continues. “Sometimes pets are on multiple medications, which [complicates] it even more,” she says. The best pill for a pet would be one that covers multiple diseases!”