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Posted June 15, 2017:
Prescriptions and Pharmacies: For Pet Owners (FAQ)
Below are answers to the most common questions we receive at the AVMA about veterinary prescriptions and pharmacies.
Q: Why do I need a prescription?
A: When you are given a prescription for a medication for your pet, it means that your veterinarian has made a decision that the medication is recommended or necessary to treat your pet's health problem. Many prescription drugs are only effective for specific problems, and may actually be harmful to your pet if used without that critical veterinary examination and diagnosis. Having these drugs available as prescription-only medications ensures that they are used appropriately.
Let's take heartworm preventives as an example. Heartworm preventives are labeled as "prescription-only" because it's critical that your veterinarian makes sure the medication is the right one based on your pet's health status. The preventives target the infective larvae as they are migrating through the tissue prior to reaching the bloodstream and developing to adult heartworms. If your dog (or cat) has heartworms, giving a preventive medication will not effectively treat the disease because the preventives don't readily kill adult heartworms. In some cases, administering preventives to heartworm positive dogs can cause a rapid kill of circulating microfilariae, leading to a life-threatening anaphylactic reaction.
There are drugs, called "over the counter" (OTC) drugs, that don't require prescriptions. Drugs can be bought OTC when the Food and Drug Administration (FDA) determines that the directions for the drug's use aren't overly complicated and are adequate for the public to follow. In some cases, such as the common headache medications for people, the OTC version is just a weaker strength than the prescription form. However, in many cases, a medication is only available with a prescription for the reasons we mention above.
Q: What's the difference between the brand name, trade name and generic name of a medication?
A: Brand names and trade names are also called proprietary names, and are just what they sound like – they are the trademarked names you recognize on the shelves and see in advertisements. The generic name, on the other hand, is the nonproprietary name of the drug and is the same for all versions (brand-name and otherwise) of that drug. For example, take ibuprofen: there are several brand names for the drug, including Motrin® and Advil®, but the generic name of the drug is ibuprofen. If you were to buy the brand/trade name of the drug (for yourself, not your pet), you'd purchase Motrin® or Advil®, but if you were to buy the generic version, it would just be labeled "ibuprofen."
Q: Is there a difference between the brand name version and the generic version of a medication?
A: For the most part, no. The United States Pharmacopeia (USP) sets the standards for the quality, purity, strength and consistency of all prescription and OTC medications in the U.S. – the goal is to make sure that the product you purchase meets these standards. If you look closely at the drug labels, you'll see "USP" printed after the drug name in the ingredients list – and sometimes it's printed clearly on the front label of the bottle/box. Based on USP standards, for example, generic ibuprofen is the same drug as the brand name-versions of ibuprofen (of the same strength) as far as the quality, purity, and consistency are concerned.
However, we have heard some anecdotal and unconfirmed reports of pets that had been receiving a brand name medication, but did not do as well when given a generic version of the same medication. Although all USP versions of a drug meet the purity standards for that drug, all of the ingredients and the processes involved in making the trade name versions are often protected by patent or other intellectual property laws, and there may be differences in the minor ingredients that could produce slightly different results between the versions, while still providing the main drug that meets USP standards. Think of it as following a recipe – even if you have the same ingredients and follow the instructions, the end result might vary a little bit. This is not a common problem with medications, and is often resolved by switching back to the effective version of the medication.
Q: Why are some spot-on flea and tick preventive medications only available through my veterinarian?
A: Some manufacturers have decided to sell their products only through veterinarians so that the veterinarian and pet owner can discuss the situation and work together to determine the best flea and tick treatment for that pet. It's not that the product is "prescription-only" – it's that the manufacturer believes the product should only be sold through veterinarians. In addition, it seems more likely that the product will be used properly (for example, a cat won't be treated with a product labeled only for use in dogs) if the veterinarian is supplying the medication and is counseling the pet owner on the proper use of the medication.
If the spot-on flea and tick product is also labeled for heartworm prevention, it is only available through your veterinarian for the reason we previously described – it is critical that your veterinarian checks for a heartworm infection before your pet is given a heartworm preventive medication.
Q: My veterinarian gave me a prescription for a pain reliever for my pet. Why can't I just buy one of the over-the-counter pain relievers at my local drug store?
A: Don't do it! Although these products are approved for use in people, many of them are not safe for pets. For example, acetaminophen (Tylenol® is the most common example) can cause severe illness, and even death, in pets. Talk to your veterinarian before you give ANY medication to your pet.
Q: Where can I get my pet's prescriptions filled?
A: You have several options when your pet needs a prescription medication:
- You can get it from your veterinarian if they keep it in stock;
- Your veterinarian can write (or call in) a prescription to a local pharmacy that stocks the medication;
- Or your veterinarian can provide a prescription so you can get the medication from an online pharmacy.
Q: Can I get my pet's prescription medications from Canada?
A: No. Drugs from Canada are not approved by the federal government for use in the United States. It is illegal for you to get medications shipped from Canada for yourself or your pet.
Q: The pharmacy told me I don't need a prescription for a medication. Is that true?
A: For some OTC medications, it is true. However, if your veterinarian tells you that you need a prescription for the medication but the pharmacy tells you that you don't need it, this might indicate that the pharmacy's staff is either confused or misinformed, or the pharmacy's ethics and standards are questionable. If this happens, talk to your veterinarian, contact the state board of pharmacy, or contact the U.S. Food and Drug Administration Center for Veterinary Medicine (FDA CVM)
Q: Why should I consider getting my pet's medications from my veterinarian?
A: There are several reasons you should consider getting your pet's medications from your veterinarian:
- If your veterinarian has the medication in stock, you immediately have it and you don't have to wait to get it from a pharmacy;
- Your veterinarian or a veterinary technician can answer your questions, provide you with instructions for use, and maybe even demonstrate how to give your pet the medication;
- If you order from a pharmacy and the medication isn't properly shipped (for example, it is allowed to get too hot or too cold) or isn't properly packaged, it could be ineffective or damaged and unusable; whereas if you get it from your veterinarian, you know it has been properly handled until it reaches you and they can inform you how to make sure you handle the medication properly.
Q: If I choose to get my pet's prescriptions filled elsewhere, can my veterinarian refuse to give me a prescription?
A: Your veterinarian might strongly recommend that you get the medication directly from them, but some states actually require veterinarians to write prescriptions for clients to have filled elsewhere if requested by the client. Some states do not require this of veterinarians.
There are certainly situations where it is in your pet's best interest to get the medication directly from your veterinarian, and we encourage you to discuss your options with your veterinarian. The AVMA's Principles of Veterinary Medical Ethics recommends that veterinarians comply with their client's wishes and provide written prescriptions if the client prefers having the prescription filled elsewhere.
Q: Can my veterinarian charge me a fee for writing a prescription for my pet?
A: There is no federal law preventing your veterinarian from charging you a fee for their services and time invested in writing a prescription. Some veterinarians charge a nominal fee for writing prescriptions, but others don't. Individual states might have specific guidance for veterinarians on prescription fees.
Q: My veterinarian is telling me that I have to bring my pet in for an examination before they'll write a prescription or authorize a refill. Why?
A: According to the AVMA Principles of Veterinary Medical Ethics, it is unethical, and in most states, unlawful, for a veterinarian to write a prescription or dispense a prescription drug outside a Veterinarian-Client-Patient Relationship (VCPR). For more information about the VCPR, including a definition, see Section III of the AVMA's Principles of Veterinary Medical Ethics. For a simpler explanation of the VCPR, read our "Frequently Asked Questions by Pet Owners about the Veterinarian-Client-Patient Relationship."
In order to maintain a VCPR, your veterinarian must see your pet regularly – how regularly they need to see your pet depends on your pet's health. If your pet is on a prescription medicine, your veterinarian may need to reexamine your pet, check blood work, or perform other tests to monitor your pet's response to treatment and determine if the medication needs to be changed. For example, a dog being treated for hypothyroidism needs to be reevaluated regularly to make sure the dosage is having the effect it needs to have.
Q: If I choose to get my pet's prescription filled elsewhere, will my veterinarian refuse to see my pet anymore?
A: That's not likely. We encourage you to talk to your veterinarian about your concerns and discuss what's best for your pet.
Q: Why do some medications cost more from my veterinarian than from an online store?
A: Online pharmacies may buy larger volumes of the medications at a time, so they may get bulk pricing that might be lower (or much lower) than your veterinarian pays - so, even with a markup, some medications from an online source are being sold to you for less than your veterinarian pays to get the medication. Anybody who keeps medications in stock has to mark up the prices above what they paid because of the overhead costs involved in keeping those medications on the shelf and the losses if the medication expires and has to be discarded.
Q: What are the risks of ordering from an online pharmacy?
A: The amount of risk depends on the quality of the pharmacy. Human error is a risk with any source, but the risk is minimal if the proper procedures are in place.
When you order from an online pharmacy, the product must be shipped to you. If the medication isn't properly shipped (for example, it is allowed to get too hot or too cold) or isn't properly packaged, it could be ineffective or damaged and unusable.
If there is a problem with the medication received from an online pharmacy, there might be a period of time when your pet isn't getting its medication while you wait for the replacement medication to arrive.
Q: How do I know the pharmacy is trustworthy?
A: Prior experience with a pharmacy is a good indication – ask your veterinarian if there is a pharmacy they recommend. You can also inquire with the state board of pharmacy to determine whether a pharmacy is licensed within the state and the status of the pharmacy's license.
In addition, accreditation by independent bodies can give you more information about an online pharmacy. Two examples of third-party accreditation include the National Association Boards of Pharmacy Vet-VIPPS program and, for compounding pharmacies, the Pharmacy Compounding Accreditation Board. (Your prescription might be called in to a compounding pharmacy if your pet needs a medication tailored just for him or her – an example would be a flavored liquid medication for a cat who otherwise won't take the medication. It is NOT legal, however, to have a compounding pharmacy make a "cheaper" version of an identical product that has been approved by the FDA.)
Q: How will I know if there are problems with the medications I get from a pharmacy?
A: First of all, talk to your veterinarian about the signs of a problem with the medication. Make sure you know what to look for, and what to do if you see it. Don't hesitate to contact your veterinarian if you are concerned that your pet is having a problem with or a reaction to the medication.
If you receive a shipped medication and the package is damaged or it appears to have been allowed to get too hot or too cold, contact the pharmacy immediately and notify them of the problem. If you are not sure if the medication is safe to use in that condition, contact your veterinarian.
If you have concerns or complaints about a pharmacy's practices or the quality of its products, you can report the pharmacy to your state board of pharmacy.
Q: My veterinarian said that my pet needs to get a different dose than what the drug package insert says. Is this legal?
A: If your veterinarian thinks the labeled dose isn't right for your pet but a different dose is what your pet needs, this is a federally regulated activity called "extralabel drug use." Basically, if the medication is used in any other way than the label dictates, this is extralabel use, and it is legal as long as your veterinarian follows the regulations. Your veterinarian can also prescribe a human medication for your pet, and this is also considered extralabel use.
Please note that we're only talking about extralabel drug use in pets here. Extralabel use is legal in food-producing animals, but the rules are much more strict.
This FAQ was produced by the AVMA Scientific Activities and Communications Divisions, with assistance from the Council on Biologic and Therapeutic Agents and the Clinical Practitioners Advisory Committee.
US Food and Drug Administration (FDA)
Asking For Client Feedback By Jessica Goodman Lee, CVPM Brakke Consulting, Inc. February 14, 2012
Historically, veterinarians have been extremely passive when it comes to soliciting client feedback; only 20% of veterinarians surveyed agreed that they solicit client feedback through after-service questionnaires.1 Yet the most successful veterinary practices realize that to keep customers coming back, they have to ensure that their services are being provided consistently and successfully. In short, we tend to run our practices based on the assumption that no news is good news. When we do hear from clients, it is more often than not when something has gone very wrong, and unless this is a frequent occurrence, we tend not to give these complaints much credence. According to studies done by the Technical Assistance Research Programs (TARP), though, for every irritated customer who complains, 26 do not, although they still have grievances, and 6 of them have serious problems2. The reality is that you probably don’t know how many dissatisfied patients you have because most people don’t complain in person. While passive about soliciting feedback, veterinarians still feel very strongly about the client experience. According to the 2011 Bayer Veterinary Care Usage Study, 81% of veterinarians surveyed indicated that they would change how their practice operated if they knew it would increase client satisfaction3. These numbers highlight the dichotomy between the desire to do something and the reality of actually making it happen. Perhaps veterinarians don’t request customer feedback because they fear criticism or the work it will take to implement change. However, it is far more expensive to attract new clients than it is to retain current ones. Consider the time and money spent on marketing initiatives to acquire new clients, all of which could potentially be worthless if they do not return based on a less than stellar experience. Add to that the increased value of
client-to-client referrals, and it is obvious that allowing ego or fear of change to get in the way of soliciting feedback can be highly detrimental to the long-term health of a practice. Soliciting client feedback is as much about finding out what you are doing right, as it is about what needs to be improved upon. The most important thing about positive feedback is that it should be openly shared with the entire team as frequently as possible. When clients take the time to tell you how you’ve exceeded their expectations, or if you consistently earn top-rated scores, the entire team should celebrate and receive praise for a job well done. Acknowledging and thanking staff for jobs well done can be accomplished by: • posting positive comments where they can be read by the whole team • congratulating and rewarding by name those recognized individuals The methods above can be a powerful incentive for others to rise to the occasion and increase their level of performance. There’s not much that makes an employee feel more appreciated than being recognized for outstanding service, especially in front of peers and co-workers. Types of Client Questionnaires It is critical to be pro-active in seeking client feedback, which means your survey cannot just sit on your website waiting for someone to find it and take the time to complete it. See sample client surveys http://www.myevt.com/story/general-client-survey Using Email… Email is definitely the most successful method of distribution (just one more reason to collect email addresses if you aren’t already doing so!); not only can email be delivered more quickly than stamped mail, but it has a greater chance of being opened and completed in one step, and timeliness is very important both in reaching the client and obtaining their response. …For New Clients The most obvious purpose of questionnaires is to ensure a stellar new client experience, which is why it is beneficial that these surveys be sent within 24 hours of the patient visit. This promptness allows the opportunity to evaluate and fix any problems that are brought to your attention before they affect others. It also decreases the time that an unhappy client will have to turn to the Internet as a way to broadcast their dissatisfaction. Often just the fact that you made the effort to follow-up and took the time to listen can turn a not so happy customer into a raving fan. Even if they have no intention of giving you a second chance,
the fact that someone reached out directly is often enough to keep their need to go public with their opinion to a minimum, thus halting the damage to a practice’s reputation. …For Current Clients As important as new business is, it is just as important to gauge the satisfaction level of current clients on a regular basis. This can be done all at once on an annual or semi-annual basis, or an appointment can trigger that a survey be sent. These surveys are also a great way to ask clients whether or not they would be interested in a new service or product before making any type of investment, financial or otherwise. For example: In an effort to better meet the needs of cat owners, a practice might consider reserving a certain day of the week for cat-only appointments. The best way to anticipate the success of such a program would be to actually ask cat owning clients if this would truly encourage them to bring their cats in more often. …For Clients “Missing In Action” Another group that is important to survey is clients that have not been seen in at least a year. While the response rate will most likely be low, those that complete the questionnaire present an opportunity to regain their business. If someone provides a reason for not returning to your practice, and you are confident that this issue has been resolved, take the initiative to let them know and offer them an incentive to see for themselves! Types of Questions When it comes to questionnaires, the key is to ask enough questions to get “useful” feedback, but not so many that it becomes arduous to complete.
Four Rules to Client Questionnaires:
1. If it takes more than 5-10 minutes, it’s too long
2. Make most of the questions simple (with multiple choice answers)
3. Include questions specific to your practice’s protocols
4. Ask new clients if they remember the veterinarian they saw Lastly, before concluding a questionnaire it can be useful to ask for an overall experience rating based on a numerical scale (1-10 being most common). Don’t hesitate to be direct—go ahead and ask new clients whether or not they intend to return to your practice.
The statement that “knowledge is power” is as true in business as it is elsewhere. The more information you have, from as many sources as possible, the more impactful and accurate the decisions regarding the future direction of your practice. Share and celebrate the good, and use whatever criticism is offered as a means to improve and grow. Doing this regularly provides the best opportunity to build a loyal fan base and decreases the chances of your practice becoming a victim of outside social and economic forces. So go ahead…ask away!
HOW TO BE A MORE EFFECTIVE PRACTICE MANAGER
By: Amanda L. Donnelly, DVM, MBA
Practice managers are supposed to be effective at human resource management or in other words-keep the staff happy and keep owners out of trouble with any regulatory organizations. In addition, managers are expected to ensure client satisfaction, resolve client complaints, keep the business running smoothly, keep the schedule hopping, contribute to marketing initiatives, control expenses, and be the owner’s go-to person for any number of other issues or concerns. On any given day, the manager’s agenda is likely to be derailed by someone or something that requires attention. Being an effective practice manager is challenging but there are specific actions that will help ensure your success. Take the following steps to increase your job satisfaction and enhance your job performance.
Define Your Job Roles and Expectations
Establish reasonable and agreed upon job duties and expectations for your position. This starts by having a written job description that outlines major areas of responsibility. There are multiple resources for writing a job description including AAHA, VHMA and veterinary consultants. Generic job descriptions are a good starting point but need to be edited to tailor them for your specific practice. Next, meet with practice owners to define specific job expectations and areas of accountability for job performance. For example, if the job description states one of the duties as “Maintain major practice expense categories within target goals” the owner(s) and manager need to agree on appropriate expectations and action steps for the manager to fulfill this job responsibility. Otherwise, the job description is only words on paper, the manager may or may not be accountable for controlling expenses, and there is no plan and timeline in place to respond to increases in expense categories if they occur. Once job roles and expectations are defined, communication is enhanced because owners and managers are clear about what duties are to be fulfilled by the manager.
Clarify Goals and Priorities
Clarify goals and action plans to meet the goals. For example, if one of the hospital goals is to grow the business by 10% and marketing plans have been drafted to meet this goal, then the manager knows what the owners want and has a roadmap to achieve success. Since managers have to juggle multiple job responsibilities, it is imperative to define and agree upon the priority for job tasks. Otherwise, managers may risk owners assuming they will get everything done that they request in a short period of time which may be unrealistic. To avoid miscommunication and the perception of ineffective job performance, it is incumbent upon managers to let owners know when they have too many job duties to complete in a reasonable time period. Managers need to ask owners which duties to prioritize first rather than assuming they know what the owners want or what they think is best. Moreover, setting timelines for completion of tasks helps everyone on the leadership team have the same expectations and knowledge regarding the manager’s job duties.
Manage Your Time Wisely
If time management is a problem for you, read one or two books to gather information and practical tips to help you become more organized. Talk to other practice managers in similar practices to see how they have conquered their time management challenges. The list serve or discussion forums for the Veterinary Hospital Manager’s Association (VHMA) or the Veterinary Emergency & Specialty Practice Association (VESPA) are excellent resources to ask questions and connect with colleagues. Most managers find it works best to set aside specific hours or time slots for employees to come to their office with questions or concerns. Obviously, emergency situations or serious concerns must be addressed as needed but having set hours for employees eliminates being interrupted by an employee that wants to talk about something that isn’t time sensitive. When working on important projects or activities close your door and strive to maintain focus for a defined period of time such as one to three hours. Ask the front office not to interrupt you with phone calls if they are not critical and avoid the temptation of checking email which can be distracting and time consuming.
Provide Effective Leadership
One of the critical roles of leaders is to make sure the team knows the mission, vision and core values of the organization. If your practice doesn’t have a written mission or vision and core values, work with the practice owners to develop these guiding statements so the team knows where they’re going and how they’re going to get there. Build trust with employees by sharing information and being true to your word. Keep team members informed about business activities that may affect their job and follow through on
promised actions. For example, if you tell an employee you will consider a change in their work schedule or send them to a continuing education seminar, you need to stick to your promise. Otherwise, staff begins to adopt an attitude of thinking management doesn’t care or take action on employee issues and morale may suffer. Being a great leader doesn’t necessarily come naturally to everyone. But leadership skills can be learned. Part of being an effective manager is taking the time to learn more about positive leadership and devoting time to honing your leadership skills.
Learn the Art of Managing Up
Managing up refers to the ability to work effectively with your boss to achieve the best results for you, them and the organization. Managing up is really all about creating win-win work relationships so you can be effective and help drive the success of the practice. The art of managing up involves improving communication with owners and understanding their management or leadership style. Be sure to schedule weekly leadership meetings to enhance communication and feedback. Weekly meetings ensure managers have the tools and information to do their jobs and avoid the need for marathon sessions which tend to occur when practice issues are not addressed on a weekly basis. Managers need to let owners know if they require any resources to do their job effectively and they need to give owners relevant feedback about management issues. Remember also that those sticky management problems, many of which may directly involve the owner and their actions, won’t go away just because you don’t talk about them. When problems arise, tackle them head on by letting the owners know how their actions or specific situations have an effect on your job performance. For example, if you work for an owner that undermines your authority, diplomatically let them know how their actions result in negative consequences for the business.
Enhance Staff Productivity with Feedback
Feedback helps you work better with your team because employees appreciate knowing how they are doing and how they can improve. Don’t forget to solicit feedback from staff as well which further assists in efforts to improve hospital operations. Take the following steps to establish effective feedback protocols. Communicate clearly: Sometimes inefficiency or lack of accountability exists because managers are unclear when communicating with staff about their job performance or when delegating job tasks. Communicate and clarify expectations to employees in a direct, straightforward manner. Be sure to assess for understanding from employees. Ask them if they have any questions about their assigned job tasks. Don’t forget to give employees deadlines when delegating job tasks. Rather than asking an employee “Can you please file these records and enter these invoices?”
instead say “I need these records filed and the invoices entered by the end of your shift. Can you complete this job task by 5pm?” Know when and how to deliver feedback: Feedback is more meaningful when it is specific and timely. Rather than saying “Thanks for doing a good job” or “We need for you to do a better job”, give specific feedback about what behavior you want to continue and/or what behavior is unacceptable. While it may seem nit-picky, not everyone has the same definition of what is an “exceptional, good or poor” job performance, what is “on-time” or what is “clean”. Be aware of appropriate times and places to give feedback. Follow the old adage, “praise in public and criticize in private”. Focus on the behavior not the person: Focus on employees’ behavior not on intangibles such as their attitude or intention. We cannot measure, quantify or see an employee’s attitude or intention. We can witness behavior and actions. Rather than telling an employee they need to have a better attitude or they need to be more efficient checking in clients, tell them specifically what words or actions demonstrate their poor attitude or poor job performance. When you focus feedback on specific behavior and actions, employees will know what they need to do differently as well as what they need to continue doing well. Relate job duties to the practice’s vision and core values: Everyone’s job role in the practice has a purpose and helps to further the vision of the business. Employees benefit from understanding how their individual job roles and assignments fit into the “big picture” or vision of the practice and how they help to achieve business goals. Additionally, how you want team members to act and do their job tasks relates to the practice’s core values. Remind employees that their actions need to be consistent with your core values.
Coach Your Team to Problem-solve
If you feel like you get mired down dealing with inefficiency or fixing problems brought to you by team members then you may need to do a better job coaching your employees to be problem-solvers. One of the biggest drains on practice efficiency occurs when team members have to seek out supervisors for assistance or approval before taking action. Assess the problem-solving capabilities of your team. Do some of your employees continually come to you seeking approval or direction before they take action? Could they have been trained to make the appropriate decisions or solve problems on their own? Answering these questions is critical if you want to maximize the efficiency of operations and promote teamwork. Employees often need to be coached to make good decisions and become problem-solvers. Encourage staff to propose possible solutions for how they think a problem should be handled rather than just asking how they should proceed. In time, employees will learn to present one or more possible solutions when they come to you with problems and will feel comfortable making
decisions on their own about minor variations in daily operations. With proper coaching, many issues that previously had to be resolved by managers or doctors will be taken care of by the staff.
Amanda L. Donnelly, DVM, MBA ALD Veterinary Consulting, Rockledge, FL