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Prevalence and nature of cost discussions during clinical appointments in companion animal practice

Jason B. Coe DVM, PhD1, Cindy L. Adams MSW, PhD2, and Brenda N. Bonnett DVM, PhD3
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  • 1 Department of Population Medicine, Ontario Veterinary College, University of Guelph, Guelph, ON N1G 2W1, Canada.
  • | 2 Department of Population Medicine, Ontario Veterinary College, University of Guelph, Guelph, ON N1G 2W1, Canada.
  • | 3 Department of Population Medicine, Ontario Veterinary College, University of Guelph, Guelph, ON N1G 2W1, Canada.

Abstract

Objective—To determine prevalence and nature of cost discussions between veterinarians and pet owners during clinical appointments in companion animal practice.

Design—Cross-sectional descriptive study.

Sample Population—20 veterinarians in companion animal practice in eastern Ontario and 350 clients and their pets.

Procedures—200 veterinarian-client-patient interactions were randomly selected from all videotaped interactions and analyzed with the Roter interaction analysis system. Additional proficiency codes and blocking functions were developed to capture the prevalence, nature, and context of cost discussions.

Results—58 of the 200 (29%) appointments that were analyzed included a discussion of cost. During 38 of these 58 (66%) appointments, the discussion involved costs associated with the veterinarian's time or with services provided by the veterinarian. Overall, reference to a written estimate was made during only 28 of the 200 (14%) appointments. Cost discussions were most common during appointments in which a decision related to diagnostic testing or dentistry was made. Appointments were significantly longer when a cost discussion was included than when it was not.

Conclusions and Clinical Relevance—Results of the present study suggested that discussions related to cost were relatively uncommon during clinical appointments in companion animal practice and that written estimates were infrequently used to aid these discussions. When discussions of cost did occur, veterinarians appeared to focus on explaining costs in terms of the veterinarian's time or services provided by the veterinarian, rather than on the medical information that could be obtained or the benefits to the future health or function of the pet.

Abstract

Objective—To determine prevalence and nature of cost discussions between veterinarians and pet owners during clinical appointments in companion animal practice.

Design—Cross-sectional descriptive study.

Sample Population—20 veterinarians in companion animal practice in eastern Ontario and 350 clients and their pets.

Procedures—200 veterinarian-client-patient interactions were randomly selected from all videotaped interactions and analyzed with the Roter interaction analysis system. Additional proficiency codes and blocking functions were developed to capture the prevalence, nature, and context of cost discussions.

Results—58 of the 200 (29%) appointments that were analyzed included a discussion of cost. During 38 of these 58 (66%) appointments, the discussion involved costs associated with the veterinarian's time or with services provided by the veterinarian. Overall, reference to a written estimate was made during only 28 of the 200 (14%) appointments. Cost discussions were most common during appointments in which a decision related to diagnostic testing or dentistry was made. Appointments were significantly longer when a cost discussion was included than when it was not.

Conclusions and Clinical Relevance—Results of the present study suggested that discussions related to cost were relatively uncommon during clinical appointments in companion animal practice and that written estimates were infrequently used to aid these discussions. When discussions of cost did occur, veterinarians appeared to focus on explaining costs in terms of the veterinarian's time or services provided by the veterinarian, rather than on the medical information that could be obtained or the benefits to the future health or function of the pet.

Contributor Notes

Dr. Adams' present address is Faculty of Veterinary Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada.

Supported by a grant from Medi-Cal/Royal Canin Veterinary Diet.

Presented at the International Conference on Communication in Veterinary Medicine, Banff, AB, Canada, November 2008.

Address correspondence to Dr. Coe.