Medication adherence in pet bird owners: index development and assessment of various application types via an online questionnaire

Adherence to medication prescriptions substantially contributes to therapeutic success. In pet bird medicine, however, measures to determine adherence and possible causes are lacking. This study aimed to develop medication adherence indices for companion bird owners, including single and multiple application types. The single veterinary medication adherence index (SVMAI-4), a 4-point index developed for individual treatment types, considers changes in treatment type, dosage or treatment time, early discontinuation, and total refusal for 9 application types. The overall adherence index OVMAI-5, a 5-point index addresses multiple application types and also considers nonprescribed medication. An online questionnaire was developed to evaluate the indices and measure determinants of adherence based on self-reports and implemented in a cross-sectional survey of 1480 bird owners. The results revealed that oral application directly into the beak (62.5% of birds) and by drinking water (28.3%) were the most common application types. Distinct differences among application types were found. With a range of 0 (full adherence) to 4 (full nonadherence), adherence was highest for cutaneous application (mean = 0.36, standard deviation (SD) = 0.736) and lowest for peroral application into the beak (mean 0.59; SD = 1.023) and injection (mean 0.73, SD = 1.126). The OVMAI-5 calculated when assessing the use of multiple application types resulted in a mean score of 0.84 (SD = 1.247), ranging from 0 to 5. The results suggest a need for action regarding the application types most commonly used in avian medicine. Wherever possible, oral administration via the beak should be avoided. Due to the self-reporting method used, it must be assumed that our results overestimate adherence and cannot be externally evaluated in a straightforward way. Animal patient-related factors are the most important determinants of medication adherence.