The veterinary team does it every day: Schedule the puppy appointment and tell the client to bring in a fecal sample from the pet to check for parasites. Of course, the client forgets (or tells you the breeder already dewormed the dog or declines the test after seeing no evidence of intestinal worms). Commence eye roll. Go into your spiel about standard operating procedures, document the pet owner’s acceptance or rejection, and move to the next exam room. You do it again with the next patient, an adult dog whose owner isn’t interested in preventives because “they cost too much.”
Why do the conversations hit so many snags? What’s so hard about grabbing a fecal sample in the backyard? Why does a dog owner think the breeder’s deworming protocol is a one-and-done treatment? What’s the problem with following veterinary recommendations meant to benefit the pet?
Before the finger-pointing starts, hit rewind and delve into each step. First, think about the client. People are notoriously noncompliant. Get a group of veterinarians, dentists and pediatricians in a room and you’ll hear how people don’t do what the doctor recommends. I don’t mean to blur the line between pets and children, but the medication compliance range for pediatric patients ranges from 11% to 93%, with an estimated average of 50%. (Learn more at bit.ly/3NOxXmn.)
Now, if that’s the statistic for children, it stands to reason that the range is similar for pets.
Potential Barriers
Why the lack of compliance? Don’t assume it’s always about money. Other reasons include:
- Difficulty administering pet medications.
- A lack of understanding about parasite life cycles, the purpose of preventives and their proper use.
- The client’s health literacy level.
- Inconvenience.
- Fear of side effects.
- A pet is symptom-free, so why bother with the medication?
- Forgetfulness.
- The pet resists taking medications.
- The treatment plan is complex.
- Cultural differences.
- A lack of perceived value.
All those reasons should provide food for thought about why clients often ignore veterinary recommendations, not just those involving parasite preventives. Pet owners can easily claim a lack of affordability when, in fact, they hate wrestling a pill into a pet’s mouth, or the condition and treatment protocol confuses them. Therefore, the client faults the price of the medication, and the hospital team backs off. The cost is like kryptonite to veterinary teams, weakening their drive to deliver care and frustrating and infuriating them simultaneously.
Find the Time
Your team needs to achieve comfort in getting to the root of the compliance issue and use that knowledge to help the client overcome the barriers. That brings us back to the team.
As painful as it sounds, your staff sometimes contributes to a client’s lack of compliance. Team members often assume that pet owners understand a lot about parasites and preventives, but do they? In most cases, no. There isn’t enough time in the day to thoroughly discuss the topic, dispel myths and talk about what Dr. Google said. Perhaps therein lies the problem: The team can’t take the time (or isn’t trying) to educate pet owners about parasites and preventives and dig into the lack of compliance.
“We think people comprehend and remember our recommendations, whereas, in reality, most clients only remember about 15% of what we tell them if we tell them at all, and they need repetition of every topic we discuss,” said Nan Boss, DVM, the owner of Best Friends Veterinary Center in Grafton, Wisconsin. “The average person needs to hear about a product at least five times before purchasing it.”
Facts and Figures
Your team members are the experts on parasites and preventives, but they need the proper tools to educate clients effectively and achieve a higher compliance rate.
The first one is the anti-assume tool (also known as the genuine attitude to overcome). Don’t assume all clients understand or comply with your recommendations. Likewise, don’t think they know your standard operating procedures for testing, treating and preventing parasites. Instead, accept that pet owners don’t do enough to control parasites and that your practice must take steps to reverse the behavior.
Start by exploring the Companion Animal Parasite Council website at capcvet.org. CAPC produces an annual Pet Parasite Forecast — the 2023 report is at bit.ly/3B1jKLx — and Parasite Prevalence Maps (bit.ly/3ssmkUd). Talking about the current parasite threat in your area and highlighting it on a CAPC map is better than presenting a slew of products for purchase.
CAPC chief Christopher Carpenter, DVM, MBA, said households that receive data on local parasites go to their veterinarian and buy preventives at a 58% higher rate than households that don’t receive the information.
Therefore, formulating a strategy to share local data is more successful at increasing client compliance than merely talking about a preventive. However, a word of caution: Just because your locale isn’t at high risk doesn’t mean a pet wasn’t exposed or infected. Remember that people travel with their pets. Your region might be at low risk for a particular parasite, but the pet possibly visited a high-risk zone. People are more open-minded about using data to make decisions, so provide evidence and discuss the risks.
Use Examples
Next, apply teachable moments during client discussions.
Stuart Dalton, DVM, the owner of White Bear Animal Hospital in White Bear Lake, Minnesota, said his team mentions the presence of roundworms and hookworms and the potential for zoonotic infection as solid reasons to give all dogs year-round preventives.
“I discuss cases where I have diagnosed a dog with one or the other intestinal parasites and the dog wasn’t on a year-round preventive,” he said.
In addition, talk about the implications of zoonotic risks.
“We ask if there is a young child in the house. We then stress the zoonotic potential and the importance of a fecal test,” said Denise Roche, DVM, of Deerfield Veterinary Hospital in Springfield, Missouri.
In veterinary medicine, someone who contracts a zoonotic disease from a pet could sue the veterinarian or file a board complaint. The burden of proof might be on the treating veterinarian to show that the doctor informed the client of the risks of intestinal parasites. Medical records should show whether the client was advised to test the animal, any recommended treatments and estimated costs, and whether the pet owner accepted or declined the recommendations.
Meanwhile, don’t ignore the power of communication. Coach your team to send a strong, relevant message instead of a weak recommendation. Utilize multiple communication channels, too.
Dr. Boss’s team calls clients to remind them to give another dose. The same goes for refilling preventives and rechecking stool samples.
“We call, text or e-mail so clients don’t forget,” she said.
Putting Technology to Use
Do you think you communicate the need for deworming and preventives well? Run a quick survey as clients check out. Ask about your practice’s parasite preventive recommendation to get an idea of what the pet owner heard.
Another suggestion is to employ technology. Connect with clients via your practice’s mobile app and remind them about flea, tick, heartworm and deworming dosing, vaccinations and appointments. Additionally, choose an app that links to the pet’s medical records and allows the owner to keep a food, medication and exercise log.
Finally, use technology to build community and educate clients. For example, Facebook, Nextdoor and other social media platforms can help get your message out about deworming and preventives.
Achieving high compliance requires a partnership between the client and the veterinary team. No matter your location, intestinal parasites, heartworms, fleas and ticks are everywhere.
Communication is the superpower for overcoming any kryptonite a client throws at the veterinary team. The goal is to support the health and well-being of pets, so use all the tools at your disposal to make your recommendations stick.
CHECKS AND RECHECKS
According to the Companion Animal Parasite Council, “Puppies should be tested for intestinal parasites more frequently than adult dogs. CAPC recommends testing for intestinal parasites, including whipworms, at least four times in the first year of life and at least two times per year in adults, depending on patient health and lifestyle factors.”
WATCH AND LEARN
Dr. Cassi Fleming and Dr. Joel Sailor discussed the difference between compliance and adherence and strategies for getting consistent parasite prevention into patients. Their VetFolio video presentation is at bit.ly/parasites-VetFolio.