DVM, DABVP (Canine/Feline), CVJ
Dr. Lori M. Teller is a clinical associate professor of telehealth at the Texas A&M University College of Veterinary Medicine and Biomedical Sciences. She serves as vice chair on the American Veterinary Medical Association board of directors.Read Articles Written by Lori Teller
How often do you walk into an exam room and ask the client whether her pet is getting its heartworm preventive and she says “yes”? Your practice management software, though, shows that Ms. Smith bought a six-pack of prevention 12 months ago and always obtains it from you. Technically, Ms. Smith might be giving Fluffy a heartworm preventive, but not every month, so she likely is not following your recommendations nor those of the manufacturer.
In the United States, 1 in 75 dogs and 1 in 150 cats test positive for heartworm antigen. So, how can we help our clients to improve compliance and protect their pets?
Cathy Lund, DVM, the owner of a Providence, Rhode Island, feline-only practice, finds that many clients claim that because their cats never go outside, the animals don’t need a heartworm preventive. She responds by discussing the difficulty of diagnosing heartworm infection in cats and pointing out that the No. 1 symptom is sudden death.
Dr. Lund, a past president of the Companion Animal Parasite Council and a creator of the organization’s parasite forecast maps, further asks if the client has heard the buzz of mosquitoes zipping by outside. She reminds the client that unpredictable weather patterns can cause mosquitoes to pop up in places where they are not frequently found.
She also notes that recent hurricanes in the Gulf Coast and Puerto Rico led to heartworm-positive dogs being transported to other parts of the United States, further increasing the risk for the spread of the disease.
The American Heartworm Society urges that every dog be checked for heartworms at least yearly. The guidelines are summed up in one sentence: Test every 12 months and prevent disease 12 months per year.
Both the American Heartworm Society and the CAPC stress the importance of discussing parasite prevention for every pet at every visit. The groups recommend that the entire team be onboard and that new employees be educated about heartworm disease and parasite control and be trained in how to raise the topic with clients.
We’ve all been told how a client needs to hear something at least three times before he comprehends the importance of the message. Here’s a solution:
- The customer service representative brings up heartworm prevention at check-in.
- The technician further discusses it when rooming the client and patient.
- The doctor reinforces the message during the exam.
- For good measure, the customer service representative can make sure the pet owner has a heartworm preventive before he leaves the hospital.
The Hidden Infection
Ed Wakem, DVM, who serves on the American Heartworm Society board and is a veterinary services manager with Ceva Animal Health, thinks that when heartworm prevention moved from daily to monthly administration, the profession might have become overconfident that the disease would be defeated in our lifetime. Unfortunately, this approach ignored the vector and dealt only with the parasite as the threat.
Dr. Wakem acknowledges that flea and tick control is not without compliance challenges of its own, but the owners get feedback when they become non-compliant; that is, their pets get fleas or ticks. Owners are much less likely to get immediate feedback about non-compliance with heartworm prevention.
“We probably could do a better job as a health care team than the once or twice a year, face-to-face visits that have become the standard of care [along with] an antigen or microfilariae test and refilling medications,” he said. “I’m not certain what better looks like, especially for those households that have compliance challenges. It may include celebrating a negative test and what that means, open-ended questions and reflective listening to best understand which preventive scheme is in the best interests of the patient.”
Veterinary teams can do a better job discussing heartworms with clients. When pet owners are given too many choices, they are more likely to choose nothing because the decision becomes overwhelming. Cost is rarely the primary reason clients don’t buy a heartworm preventive; however, they do need to see the value in buying it and giving it.
A study conducted by the American Animal Hospital Association found that over 75 percent of pet owners will buy a veterinarian-recommended product, especially when they know a practitioner has taken into consideration their pet’s specific needs. To Dr. Wakem’s point, perhaps if veterinarians and team members do a better job evaluating each client’s lifestyle and each patient’s environment, and then recommend the single, most appropriate preventive for the dog or cat, the client will be more likely to purchase and administer the medication appropriately.
Phone Calls and Text Messages
The vast majority of veterinary practice software sends a reminder when a patient is due for a refill of a heartworm preventive. Dr. Lund’s staff calls clients to remind them it’s time. This personal touch is another way team members can reinforce the importance of giving a monthly preventive or, in the case of moxidectin injections, scheduling an appointment to come in every six months.
For financially strapped clients who opt to buy a single dose of prevention every month, the phone calls can be even more important. These clients can least likely afford heartworm treatment for their pet, and the call reminding them to pick up the month’s dose can be a lifesaver and another touchpoint in bonding the client to the practice.
Jeff Herman, practice administrator at Meyerland Animal Clinic in Houston, is experimenting with sending monthly text messages to clients to remind them to administer their pet’s prevention. Whether his tactic makes a difference is unclear at the moment, but clients appreciate receiving updates.
Tech-savvy clients have lots of options. Many people can set a reminder on their phone or electronic calendar. Christine Longo, DVM, of Ocean Springs, Mississippi, does this for her pets.
A host of apps for medication reminders are available on the iTunes and Android platforms. Clients can choose the one that works best for them. A Merck app, My Pet Reminders, is specifically for animals.
Other brands allow you to sign up online and receive a monthly text or email as a reminder. Schertz, Texas, veterinarian Todd Phillips, DVM, recommends going one step further: Have the client sign up in the exam room. On your computer or tablet, navigate to the product website and let the client fill in her information.
Dr. Phillips also suggests that clients link the administration of heartworm prevention to other monthly activities, such as paying the mortgage or attending a PTA meeting. For families with children looking for extra spending money, he might recommend that parents pay their kids to remember to give the heartworm preventive. It’s cheaper than heartworm treatment, and kids are savvy enough to put a reminder on their phones or in an app.
He also recommends using tried-and-true educational materials:
- A jar filled with formalin and a heart infected with vessel-clogging parasites.
- Testimonials from clients whose pets were treated for heartworms at your office.
- CAPC parasite maps.
- Rebate coupons or codes that can be provided at the time of purchase.
In the end, messaging must be consistent across the veterinary team, from customer service representatives to technicians to the veterinarians themselves. And the messaging must be repeated every time the patient comes in the door.
- Make technology your friend. Use apps or electronic notifications to remind clients to give heartworm prevention monthly and to come in every six months to get refills or a moxidectin injection.
- Take advantage of resources from the American Heartworm Society, the Companion Animal Parasite Council and manufacturers.
- Educate clients that mosquitoes and heartworms are showing up in places where they were previously less common and that every state has reported heartworm cases.
- Reward good compliance by showing extra appreciation to clients who administer preventives appropriately and get timely refills.