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Veterinary Forum July 2009 (Vol 26, No 7)

Practice Watch — Parasite Prevention Perception and Reality

by Paul Basilio

    In the new parasite landscape, best business and best medicine can go hand in hand

    The AAHA compliance studies from 2003 and 2009 reflected the difficulties some practitioners face when recommending parasite prevention. According to AAHA, veterinarians believed that their client compliance rates were good, but survey results showed the rates of compliance for parasite products hovered around 50%, at best. These numbers do not bode well in a time when parasite prevalence and incidence are rapidly changing.

    To ensure pets are protected out in nature and at home, veterinarians should make a solid case to clients about year-round, broad-spectrum parasite prevention — and reap the benefits of increased compliance.

    Unfortunately, there is a difference between compliance perception and reality, says Tom Nelson, DVM, of the Animal Medical Center in Anniston, Ala. "A lot of people think they have a good program that everybody follows, and then they look at the actual numbers and reality sets in," he explains. "When practices consider their compliance rate for heartworm prevention, for example, they sometimes believe that because they are in an endemic area and the doctors recommend heartworm preventatives for every dog, the compliance rate is around 85%. When they compare how much product has been sold with how many dogs they've seen, however, the numbers come out to about 35%."

    One of the best opportunities to remedy this trend is to educate the client when the pet presents with a parasitic infestation.

    "The biggest opportunity we have for education is when we're presented with the parasites fleas and ticks," says Steven A. Levy, president of Veterinary Clinical and Consulting Services. "When clients come in and say they can see worms in their pet's stool, you can educate them right there and explain how the problem can be taken care of immediately. By doing so, you are integrating [parasiticidal] products into the visit."

    Levy says that practitioners should stress to owners that puppies and kittens can be born with internal parasites that can lie dormant for long periods, so it is important to conduct at least one fecal examination each year and place the pet on a broad-spectrum monthly preventative.

    Solidifying the practice's message can help raise compliance rates dramatically, suggests Jay Stewart, DVM, owner of Aumsville Veterinary Clinic in Aumsville, Ore., and president of the Companion Animal Parasite Council (CAPC). "It can be especially difficult in multidoctor practices," he said. "The problem is that interoffice communication often is not as good as it could be. If we have four or five people recommending four or five parasite control protocols, it can become confusing for the client. It is important to have staff meetings to educate the doctors and staff so everyone can get on the same page."

    Sidebar: Clearing Lyme in the Heart of Lyme Country

    If a doctor gives a recommendation for a repeat puppy deworming in 3 months, but the receptionist does not reinforce that message or does not believe it is worth reiterating to the client, then the message can become lost, Levy says. "The decision-makers need to determine what the right message is," he explains. "They need to understand the science behind the products, not just the marketing, and then explain it to the staff. The people in charge need to say, ’This is what we do at this practice. Each puppy and kitten is going to be dewormed at each of their first series of visits, and a fecal examination is going to be conducted every year or twice a year.' Make sure everyone is in the same place."

    Connecting with the client

    Experts agree that a little message tailoring can help raise compliance rates for parasite prevention. Every pet owner is different, and what is important to one may not be important to another. A client with an elderly or immunosuppressed relative living in the home will be receptive to preventing zoonotic infections, and a client who had a pet die from a heartworm infection in the past will be first in line for heartworm preventative refills.

    "We used to be able to sell 6 months' or a year's worth of parasite prevention, but if we stop at that and don't find a way to motivate the client to administer that preventative when they have it, we're not really doing the rest of the job," Stewart says. "We need to make the sale and encourage the client to continue to administer the medication."

    Levy, who works in a private practice and a low-cost clinic in Missouri, sees the full spectrum of clients — those who visit once for vaccinations and are never seen again and those who form a bond with the practice and contribute to a family atmosphere. "At the private practice, we have long-term clients," he says. "The owner of the practice has the client's trust, and when he makes a recommendation, people listen and take the recommendation to heart. The clients also will trust me and do what I suggest. A personal relationship means so much for compliance. People are looking for recognition. They want you to know their pet's name. Even if the staff has to look at the appointment book in the morning and learn the names of two dogs that are coming in, it helps."

    Reassuring the client that veterinary-exclusive parasite products are a better option than over-the-counter products from pet or grocery stores is another way to connect and reinforce the bond.

    "Bring up the over-the-counter products and discuss how they work," suggests Nelson, who also is a member of CAPC. "Most of the flea control products work by paralyzing the flea. The difference is that the neurotransmitters that the veterinary-exclusive products work on are only found in invertebrates. There is a big safety factor."

    Bug geography

    Prevalence maps are becoming vital tools for increasing parasite prevention compliance. By understanding which parasites are endemic to an area where a client lives or travels, a veterinarian can customize a parasite prevention program to individual pet needs. However, endemic areas are always changing.

    "The threat is ubiquitous," Levy says. "Deer ticks, for example, are prevalent early in the fall in most areas, and those that don't feed between September and November will remain quiescent until a warm day in December. In Missouri, we're seeing warm-weather ticks in February."

    Despite the changing threat, prevalence maps have not been used as well in the past — something Stewart says CAPC is working on. "There has been a lack of consistency with the maps," he explains. "One of our priorities is to help with incidence reporting and mapping so practitioners can be aware of what is being seen in their area."

    The difficulty with maintaining prevalence maps is that they are not static. Every season, it seems, ticks and mites rear their heads in areas once thought too inhospitable.

    "The maps can be dynamic," Stewart adds, "which is probably unexpected to most practitioners. In some areas of historically low incidence, you can see heartworm begin to creep in, for example. Vectors are moving, vectors are changing and incidence is changing. You cannot rest on your laurels as a practitioner. Our patients are exposed to things we didn't consider in the past."

    In the new parasite landscape, best medicine and best business can go hand-in-hand.

    "If you're selling a veterinarian-exclusive product," Levy says, "it's best medicine because you control it and you know it's not counterfeit or diverted. It is good business because you're making the money and you're educating the client on the spot. If you finish a heartworm test, sell heartworm prevention. If you've found tick-borne disease in a pet or not, have strong protocols for dealing with Lyme disease and others, and send people home with appropriate tick control so they don't buy something from the Internet."

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