In June 2011, I walked into the American Animal Hospital Association office for my first day of work as a marketing copywriter. While the job was my first in the veterinary industry, it didn’t take long for me to learn the phrase “gold standard of care.” AAHA was all about high standards, after all. Now, nearly 11 years later, the industry has shifted. The focus has pivoted from the gold standard to the spectrum of care in an effort to be inclusive and improve access to veterinary services.
While most veterinarians want to recommend the gold standard to clients, many practitioners in small animal practice provide the spectrum of care whether they know it or not. According to the Access to Veterinary Care Coalition’s 2018 survey (bit.ly/33ZfbAm), 95% of U.S. veterinarians surveyed agreed that “All pets deserve some level of veterinary care,” and 98% of private practice veterinarians had implemented at least one strategy within the past year to address and mitigate financial barriers to veterinary care. The most frequently cited strategy was exploring treatment options with clients to best match their economic constraints.
But what if the economic constraints mean pet owners can’t purchase year-round parasite prevention? Isn’t year-round parasite prevention the gold standard? It’s best for the pet, right?
According to the AAHA-AVMA Canine and Feline Preventive Healthcare Guidelines (bit.ly/33YVuwZ), every dog and cat should have annual heartworm testing and at least annual intestinal parasite testing. The guidelines also state that every dog and cat should receive year-round broad-spectrum parasite control with efficacy against heartworms, intestinal parasites and fleas.
How can veterinarians balance what’s best for the pet with what the owner can afford? Here are five tips.
1. Stop Assuming
I live in Denver. A couple of years ago, I took my dog to a veterinarian I hadn’t seen before. Toward the end of the wellness visit, I asked about flea and tick prevention.
“Oh, we don’t really have fleas in Colorado,” a technician responded. “We could order something for you if you want it.”
Feeling perplexed, I left without a flea and tick preventive.
A few days later, I spoke with the practice owner, who told me that her clinic didn’t “push flea and tick prevention on clients” because they might think the practice was just “trying to get more money out of them.”
She seemed surprised that I wanted to spend the money. The moral of the story? Stop assuming what clients want, what they will or won’t purchase, and how much money they have to spend.
“As an industry, we tend to prejudge clients way too fast,” said Craig Prior, BVSc, a board member and past president of the Companion Animal Parasite Council. “I’ve seen too many times where we see this little old lady who’s on a fixed income, and we say, ‘She can’t afford it, so we’re just not going to offer it.’ Who gave us the right to do that?”
2. Practice Relationship Medicine
Establishing protocols and standards in your practice is a good thing, right? But how flexible should those protocols be? Should you ever bend the rules?
Absolutely, said Stacee Santi, DVM, who designed a veterinary practice mobile app because she wanted an easier way to remind clients to administer monthly parasite preventives.
“You can’t assign a blanket policy to everyone,” Dr. Santi said. “If your client lives 8 miles away from everything in the Colorado mountains, their pet truly never encounters pets from other locations and they don’t want to pay for parasite prevention, that’s a judgment call you have to make as a veterinarian.”
The CAPC’s Dr. Prior stresses the importance of asking about a patient’s lifestyle to get the complete picture. Then, clearly and concisely communicate the reasoning behind the questions and the implications of a client’s answers.
Regardless of the clinic location, here’s what to ask clients:
- Where do you plan to travel in the next six to 12 months? Will you take your pet?
- Does your dog go to dog parks or boarding or grooming facilities?
- Do you encounter other dogs during walks?
- Do you use potting soil for indoor plants?
- Do you ever open your home’s doors and windows?
“Cats love to hunt insects, so if you have a cockroach problem, or other insects are getting into your home, your cat can end up with parasites,” Dr. Prior said. “About 15% of all soil samples are positive for parasitic elements. Is that potting soil sterilized before your client brings it inside? And anyone can visit a dog park, whether their dog is free of parasites or up to date on immunizations. Dog parks are equal-opportunity infectors. These are important questions to ask to assess lifestyle risk factors.”
3. Know the Trends
“Parasites are dynamic and ever-changing, and they’re on the move,” Dr. Prior said. “People are also on the move. Especially during the pandemic, we’re seeing more people working from anywhere and becoming very mobile, and they’re taking their pets with them.”
The relocation of animals contributes to the spread of parasites.
“Animals are being rescued and shipped all over the country, and now we’ve seen hotspots show up in Denver,” Dr. Prior said. “The prevalence of heartworms in Denver has almost doubled from 2014 through 2018. And that’s been from the introduction of all these shelter and rescue animals.”
While some parasites are seasonal, Dr. Prior said the seasons can get longer, and the areas where the pests live are expanding. Tick habitats are changing, too. The hearty Asian longhorned tick is now in the United States and “can basically survive anywhere,” Dr. Prior said.
“We have ticks that survive well through the winter,” he added, “and some that prefer indoor human habitats.”
Internal parasites have different seasons, Dr. Prior said.
“Roundworms and whipworms peak in the winter months, and hookworms peak in the summer months,” he said. “So, which season do you choose? This just shows you that [the threat] isn’t seasonal; it’s year-round.”
He recommends the Companion Animal Parasite Council [capcvet.org] as a resource to keep up with the changes.
“CAPC provides parasite mapping for everyone so that they can see not only what’s going on in their backyard today but also the trends,” he said. “The veterinarian can pull it up and say, ‘Well, we’ve got a moderate risk for Ehrlichiosis still at this time of year. We need to stay on preventives.’”
4. Keep Things Simple
Don’t overwhelm clients by offering too many parasite prevention options. Pet owners are paying you for your education and expertise. If you provide too many choices, you could confuse clients, and they might leave with nothing.
Drs. Santi and Prior agreed that product consolidation is a best business practice.
“From pet food to parasiticides to pet insurance, practices need to educate themselves and then choose the one they want to get behind,” Dr. Santi said.
“I want clients to go out the door with something, not nothing,” Dr. Prior said. “We know that about 60% of clients leave the vet clinic without buying anything — no heartworm prevention, no flea and tick prevention.”
5. Use the Right Words
While “heartworm prevention” is common terminology, the prescribed preventive likely fights intestinal parasites, too. By referring to the product as “heartworm prevention,” veterinarians might devalue it in the pet owner’s mind.
“We’re protecting against heartworms through the summer months and intestinal parasites through the winter months, so we’ve got good reason to meld that together for a year-round message,” Dr. Prior said.
“It comes down to clear, concise, thorough communication,” he said. “We should start with the gold standard, always offer our best care, and then let the client decide.”
WHAT’S SENSIBLE?
Stacee Santi, DVM, questions the hard-and-fast rules that veterinarians need to require a heartworm test every year and that practitioners need to have seen the patient within the past 12 months to prescribe medications legally. What if a client can’t pay for a test?
“Is it better to get the client two boxes of parasiticide, or is it better to get them one box of parasiticide and one heartworm test?” Dr. Santi questioned. “The true answer is, it depends on the situation, the client, the patient and the doctor’s comfort level.
“These black-and-white policies need to go away, and we need to start actually practicing medicine based on the needs of our individual patients and clients.”
Dr. Santi advises veterinarians to read their state practice acts to determine what’s required.
“In Colorado, it says you have to have seen the patient in a reasonable amount of time, which is subjective,” she said.