Stanley Truffini, DVM, of Georgetown Veterinary Hospital in Connecticut, has seen almost four decades\u2019 worth of product introductions designed to combat an age-old pet conundrum: fleas and ticks.<\/p>\n
First were the flea collars.<\/p>\n
\u201cYou can sometimes forget about the fleas, but they always come back,\u201d Dr. Truffini said. \u201cI\u2019ve seen this happen frequently. Over the summer, you\u2019ll never see fleas on the dogs that are protected, but all of a sudden a cat or a dog that doesn\u2019t have some sort of preventive will show up. You tend to think they aren\u2019t out there, but they are.\u201d<\/p>\n
Then came the topicals.<\/p>\n
\u201cWe originally started with the topicals because that was what was available,\u201d he said. \u201cThey had their issues with application, applying it properly. We always recommended them to families with children but would advise that they didn\u2019t hug or touch their pets in the area the topical was applied, and that was always a little bit of an issue.\u201d<\/p>\n
Then the oral preventives started appearing. Dr. Truffini\u2019s team waited a year or so before bringing a new product into the hospital.<\/p>\n
\u201cThey seem to work well,\u201d he said. \u201cWe didn\u2019t have too difficult a time convincing clients, especially with families. Families were key, with children hugging pets and hanging around them.\u201d<\/p>\n
Indeed, preventive products for years have been able to combat fleas and ticks and the diseases they carry. It\u2019s the compliance component \u2014 convincing the clients of the benefits of the products and then follow through with appropriate use \u2014 that\u2019s remained a challenge.<\/p>\n
Compliance isn\u2019t just an animal health challenge. Human medicine and pet medicine studies have shown that the adherence step of compliance \u2014 what clients actually do when they get home \u2014 is poor across the board, said practice management consultant Karyn Gavzer, MBA, CVPM.<\/p>\n
As the former director of marketing for the American Veterinary Medical Association, Gavzer created public campaigns within the industry, such as \u201cPets Need Dentistry, Too\u201d and training programs to help veterinarians and their teams market their services more effectively.<\/p>\n
Poor compliance has many potential causes, Gavzer said.<\/p>\n
\u201cClients may get confused,\u201d she said. \u201cThey may forget to give the medicine to their pets. They may have trouble giving the medication because the pet fights it, such as ear squirt treatments and pilling cats. Or clients may run out of the medication and forget to order more.\u201d<\/p>\n
One interesting development Gavzer sees on the human medicine side is experimentation with \u201csmart pills\u201d that digitally log in when they are taken and with implantable dispensing devices that automatically deliver needed medications.<\/p>\n
\u201cIn the meantime, they are little better off than we are with our veterinary patients,\u201d she said. \u201cFor now, the two main tools to improve client compliance are more convenient products and medications, and human support.\u201d<\/p>\n
Gavzer has seen tremendous improvement in products that can be administered in the veterinary practice, like ear treatments, injectable antibiotics, heartworm preventives, and chewables for flea and tick.<\/p>\n
\u201cProducts like these are usually the best choice to ensure our patients get what they need, and they are so much easier on clients. We do all the work for them,\u201d she said.<\/p>\n
Although determining compliance is more difficult today when clients purchase flea\/tick products online and over the counter, as well as from veterinary practices, Gavzer said the hurdles to compliance remain the same:<\/p>\n
Do clients know that their pets need the products and do they know how to give them?<\/strong><\/p>\n \u201cDid we recommend the products when they were in?\u201d Gavzer said. \u201cDid we let them know that they could get everything they needed for their pets before they left us and that we could give the first dose while they were there? Also, did we dispel the myth that our prices are higher? Did we let them know that our price would be about the same as they would pay online and they could take it home and be done?\u201d<\/p>\n Do clients give the product regularly even if they have it?<\/strong><\/p>\n \u201cWe can help them with this by offering to do it for them,\u201d Gavzer said. \u201cIs there an injection in lieu of a pill their pets could take? Or are there pills that could be given every three months instead of monthly? Can we offer to send text or e-mail reminders when their pets need their next dose?\u201d<\/p>\n Product safety is always top of mind for clients and veterinarians. That\u2019s why Dr. Truffini said his practice waits at least a year when a product is introduced in the market and reads up on the research before using it. Fortunately, there is a familiarity with chewables as preventives, having been on the market now for several years, as well as the similarity to heartworm preventives.<\/p>\n \u201cEverybody is used to giving something oral to kill something, such as heartworm,\u201d Dr. Truffini said. \u201cClients are already aware that these products are safe based on safety studies. They know about heartworm meds being safe, so that has paved the way for allowing these other oral products. We do explain the safety involved and studies done, and how little medication is needed. Knowing these products are safe when taken as directed, they are pretty much on board with it.\u201d<\/p>\n Like Dr. Truffini, Shannon Jensen, DVM, of Perkins County Veterinary Hospital in Grant, Nebraska, waited to try chewable flea and tick products when they were introduced.<\/p>\n \u201cI resisted selling chewable flea\/tick products when they first came out due to the fact that they last so long in the body,\u201d she said. \u201cI had past experience with chewable heartworm prevention causing GI signs for the full four weeks of efficacy.\u201d<\/p>\n Last summer was her practice\u2019s first to really offer chewables, and Perkins County chose Bravecto (fluralaner).<\/p>\n \u201cClients love the convenience of once every three months, and so far we have not seen any adverse reactions,\u201d she said. \u201cThe monthly preventives drive traffic in the clinic more so than Bravecto as far as frequency of visits [monthly vs. quarterly]. Availability of oral, however, brings clients to the veterinary clinic.\u201d<\/p>\n One of the biggest selling points for the new chewables is in how quickly they act, Dr. Truffini said.<\/p>\n \u201cWe\u2019re getting more complete killing of the tick before it can actually transmit anything,\u201d he said. \u201cThat\u2019s important.<\/p>\n \u201cMost of our clientele is pretty well educated that you have to do something about ticks, especially because of Lyme disease,\u201d he said. \u201cWe\u2019re in the No. 1 place in the United States for them. This area of Connecticut has the highest rate of Lyme disease. People are wary. Usually one or two family members have had Lyme disease. So they are aware, and they see ticks on their dog and know what\u2019s going on. They\u2019re all pretty much on board.\u201d<\/p>\n Zack Mills, DVM, owner of Tiger Tails Animal Hospital in Duluth, Georgia, and a member of the Today\u2019s Veterinary Business editorial advisory board, said the vast majority of his clients are switching from topical to oral\/chewables medications.<\/p>\n \u201cWhen it is easy to administer, clients are more apt to use the product,\u201d Dr. Mills said.<\/p>\n Manufacturer rebates help create a high compliance rate among owners purchasing a year\u2019s supply, Mills said.<\/p>\n \u201cWhat gets people to purchase is the rebate,\u201d he said. \u201cThe [manufacturer\u2019s guarantees] help, but it\u2019s really about price.\u201d<\/p>\n Pricing products competitively is extremely important, he said.<\/p>\n \u201cToday\u2019s consumer is going to price shop if they are used to purchasing items online,\u201d Dr. Mills said. \u201cWhen you price products too high customers can easily check to see if you are overcharging, and if you are overcharging for these items, they will ask themselves, \u2018What else are you overcharging for?\u2019\u201d<\/p>\n Compliance products are attractive and desirable to clients if they know about the products, Gavzer said. That\u2019s where clear communication from the entire veterinary practice team comes in. Having the preventive conversation is important during wellness checkups and at appropriate times during other visits. Veterinary practices might be surprised by the client response.<\/p>\n \u201cIt\u2019s been my experience that clients don\u2019t always hear about these options because they can cost more,\u201d Gavzer said. \u201cMany in practice shy away from recommending them for that reason. I think we\u2019ve misread clients. I think that most would say \u2018yes\u2019 if we offered them a better way to take care of their pets, even if it cost more.\u201d<\/p>\n Dr. Truffini hasn\u2019t seen a bump in sales as much as he has seen clients switching from topicals to chewables when his team initiates the discussion.<\/p>\n \u201cIt hasn\u2019t been too hard to talk to people or convince that there are options with flea\/tick products,\u201d he said. \u201cI would say maybe a third of clients are using orals.<\/p>\n \u201cEvery time we talk to people and they need to have refills, we mention the chewables. Clients are already used to giving once-a-month heartworm, so it becomes a pretty easy thing. They like that they aren\u2019t parting fur. People weren\u2019t always applying it properly. So with that issue, it\u2019s a very convenient thing to hand them this tasty, once-a-month treat. We are getting good compliance.\u201d<\/p>\n Chewable flea\/tick products have made a noticeable impact in the market in a short period of time. According to industry reports, compounded growth in flea\/tick products that have been veterinarian dispensed has been just under 5 percent since 2011. However, using 2014 as the baseline year shows a sharper uptick of close to 16 percent.<\/p>\n What accounts for the increase? In 2014, Boehringer Ingelheim\u2019s NexGard (afoxolaner) and Merck Animal Health\u2019s Bravecto were introduced to the market. The movement accelerated when Zoetis jumped into the space with Simparica (sarolaner) in early 2016.<\/p>\n Examining compliance through a two- or three-year window is important rather than looking at year over year. That\u2019s because pet owners traditionally stretch their use of flea\/tick products beyond a calendar year. One analysis showed that most owners who buy a six-pack of a monthly topical typically didn\u2019t buy it again for 25 months. At some hospitals, subsequent purchases are 36 to 38 months out. So, when clients make the initial purchase at a yearly exam, they might tell the veterinary team when asked about flea\/tick product refills that they still have some preventives at home.<\/p>\n Veterinary hospitals must have total buy-in when it comes to the products they carry.<\/p>\n \u201cThe most successful hospitals, no matter what product they are carrying, have a consistent recommendation from the entire veterinarian staff instead of a plethora of options,\u201d said Pasquale Bondi, a regional manager with Merck Animal Health.<\/p>\n Chewables aren\u2019t limited to flea and tick preventives. The formulation and palatability make antibiotics easy to administer as well. Here\u2019s a sampling of what\u2019s on the market:<\/p>\n There is a familiarity with chewables as preventives, having been on the market now for several years.<\/p>\n","protected":false},"author":40,"featured_media":3003,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"iawp_total_views":0,"footnotes":""},"categories":[338],"tags":[],"class_list":["post-3002","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-june-july-2018","column-features","clinical_topics-patient-care"],"acf":{"hide_sidebar":false,"hide_sidebar_ad":false,"hide_all_ads":false},"yoast_head":"\nSafety First<\/h3>\n
At the Right Price<\/h3>\n
Conversation Starters<\/h3>\n
Market Impact<\/h3>\n
\nCHEWABLE ANTIBIOTICS<\/span><\/h3>\n
\n