Extreme makeover: parasite edition

When Dr. Jane Brunt learned that her mother's cat was scooting on the rug outside the bathroom door because it was infected with roundworms, she became angry. "My mother and her beloved cat did not need to endure something that could have had very serious consequences," says Dr. Brunt, executive director of the CATalyst Council in Kansas City, Mo.

Top internal parasites in dogs and cats

It's a problem the Companion Animal Parasite Council (CAPC) has been puzzling over for some time: Why are so many pets still not completely protected from parasites? "Neither pets nor people should have parasites when they're so easily prevented," Dr. Brunt says. Let's examine how you and your team members can transform your parasite program to help wipe out the barriers to 100 percent parasite control.

TAKE A CLOSER LOOK

"If we're not looking for parasites, we can be sure we will not find them," says Dr. Jay Stewart, owner of Aumsville Animal Clinic in Aumsville, Ore., and president of CAPC. According to a 2006 CAPC study, Dr. Stewart says, veterinarians and many pet owners are aware of parasite risks, but they're not necessarily paying attention to the problem consistently. Why? Here are a few factors that can batter the most well-constructed parasite prevention programs:

1. Fecals fall short. One of the biggest reasons fecal examinations and follow-up tests don't happen is that you simply never get a sample. After all, you can't force a reluctant pet owner to collect and deliver the poop to your practice. Julie Legred, CVT, a practice manager in Bricelyn, Minn., offers this team protocol to help you lock in a sample: First, include a note requesting a fecal sample when you send the appointment-reminder postcard. Next, when a client schedules an appointment, have the receptionist remind him or her again on the phone. And finally, if the client still fails to bring in the sample, follow up with phone calls after the visit.

Once you've identified an infected pet, make sure you plan follow-up tests, Legred says—especially for puppies and kittens. If you don't, a young animal that's still infected can reinfect its littermates or spread parasites to other household pets. She recommends following CAPC guidelines (see capcvet.org) for treatment and recheck protocols.

The CAPC site helps team members sharpen their skills by offering a fecal-test demonstration video and encourages practices to use centrifugal flotation versus simple flotation since centrifugal flotation is more sensitive. "Performing fecal exams might not be anyone's favorite job, but it's one of the best diagnostic tools we use to protect pets," says Karyn Gavzer, MBA, CVPM, a veterinary consultant in Springboro, Ohio.

2. Pets (and pests) are on the move. More and more pets are living mobile, active lives—which means they experience greater exposure to parasites. Often clients will report that their pets never go anywhere, but when you inquire more thoroughly, you discover the truth. "Dogs are out in parks, they're eating other animals' poop, they're splashing around in ponds and puddles, and they're exposed to lots of parasite agents," Gavzer says. "That's why it's so important to educate clients about the risks."

Dr. Stewart says clients should be encouraged to keep their pets on preventive products and to consistently pick up their pets' waste in public areas. Good hygiene is one of the best ways to reduce the number of parasites in the environment, he says.

3. Cats get ignored. All of our experts agree that feline heartworm disease is a serious concern, and many cats aren't protected. "It's irrefutable that cats are getting heartworm disease, but it manifests as heartworm-associated respiratory disease," Gavzer says. "Veterinarians are seeing all of these cats with what they thought was asthma, but now we think it's more likely the effects of heartworm disease. The cats have rid themselves of the infection, but not before respiratory damage was done. Then veterinarians have to treat the lifelong effects of that infection."

Simply put, when you make a strong recommendation for feline heartworm prevention, you're practicing high-quality medicine, protecting cats from heartworm-associated respiratory disease, and improving practice profits.

PARASITE PREVENTION GUIDELINES: CREATE THEM, THEN TRAIN THE TEAM

So now that you know where many practices fall short, how can you fix an ailing prevention program? It starts with creating written parasite control guidelines outlining how you prevent and treat parasite infections—and then making sure everyone understands and follows those protocols.

"In many clinics, doctors and staff members hold different points of view," Dr. Stewart says. Here's a problematic scenario he sees often: The doctor makes a recommendation in the exam room. Later, a team member comes in and the client starts asking questions. The team member says, "Well, this is what I do for my pet"—and it's different from what the doctor has recommended. "I think getting the entire hospital team on board is one of the most important things you can do to create a consistent message," Dr. Stewart says.

Gavzer agrees. And to generate team buy-in, she suggests that doctors invite team members to be present when they create their protocols. "If a practice manager, a technician, and a receptionist sit in on this discussion, they hear how thoughtfully the doctors have decided on these guidelines, and they can take a look at their own role," Gavzer says.

What's more, team members can mention their own client experiences. "They can tell doctors about the situations that occur with the technician in the exam room or with the receptionist at the front desk, when clients are asking questions the team member doesn't know how to answer," Gavzer says. Once everyone works through how to handle these different scenarios, the entire team is positioned for success.

Once you've created your parasite prevention guidelines, take time to train your team to follow them. Legred says the most effective team training she's seen incorporates a series of modules in which team members complete worksheets, listen to talks from doctors and technicians at staff meetings, and take quizzes. Once they've passed a quiz for a module, such as parasite control, they're allowed to talk to clients about the topic. "The goal is to promote one solid message to clients that everybody takes part in," Legred says.

It also helps, Gavzer says, if you designate an advocate for your parasite prevention program in your practice. This can be any team member, and his or her role is to keep the fire lit. "This advocate tracks and reports on how the team is doing to reinforce success, or brainstorms ways to get back on track if things start to slide," Gavzer says. The parasite advocate can also help doctors and team members stay apprised of new client questions that arise.

A PUBLIC RESPONSIBILITY

While you possess a heartfelt interest in the well-being of your patients and their owners, it's also important to realize that your parasite prevention program can have a larger impact on society. Our experts emphasize that parasites in the environment can infect people who don't own pets if your clients don't responsibly handle their pet waste and stay current with prevention programs.

"Zoonosis is not one of those things that's someone else's problem," Dr. Stewart says. "So we need to put the message out, but we need to do it in a way that doesn't scare people into not wanting to own pets. We have high-quality tests and products that let us live with animals safely."

So what's the best way to educate clients without frightening them? Dr. Mike Paul, CAPC executive director, says that if your relationship with clients is built on trust, they'll hear the truth in what you're saying. For example, you might tell them, "We need to take preventive steps to maintain Sophie's health, prevent diseases that can kill her, like heartworm disease, and protect your child or grandchild."

And remember, we're past the days of profiling patients and offering recommendations based on what you know about their home lives. Clients may forget to tell you about the elderly parent who lives with them. They might not mention their own kidney transplant or other factors that put them at risk. So complete, year-round prevention with regular screening for infection is the best way to safeguard everyone's health, Dr. Paul says.

Dr. Stewart adds that teams need to use clients' language when it comes to parasite prevention. "Speak simply, give easy-to-understand instructions, and make sure that what you're asking clients to do is something they can do," he says. "If we just list options without offering a strong, specific recommendation, we can actually prevent clients from following our instructions."

MEASURE YOUR SUCCESS

You can't guarantee a successful prevention program if you don't know how you're doing. So you must measure your progress. Gavzer says a manual audit of records to determine client compliance is always a good idea. But a shorter way to get there is to simply compare the number of products you've prescribed to the number of active clients in your practice. Here's how it works.

Estimate how many cats and dogs were seen in your practice last year. Then look at a specific product or service, such as fecal tests. Maybe you ran 200 exams. That may seem impressive—until you realize you have 2,000 patients.

Next, use this information to set a goal. If you're testing 10 percent of patients, choose a realistic percentage for improvement, such as 20 percent. Then, at your next staff meeting, share ideas about what you can do to get to your target. For example, perhaps you offer clients the option to prepay for the fecal exam at their regular appointment and send home a container for collection. When clients know they've already paid for the test, they're more likely to return the sample.

It also helps to provide weekly feedback to the team on your progress. In our example, if your goal is to increase fecal exams from 10 percent to 20 percent, you'll need to perform 400 tests a year. If the average practice is open about 240 days a year, you'll need to perform about two fecal exams per day.

"Two pets a day is a very good measurement, because it doesn't seem like a big scary number," Gavzer says. "And we're helping pets, which is why we're all here. You can say, this pet went home with a fecal test complete and with parasite prevention. We did a good job."

And ultimately, that's your goal: to help pets and their people live happy, healthy lives together. "Most pet owners are good people, and they want to do the right thing," Dr. Paul says. "And good people given good information will make the right choices."

Portia Stewart is the former editor of Firstline and a freelance writer in Lenexa, Kan. Please send questions or comments to ve@advanstar.com

Editors' note: Don't miss the May issue of Firstline, which will feature tips to get your team involved in improving your parasite prevention program.