Overcoming the barriers to heartworm prevention in your veterinary clinic

This article was contributed on behalf of the American Heartworm Society.

Heartworm has been diagnosed in all 50 states, so regardless of where in the country you practice veterinary medicine, heartworm disease poses a threat to your patients. The specific challenges you face in convincing clients to protect their pets from heartworm may be different, however, from those of the practitioner who practices on the other side of the country—or even the other side of town. Weather, parasite incidence, client knowledge and client income all play important roles.

Following are four stories about heartworm compliance from practitioners who, like you, face challenges. Their solutions and approaches to these challenges demonstrate that compliance can be significantly improved and that patients and clients will benefit.

Lynn F. Buzhardt, DVM

Co-owner, The Animal Center West, Zachary, La.

Buzhardt lives and practices in southeastern Louisiana, a.k.a. Heartworm Central. Unfortunately, living in a known heartworm-endemic area is no guarantee of heartworm compliance, thanks to misperceptions clients hold about the disease and its prevention.

The first misperception is that, while clients understand that mosquitoes transmit heartworm disease, they assume that only outdoor pets are at risk.

Another problem is that clients read the prescription label on the preventive but have different ideas about what "monthly" means.

Finally, pet owners don't realize that heartworm prevention can save them money—as well as pets' lives. According to Buzhardt, it sometimes helps to talk about the monetary benefits as well as the medical benefits of heartworm prevention.

The Animal Center West plays it by the numbers. The veterinarians and staff follow a "Rule of Three" to educate clients about heartworm disease. The goal: to deliver the following three-point message three times by three team members.

1. Heartworms are a real danger. Heartworms pose a serious threat to dogs' and cats' health and are transmitted by mosquitoes.

2. Heartworm disease is hard to treat. A heartworm infestation is difficult and expensive to treat in dogs and there is no approved treatment for cats.

3. Heartworms are easy to prevent. Heartworm preventives are effective and easy to administer to pets.

At Buzhardt's practice, the receptionist is the first to introduce the message by handing out written materials when a client checks in. The technician is the next messenger, repeating the three messages in the quiet learning environment of the exam room while taking a blood sample for the requisite heartworm test. Finally, the veterinarian validates the messages when prescribing or injecting the preventive medication.

Buzhardt believes that consistency and repetition are key to communicating with clients.

Robert Stannard, DVM

Owner, Adobe Pet Hospital, Livermore, Calif.

Even in parts of the country where the risk of heartworm disease is considered low, prevention is important. "I admit that prior to 2004, I didn't think there was a heartworm risk in northern California," says Stannard. That belief was challenged when Stannard attended a continuing education presentation on zoonotic intestinal parasites.

During the seminar, Stannard learned that diseases such as ocular larval migrans and neural larval migrans are more common in humans than most pet owners realize. The magnitude of this risk was reinforced dramatically for Stannard when a practitioner in southern California lost his practice and his home in a settlement over a case in which a child went blind.

At that point, Stannard was even more determined to safeguard his patients and clients against intestinal parasites by recommending year-round prevention. Getting protection from heartworm disease seemed like an added, but largely unneeded, bonus.

This belief was about to change. Implementing recommendations for protection against internal parasites required Adobe Pet Hospital to add heartworm testing to its junior and senior wellness blood panels to start all canine and feline patients on monthly medications. To his surprise, 16 cats—including 10 strictly indoor cats—and three dogs tested positive in the first year alone.

Today Stannard's clients learn that there are two important reasons for providing year-round protection for pets against heartworms and intestinal parasites.

1. Heartworms are serious but preventable. Heartworm disease can be devastating, but it's easy to prevent it.

2. Parasites impact pets and people. Preventing intestinal parasites in cats and dogs also prevents people from contracting potentially serious diseases.

When asked how this approach is working, Stannard replies, "Over and over again, clients thank us for protecting their precious pets and their family members as well."

Stephen Jones, DVM

Partner, Lakeside Animal Hospital, Moncks Corner, S.C.

For Jones, the challenge with his clientele is getting owners to understand the importance of a parasite they can't see.

"Outward signs that a dog or cat is infected are not apparent until the disease is advanced, which can take years," he says. "Unfortunately, at that point clinical signs such as cough, exercise intolerance and heart failure may mistakenly be attributed to old age."

Recognized or not, though, heartworms damage and obstruct pulmonary arteries, often lead to pneumonitis and can permanently alter the heart.

Meanwhile, veterinarians themselves sometimes need convincing. While Jones understood the risk and consequences of canine heartworm disease, at one time he himself believed that feline heartworm disease was so rare it wasn't worth discussing with cat owners. That changed when a feline patient died and heartworms were discovered during necropsy.

The team at Lakeside Animal Hospital now uses visual aids to communicate the compliance message. They find that setting a jar containing a heartworm-infected heart in the exam room tells a greater story than any brochure or handout can.

But Jones's staff doesn't rely on a single touchpoint to achieve better compliance. Like Dr. Buzhardt's team, they employ a three-pronged approach during each visit.

1. Ask. The technician asks the client about compliance.

2. Comment. The veterinarian either commends the pet owner for good compliance or discusses the dangers of failing to protect a pet.

3. Refill. The receptionist makes sure the client either has a supply of heartworm preventive or makes a purchase before leaving the hospital.

Because heartworm prevention is such an important part of pet health, Jones doesn't let cost become an obstacle to compliance. "I make it a point to carry an array of heartworm products," he says. "I also do my best to price-match online pharmacies. Once a pet owner purchases elsewhere, you have no way of tracking compliance."

Sheldon Rubin, DVM

Emeritus director, Blum Animal Hospital, Chicago

Past president, American Heartworm Society

The Midwest with its frigid winters may seem like a region where the risk of heartworm disease is reduced. The real risk, says Rubin, a long-time Chicago resident, is that owners will try to guess when their pets are "safe" from heartworm transmission.

The incidence of heartworm disease has been on the rise in Illinois, thanks to warmer winters, a large reservoir of wildlife vectors, the transfer of homeless pets from the South for adoption and urban microclimates that allow mosquitoes to survive cold weather.

Rubin is happy to share a few of the tips he developed over the years.

1. Use visuals. Pull out that dusty jar of heartworms and place it on the reception desk to stimulate questions.

2. Talk and listen. Have staff place a "not current on heartworm medication" note in a patient's record so the veterinarian can have a discussion with the client. This is also a good time to remind pet owners that most heartworm preventives also protect pets against intestinal parasites.

3. Don't be shy. Don't hesitate to discuss cost as part of your "prevention is important" message. Let clients know that your prices are competitive with online pharmacies.

4. Send reminders. Program your practice management software to automatically remind clients to repurchase heartworm preventives when needed, based on the type and quantity they were originally dispensed.

5. Keep it simple. The easier it is for pet owners to purchase the medication, the better (e.g., provide online ordering and mail items at no charge). And have clients sign up for an online reminder service to help them remember to give preventives year round.