Veterinarians need to develop tailored vaccine schedules to meet the individual needs of their patients.
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Developing vaccination protocols for cats and dogs used to seem like an exercise in futility. But now that the American Animal
Hospital Association (AAHA) and the American Veterinary Medical Association (AVMA) have each published vaccination guidelines
for these species the exercise has become more rewarding because practitioners can now use this information as a benchmark
to tailor a specific program for each patient.
If you are like me, you changed your feline vaccination protocols a few years ago when the American Association of Feline
Practitioners (AAFP) established their recommendations. At that time, you may have also toyed with the idea of changing your
canine vaccination schedules as well. We actually did change our canine vaccination recommendations then. It was a brief,
brave moment in time. It didn't last. Maybe it didn't last because clients didn't buy into it. Or, maybe my staff didn't wholeheartedly
accept it. Or, maybe I put too many caveats on it ("even though the label says yearly", or "Although the vaccine manufacturer
probably won't back this", or "You can stay on yearly if you feel your pet would be more protected..."). Most likely all of
these affected the fact that most of our clients elected to stay with yearly vaccines. But today many of your clients have
heard something from someone or through the news media or online about "over vaccinating" and are making their own decisions.
How we handle their inquiries, allay their fears, and overcome their suspicion that we knew this information long before they
did and did nothing about it because it would affect our bottom line, will shape our relationship with our clients in the
future.
Figure 1.
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Getting started To develop vaccination protocols for your practice, start with the information guidelines provided by the AVMA and AAHA. Both
of these define core and non-core vaccines. It is also a good idea to research other available information on the subject
of vaccines (See Resources, p. 51). Good places to start include DVM Newsmagazine and Compendium. I also like to do searches
on the Veterinary Information Network (VIN). This online educational service provides an excellent way to see what your colleagues
are doing and saying about vaccinations. Board-certified specialists monitor the discussions, and the conversation can get
quite involved. Be sure to also check with the vaccine companies. If you are going to change from the labeled recommendation,
it is always wise to know if the company is going to back you to the new industry standard. Then take a good, truthful look
at your clients and what they do with their pets. Are you in a rural area with ponds and wildlife? If so, perhaps including
the leptospirosis serovars would be advantageous to your patient population. If you live in Connecticut or another area with
a high risk of Lyme disease, it would make sense that the Lyme vaccination would be a core vaccine for you. However, if your
clients are high-rise apartment dwellers, these vaccines would be on your non-core list. As a matter of fact, you might consider
a little Maltese that is treated like a cat and never leaves her apartment, even for walks, may only require vaccines every
five years instead of every three years.
Look also at your geriatric patients. Some veterinarians do not continue to vaccinate after a pet is 7 or 8 years old. Others
feel it is important to continue the vaccination series which has been established in their practice throughout a pet's older
years. When developing a vaccine protocol for these "senior" patients, I look at their activity level and travel experience.
If a dog goes camping or is a frequent participant in a dog sport, I continue their vaccines as I would for a younger dog
with the same lifestyle.
Executing your protocols
How do we implement new protocols for our patients? Both AAHA and AVMA guidelines stress that no statement will cover all
contingencies nor is only one protocol going to fit all dogs or all cats. The best interest of the patient must, as always,
be our priority.
Figure 2.
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First, all veterinarians in the practice should meet and develop a vaccination philosophy for the practice. You can accept
the core and non-core vaccines as described in the guidelines, or you can develop your own list of core and non-core vaccines
for the practice. In the areas where your list differs from the published guidelines, ensure that every doctor is in agreement
on why you are different. For instance, we decided that Bordetella is a core vaccine for our practice. We see a large number
of show, hunting and competition dogs, and many of our clients use a boarding kennel or groomer. We also see several cases
of confirmed Bordetella pneumonia every year. We felt that the benefits of the vaccine outweighed the risk. We also elected
to use an intranasal vaccine.
Clear vision Once this is completed, a meeting with your staff is next. This can be one meeting, if, as with our hospital, the doctors
and staff have been discussing the changing role of vaccines for quite some time. It may need to be several shorter meetings
if you feel that it is going to take more time for your staff to buy into the new program. In each case, the discussion with
your staff needs to be thorough, practical and written down. Find out what clients have been saying to the receptionists on
the phone. This is how I discovered that one of the reasons our reminder compliance was down was because some clients had
seen a television news report on the dangers of over vaccinating and had decided not to come in for their vaccines this year.
They didn't call us, they just ignored our reminders. We had obviously had done an inadequate job of informing our clients
of our changed protocols, and their impression was that we didn't know the "latest information." This is a not-so-small, subtle
message, which may loom large in the future when that same client has to decide whether we can be trusted to work with his/her
pet on a complicated medical or surgical case. In these meetings, veterinarians also need to listen to what your staff says
and, more importantly, watch their body language. Do they trust that you know what you are doing? Do they feel their pets
are receiving adequate vaccination coverage? Your employees are your internal clients, and if they believe in you, so will
your external clients.
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