Heartworm prevention: The reminder quagmire
While the American Heartworm Society (AHS) recommends that pets be protected from heartworms year-round, spring is the season when heartworm checks tend to be top of mind for both veterinarians and pet owners. It follows that spring is also when troubling questions about heartworm tend to surface.
Thus, a series of Q&As with AHS board members Tom Nelson, DVM; Clarke Atkins, DVM, DACVIM; and Matt Miller, DVM, MS, DACVIM, that address three questions that commonly vex veterinarians. First up, Dr. Nelson addresses the importance of reminders.
Q. Do heartworm reminders matter?
A. Years ago when the six-month injectable heartworm preventive was introduced, I created an automatic reminder system for owners to bring their dogs in for injections. That prompted one of my technicians to ask a very good question: Why don’t we have a reminder system for clients who give monthly preventives? So we created one for those clients, too.
When I give talks to veterinarians and ask them how many send reminders for heartworm tests, more than 80 percent raise their hands. But when I ask how many send reminders about giving preventives, only 20 to 25 percent do so. If we consider what a challenge heartworm compliance presents for our clients, it’s clear this needs to change.
Issue 1: Getting a preventive on board in the first place
Studies have consistently borne out that less than half of owners whose dogs receive veterinary care give preventives. In the south and southeast, where heartworm disease is very common, percentages range from 42 to 45 percent. In the far west, only 18 percent of owners give preventives, in spite of the fact that roundworm incidence is actually much higher in the west than the southeast—and most heartworm preventives protect against roundworms as well as heartworms. The midwest and northeast fall somewhere in between, with roughly 38 percent of owners giving preventives.1 My practice in Alabama is no exception. In spite of my conviction that heartworm prevention is vital, more than half of the dogs in my practice leave the veterinary office without their owners’ purchasing heartworm preventives.
Issue 2: Giving a preventive reliably and year-round
When you make reminder calls to pet owners about refills, what do they usually say? “I still have medication left.” Giving preventives on time, every time, isn’t happening enough of the time. Sadly, I’ve been guilty of this myself. In the 1980s, when we only had daily heartworm preventives, I was extremely compliant with my two Labradors—each had their pill every morning when I fed them. However, a year after I switched to a monthly medication in the late 90s, my own dog turned up positive for heartworm disease. I couldn’t believe it. But when I looked at the medication I had been using, I had only given nine of the 12 pills. Unfortunately, this is what happens with our clients, too.
Just jog their memory
As veterinarians, we tend to be sensitive about making recommendations that cost our clients money. However, research on heartworm compliance tells us that cost is not the barrier—it’s simple forgetfulness. That’s why communication is key. Back in 2001, when my practice started sending routine reminders about monthly preventives, we saw a 33 percent increase in our monthly preventive sales. Refill reminders work because they can help overcome the obstacle of forgetfulness.
Fortunately, reminding clients to give heartworm preventives has never been easier. It’s not like the old days when we had to send hand-written postcards—we can readily set up email or text reminders, and both veterinary companies and associations have programs to help us. So take the time, and help your clients be compliant. Heartworms are easy to prevent, but difficult to treat.
1. Data on file, Zoetis. Vetinsite Analytics, 9/2013.
This question and others are the focus of a new series of 15-minute recorded talks designed to offer practical information on heartworm prevention, diagnosis and treatment. The “Eye on Heartworm” videos, which are made available by the AHS, can be found at https://www.heartwormsociety.org/veterinary-resources/veterinary-education/videos.