Today's Veterinary Practice provides comprehensive information to keep every small animal practitioner up to date on companion animal medicine and surgery as well as practice building and management.
Issue link: http://todaysveterinarypractice.epubxp.com/i/561362
tvpjournal.com | september/october 2015 | Today's VeTerinary PracTice aHs HearTWorM HoTLine Peer reviewed 75 heartworm infections can be attributed to two factors: (1) lack of recommendation (not all clients are given a veterinary recommendation for heartworm prevention); and (2) compliance (not all clients follow recommendations given by veterinarians to administer heartworm preventives). This article will focus on the latter factor—the challenge of achieving client compliance with veterinary recommendations for heartworm prevention. EXPLORING COMPLIANCE compliance is defned as the consistency or accuracy with which someone follows the regimen prescribed by a physician or other medical professional. 2 Terms such as adherence, which is defned as attachment or commitment to a person, cause, or belief, have also been used to describe this behavior. regardless of terminology, when considering HWd, compliance depends upon: • acquisition (purchase) of preventive • owner or veterinarian administration of product • ensuring medication is not vomited or otherwise removed from or by the pet. The fact that lack of compliance persists as a problem in heartworm prevention is not due to a lack of options in preventives. • The first canine heartworm preventive medication, which contained diethylcarbamazine, was approved by the U.s. Food and drug administration (F da) for daily administration in 1977. • The first monthly preventive, which contained ivermectin, was launched in 1987 and ushered in an era when heartworm prevention would become convenient as well as more affordable. • Today U.s. practitioners can choose from a number of monthly oral and topical medications for dogs and cats, as well as a semi-annual injectable preventive for dogs. Furthermore, monthly heartworm preventives offer the added value of addressing multiple internal and external parasites. The aHs survey also confrmed that compliance is a major factor that infuences heartworm incidence. some veterinarians reported incidence to be rising, while others reported declining incidence (Figure). 1 • among the 21% of veterinarians who perceived a drop in heartworm incidence, 74% attributed the drop to more pet owners administering preventives, while 63% reported that more preventives were being administered on time and year-round. 1 • Meanwhile, among the 19% who perceived a rise in heartworm incidence, 61% attributed the rise to poor compliance—either not administering preventives year-round or failing to give doses on time. 1 Understanding the factors involved in compliance is the key to addressing lack of compliance (Table, page 76). COMPLIANCE BY THE NUMBERS compliance rates for heartworm prevention are not precisely known. Part of the diffculty in evaluating compliance is due to the fact that clients cannot be compliant if their veterinarians do not recommend use of heartworm preventives. in a survey of more than 4000 veterinarians conducted in early 2014 by the aHs, 1 72.4% indicated they follow the aHs guidelines for prevention, diagnosis, and treatment of HWd. Because the guidelines recommend year-round prevention in all dogs and cats, it is reasonable to assume that a majority of veterinarians are recommending heartworm prevention to at least some of their clients. in the same survey, 13.4% of veterinarians surveyed said they "never" see heartworm-positive dogs, thus, suggesting—but not proving—that routine heartworm prevention may possibly not be part of their practice recommendations. Meanwhile, compliance studies with both human and animal health medications lend insights to an understanding of heartworm compliance (see also Strategies for Compliance Success, page 77). r elate to Clients as a p et o wner Like my clients, I am a pet owner. And like them, I need to remember to give my own pets' heartworm preventives on time . Showing my clients I understand the challenges they face, while also sharing how I personally remind myself to protect my pets, is a compelling way to inspire clients to do the same. I explain to my clients that I use the stickers provided with the heartworm preventive and put them on my calendar, placing the stickers on the frst day of each month. When I administer the heartworm preventive to my own cats and dogs, I take a marker and cross through the month's sticker to show the medication has been given. As I turn over each month's new page, I see the reminder I need. Some clients like this approach; others prefer a different kind of reminder. For those clients, I recommend remindmypet.com for email or text message reminders.