Human Nature and Preventatives Compliance

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Compliance on preventatives ultimately boils down to a people problem – human behavior.

There is a simple solution to heartworm disease. It is 100% preventable. But, judging by the most recent data, it’s still a challenge.

There was a reported 21% increase in the average number of cases of canine heartworm disease per veterinary clinic that was recognized between 2013-2016, according to research.1 “That’s a significant increase occurring, but only 1 out of 3 dogs actually were prescribed heartworm preventatives nationally during that time period, and of those, they only received about 8 and a half months of product pet year,” said Daniel Edge, DVM, MBA, MSc, director of medical affairs at Zoetis Petcare (a U.S. business unit of Zoetis), citing industry studies.


In a 2017 market research study, on average, 34% of pet owners left a practice after their wellness exam with a heartworm preventative. And 66% left with nothing at all.

“So, there is an increase of incidence in heartworm disease, yet we’re not doing a good enough job of getting pet owners to actually purchase and administer the products that can prevent it at home,” said Dr. Edge.

Veterinary Advantage spoke with Edge about the challenges – and opportunities – presented in addressing compliance among pet owners.

Veterinary Advantage: The science on preventative products coming out has never been better. How do you build a brand with a pet owner in today’s marketplace?

Dr. Daniel Edge: We spend a lot of effort in communicating with pet owners so that they know they’re being appreciated, and so we can better understand what obstacles they have. I’m a pet owner, and none of us are perfect. There are days that we have the best of intentions to do what we need to do in our lives and for our pets, but it doesn’t always happen. Our profession has very solid science regarding heartworm disease and practitioners have access to safe and effective products, but at the end of the day, there’s still a reliance on prescribing by a veterinarian and compliance by the pet owner. So we have to understand their obstacles and their struggles to be able to fit their needs.

Veterinary Advantage: How much of compliance involves the psychological component, i.e. consumer behaviors?

Dr. Edge: Compliance is a human behavior issue. It’s human nature.

For instance, when it comes to a person who has been diagnosed with a disease as devastating as HIV, you think you would take care of yourself and take whatever medication you’d need on a daily basis. However, in a compliance study2 of patients who had HIV taking their medication, only 60% of that patient population was 80% compliant. So you’re not getting to 100% compliance with that.

When it comes to parents, even in that regard people tend to not always be compliant. In a study3 of children who had acute ear infections, only 7.3% of the parents were compliant giving the medication that was prescribed for the full regimen of antibiotic therapy. That’s startling. You’d think you would do the best for yourself and the best for your children.

I have an even more extreme scenario. Over the course of recent history there have been anthrax scares at the postal service from packages mailed to political figures. There was a 2002 study4 evaluating adherence among postal workers taking medication for post exposure to anthrax. Anthrax is a deadly disease. You can die from it in a matter of days. Of those postal workers surveyed (N=245), only 40% were 100% adherent. And that’s after being told directly, “You could die if you don’t take it.”

Compliance is a behavioral issue when it comes down to it. It’s a human nature problem that we’re trying to solve.

Veterinary Advantage: What are some of the best practices of doing compliance well?

Dr. Edge: What we’ve spent our effort on, and been successful with, is taking the problem out of the hands of the pet owner. I’m a veterinarian. But if I’m giving an antibiotic to my dog three times a day for seven days, I know it’s going to be difficult even for me to meet that standard for compliance.

Zoetis has addressed the limitation of human behavior in clients with innovation in the products we bring to the market. Examples of that include ProHeart® 6 and ProHeart® 12, which are injectable heartworm preventatives. We also have Convenia®, which is an injectable antibiotic, and Cytopoint™, which is a monoclonal antibody therapy licensed to help provide sustained control of the clinical signs associated with allergic dermatitis and atopic dermatitis in dogs.

The practice is able to administer these products almost as a one-and-done service. The owner doesn’t need to worry about it at home any longer, and when their time is due for the next medical evaluation and interval of that medication, then there are programs in practice for reminder systems and things like that to get the client back in for the pet’s next dose.

Veterinary Advantage: How does Zoetis help equip veterinary practices to promote and increase compliance among its client base?

Dr. Edge: Two things. We have a reminder system, and we incentivize the owners to come back in. Owners can be placed within the Zoetis Petcare pet medication reminder system, and when a product is due for a refill, an email or text is automatically generated and sent to them.

Specific to Cytopoint, we have a program called Cytopointments, where pet owners will get a reminder of when their pet’s next appointment to get their treatment is.

Beyond those reminder systems, we have an incentive program for pet owners called Zoetis Petcare Rewards (zoetispetcare.com/rewards). It’s a comprehensive loyalty program across a range of our products that allows members to earn rewards on their purchases. For example, if an enrolled client were to purchase one of the eligible Zoetis products, they would receive points that they could convert into monetary credits on their Zoetis Petcare Rewards Mastercard that could then be used in a veterinary practice.

The cool thing for the veterinary practice is the money earned on the cards is only able to be used in their practice. The client can’t go to Walmart, Target or an online retailer to use it. It brings money back into that practice, so it encourages them to promote membership enrollment to their clients. For the pet owners, it’s money they can spend toward any purchase at the practice. For example, if you get $15-$25 of credit based on your purchases, you can use that toward your next refill of product or toward an exam fee, vaccines, prescription diets and more.

Veterinary Advantage: What role do distributor reps play in helping to increase compliance?

Dr. Edge: In my experience, distributor reps tend to have close relationships with their veterinary practice customers. They tend to be long-term representatives of their companies, so they have those deep ties to the veterinary practices.

Because distributor reps are frequently at the practices, they can present the market research and studies on how pet owners don’t always do what they should in regard to compliance, and even when they say they’re going to do something, pet owners don’t always follow through in terms of actually giving the medication at home. Or maybe the pet owners buy one dose and don’t come back for the rest of the year. Helping the practice understand opportunities to approach compliance through innovative products and programs is a great asset.

Another opportunity is for distributor reps to look at and discuss the practice’s own data set to promote and increase compliance. One of our largest advocates for ProHeart loves the product, and his clients love the product. He did his own compliance survey within his own data set. He looked at his practice and the clients that came in for ProHeart 6 injections. After the initial injection, they should have come back within the next 5-7 months for their second injection. Even in the practice of this recognized expert on heartworm disease, about half of his clients didn’t return in time for that second dose. So even in a practice that’s doing an amazing job, a distributor rep could encourage them to look at their data. Your local Zoetis sales representative can partner with you to run a Parasiticides Compliance Report to assist in this conversation. Sometimes the pushback we get is, “Maybe the heartworm prevalence is true two counties over or in the next state, but I know my practice.” It’s important to get the practice to look at their own data set and come to their own conclusions. Guiding the practice to understand the compliance challenges they face opens the door to discussing opportunities and available strategies to help improve both the health of patients as well as the practice business experience.

1 Increasing incidence of Dirofilaria immitis in dogs in USA with focus on the southeast region 2013-2016; Jason Drake and Scott Wiseman. Parasites & Vectors (2018) 11:39 DO1 10.1186/s 13071-018-2631-0

2 N. Singh C. Squier, C. Sivek, M. Wagener, M. Hong Nguyen & V. L. Yu.  Determinants of compliance with antiretroviral therapy in patients with human immunodeficiency virus: prospective assessment with implications for enhancing compliance. AIDS Care. 1996 Jun;8(3):261-9

3 M.D. Mary E. Mattar, M.D. James Markello, M.D. Sumner J. Yaffe.  Inadequacies in the pharmacologic management of ambulatory children.  The Journal of Pediatrics July 1975 Volume 87, Issue 1, Pages 137–141.

4 Mariaelena D. Jefferds,* Kayla Laserson,* Alicia M. Fry,* Sharon Roy,* James Hayslett,* Laurence Grummer-Strawn,* Laura Kettel-Khan,* Anne Schuchat,* and selected members of the Centers for Disease Control and Prevention Anthrax Adherence Team.  Emerging Infectious Disease 2002 Oct; 8(10): 1138–1144.

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