The Zoetis Lifelong Care Initiative: Putting the Promise into Practice

At the start of a veterinarian's career and on the day a family brings a new pet home, a promise is made to provide pets with the best possible care. The desire to help pets live long, healthy and happy lives is shared by all members of the practice team after all, our love of animals is why we went into veterinary medicine in the first place and it's also a common bond we share with our clients.

The Objective

Our goal is to keep pets healthy, with health defined as a state of physical, emotional and social well-being, not merely the absence of disease.1

Questions to Ask

While most of us believe we are providing a high level of healthcare to our patients as well as good service and value to our clients, is it possible that:

  • There's room for improvement?
  • Our patients are not receiving the quality preventive healthcare they deserve?
  • We do not have a personalized lifelong vision for the care of each pet?
  • There are communication gaps that could be causing poor client compliance with recommendations?
  • Associates and staff are not empowered to become more successful?
  • The practice is not enjoying the desired level of growth?

THE CASE FOR LIFELONG CARE

The overarching objective of the Lifelong Care initiative is to transform veterinary care from a reactive model to a healthier proactive model that shifts veterinarians from problem solving to problem preventing2 and encourages pet owners to establish healthier habits for their pets and engage with their veterinarian more frequently and meaningfully. Lifelong Care will provide the educational tools and resources to put that promise into practice.

Lifelong Care is an initiative of Zoetis providing veterinarians with educational tools and resources to help transform veterinary care to a healthier proactive model.

Lifelong Care encompasses comprehensive, ongoing veterinary care throughout a pet's life including

  • Preventive care visits
  • Diagnostics
  • Nutrition
  • Vaccination
  • Lifelong management of chronic disease
    • (e.g. osteoarthritis, diabetes mellitus, atopic dermatitis)

This approach goes beyond emergency and "routine" veterinary care to enhance the human–animal bond, resulting not only in healthier pets but also healthy families, practices and communities. This strategy of a continuum of care is supported by three distinct pillars: prevention, detection and treatment (Figure 1).

Figure 1

Evidence-based Care

To achieve the goal of Lifelong Care, the veterinary team needs to be prepared to:

  1. Embrace evidence-based practice of the most common preventive, wellness and acute-care strategies
  2. Develop care pathways to ensure the thoughtful long-term management of chronic conditions.

Hospitals should endeavor to codify best practices that are common to all veterinarians in a practice and are based on the most current standards of care (Table 1). These standards need to be periodically reviewed and updated as new evidence becomes available.

Pet owners want veterinarians to provide them with health guidelines in accordance with their pets needs that map out the

  • Timing of routine veterinary visits
  • Signs of pet illness
  • Approaches to optimize their pets health3

Adopting and implementing guidelines, protocols and evidence-based care allows the veterinary practice team to satisfy this desire of pet owners while simultaneously better meeting practice revenue requirements.4,5 As starting points:

  1. Consider what risk factors might influence the decision-making process.
  2. Evaluate which strategies should be employed for prevention, detection and treatment for an individual pet.

THE EVIDENCE FOR LIFELONG CARE

Prevent

Preventive medicine is a core competency of the veterinary profession. Our major preventive strategies include

  • Vaccination
  • Screening for early indicators of disease
  • Parasite control
  • Optimal nutrition and physical activity for each life stage
  • Behavior counseling
  • Sensible exercise programs
  • Breeding recommendations (to help prevent heritable conditions)
  • Optimal spay/neuter timing
  • Oral hygiene
  • Counseling on pet selection to minimize the risk that a pet will later be relinquished to a shelter, abandoned or euthanized for non-medical reasons6)

Two Common Obstacles to Preventive Healthcare

  1. Currently, many pet owners only associate the need to see a veterinarian with vaccination or for serious illness.
    1. Only 32% of pet owners surveyed are fully convinced that routine examinations are necessary.
    2. Some 36% take their pets to a veterinarian only for vaccinations.3

This data points to a larger underlying issue in the overall decade-long decline in veterinary visits7 the failure to grasp the true value of preventive medicine and regular lifelong care.

  1. Another troubling trend is a belief held by many pet owners and some veterinarians that certain preventive practices may be inherently risky or unsafe.8 For example, some pet owners express the concern that veterinarians have been overvaccinating their pets without good evidence to support more frequent vaccination.8
    1. Vaccination is associated with minimal risk and should be part of routine preventive healthcare.4,9 Two studies with substantial data sets have convincingly demonstrated that the actual occurrence of adverse events following routine vaccination is, in fact, very low, at 0.48% in cats10 and 0.38% in dogs.11
    2. In fact, there is evidence that pets routinely brought to veterinary clinics for vaccinations tend to be in better health than those that are not.9

Adoption of existing vaccine guidelines (Table 1) may further decrease any potential adverse events associated with vaccination.12,13

Consequences of Neglecting Preventive Healthcare

Zoonotic parasitism: Each year, despite the availability of highly effective parasiticides and treatments, thousands of cases of parasitism are still diagnosed, with many more not identified or reported. Fleas, ticks and parasites, while commonly seen as a "nuisance" to the pet, can also transmit diseases between pets and people.14

Heartworm disease: Heartworm infection is certainly not a new threat and yet, despite recommendations from experts (Table 1) including the American Heartworm Society and Companion Animal Parasite Council, roughly half of the more than 78 million dogs in the U.S.15 and an even higher percentage of cats still fail to receive appropriate prophylactic medications for this entirely preventable infection.14

Conclusion

Year-round protection encompassing both internal and external parasite control is now recommended for all dogs and cats.17 From a cost perspective, preventing the problem is always less expensive than treating a parasite infection or infestation.

Detection

The second pillar of Lifelong Care is the early detection of a disease or disorder while the condition is still subclinical and the pet is "well." Key components of detection include

  1. Comprehensive history
  2. Physical examination
  3. Appropriate periodic diagnostic

Diagnostic screening might also include genotypic (e.g., DNA) and phenotypic testing (e.g., radiographic assessment for hip dysplasia or other actual physical expression) for heritable medical issues.18 A good patient history is important not only as a diagnostic tool, but also to discern the clients needs and expectations.

The Importance of Routine Diagnostic Screening Tests

  1. For Older Animals

    Presently, veterinarians recommend routine diagnostic screening tests for the health or wellness of older animals.19

    • In one study, a previously unrecognized problem was identified in 80% of senior dogs (see sidebar).20
    • A second study found a new diagnosis attributable to routine screening blood analysis in 30% of senior dogs tested.21
    • Polzin et al reported that chronic kidney disease was present in about 20% of dogs between 7 and 10 years of age, increasing to 45% in dogs older than 10 years of age.22
    • A recent study in cats23 (see sidebar) showed that, despite being apparently healthy, middle-aged and older cats can often have abnormalities found through physical examination or laboratory tests that might benefit from veterinary intervention and monitoring.

  2. For Younger Animals
    These findings underscore the need for routine health examinations in younger as well as older animals.
    • In 7,827 adult dogs—the majority aged 2 to 11 years—from across the U.S. that presented for a routine wellness visit, screening tests uncovered anomalies warranting further investigation in 31% of cases (Pet Wellness Report, Zoetis, data on file).

Conclusion

Diagnostic screening tests also can provide baseline values and facilitate long-term monitoring to establish trends that may help to identify subclinical disease. Without early detection and management, many of these conditions can lead to a significant decrease in a pet's quality of life.24 In addition, results in the normal range can reassure pet owners that their pet is healthy, providing peace of mind.

Treatment

The third component of Lifelong Care centers on the medical management of conditions.

  • Early therapeutic intervention has been shown to offer the best chance of successful long-term management of many conditions such as kidney failure or cardiac disease.25,26
  • Clearly distinguishing between curing a medical condition and long-term management is important when discussing the many benefits of intervention with pet owners.
  • One component of health management is the systematic and organized approach to providing care for such chronic conditions as osteoarthritis, atopic dermatitis and diabetes mellitus, to name a few.27

The Benefits of Early Intervention and Lifelong Care

If the veterinarian has not communicated the benefits of Lifelong Care nor established an ongoing relationship with the pet and owner, care may not be sought until late in the course of a disease.

A 2011 survey indicated that

  1. Only 36% of dog owners and 28% of cat owners would take their pet to a veterinarian for management of existing disease.25
  2. Among surveyed cat owners, 55% were unaware that cats could have subclinical kidney disease.
    1. When cats are diagnosed with kidney disease in its early stages, they often live for a further 2-3 years with appropriate management.
    2. Those diagnosed in later stages often live less than 6 months after diagnosis.25

Early intervention in primary conditions can also reduce the risks of secondary problems.

  • Periodontal disease is among the most common conditions affecting dogs and cats, yet it is often ignored by pet owners or under-treated by veterinarians.
  • A recent large study demonstrated that the likelihood of kidney and cardiac diseases increased over time with an increasing severity of periodontal disease.25,26
  • Furthermore, when existing periodontal disease was treated, the risk of life-threatening kidney failure in dogs was reduced by 23%.27

These findings highlight the value of routine oral health exams by veterinarians and early intervention to correct underlying dental problems.

In addition, prevention, detection and treatment of pain should be provided to all patients.

This process is likely to improve

  • Patient quality of life
  • Pet owner satisfaction
  • Perceived value of veterinary care

And decrease

  • Patient stress
  • Recovery time
  • Potential for exacerbation of comorbidities

Quality of Life in Veterinary Medicine

Measurement of quality of life in veterinary medicine has until recently been based on subjective findings, with behavior change the most common and consistent indicator.28 Validated quality of life surveys may be of particular use in evaluating the impact of early interventions on the quality of life of veterinary patients.29

PUTTING THE PROMISE INTO PRACTICE:
FUNDAMENTAL DRIVERS OF LIFELONG CARE

To facilitate the adoption of Lifelong Care in practice, veterinarians need to understand the major "drivers" of pet owner engagement in the process:

  • The Human–Animal bond
  • Communication skills
  • Value
  • Customer service
  • High level of clinical competence

The Human–Animal Bond

Companion animal relationships provide consistent, reliable bonds and facilitate transition through an individual's or a family's life changes. In addition, the tangible health benefits that pets provide their human companions continue to be elucidated.30,31

Regardless of a pet's ascribed role in a household,32 its presence can provide human health benefits such as decreasing stress and pain, improving cardiovascular and psychosocial health and providing a nurturing environment for children.

Benefits of Integrating the Human–Animal Bond

The veterinary healthcare team is in a privileged and unique position to help pet owners optimize and lengthen their relationships with their pets through the provision of enhanced lifelong care. Clinics that have successfully integrated consideration of the human–animal bond into their day-to-day procedures recognize multiple benefits to the practice.33,35

  1. First, because of the trust and rapport that exist between veterinarians and highly bonded clients, those clients are more likely to accept veterinary recommendations—that is, they are more likely to believe that the veterinarian will recommend only interventions that the pet needs without attempting to "sell" them unnecessary products or services.36
  2. Second, pet owners who are highly bonded to the practice are far more loyal than owners who are not.36
  3. Finally, individuals who work in practices that successfully incorporate the human–animal bond tend to have excellent communication skills, which facilitate the conversation team members must have about the value of recommended diagnostics and treatments.36

Veterinarian–Client Communication

Communication skills are vital to:

  • Building healthy veterinarian–client relationships
  • Enhancing client satisfaction and compliance with recommendations
  • Improving patient medical outcomes

Two Ways to Improve Communication Skills

Fortunately, communication skills are eminently teachable.37,38 This fact is often overlooked as "communication" is frequently considered as a single, broad construct attributable to an innate quality of personality trait rather than a defined skill set. In fact, specific communication skills can be learned and implemented with great success.35,36

  1. Appropriate training programs and workshops, such as the frank Communication Series (see sidebar), can improve the communication skills of all veterinary practice staff.
  2. Online tools, such as the Pet Wellness Report® (see sidebar), can help enhance communication among the veterinarian, clinic staff and pet owners.

Although the importance of communication skills in veterinary medicine remains an emerging topic, considerable evidence indicates that communication skills are critical to successful patient and practice outcomes:

  • Utilizing key communication skills such as open-ended rather than close-ended questions and reflective listening has been shown to elicit valuable medical information from owners, including key diagnostic clues that most likely would not have been revealed in response to basic yes/no questions.20,39,40
  • Gaining a clear understanding of the client's expectations has been shown to inform the veterinary team and shape its ability to meet or even exceed them.37,41,42
  • Good communication skills drive the perception of value and increase the likelihood that a client will follow a veterinarian's recommendations. Being able to effectively communicate the reason for the recommendation and the potential outcomes and risks is a very important component in soliciting owner compliance.3,43-45
  • The appropriate use and recognition of nonverbal messages and the expression of empathy36 are skills that are vital to building an effective veterinarian owner relationship. Following a relationship-centered approach, client input should be used in the decision-making process to determine a patient's care.37
  • While veterinarians may often be focused on explanations of disease states and the value of their services, clients want explanations focused specifically around what it means for the health and well-being of their pet.46 Information should be provided in small portions and the veterinarian should frequently check the owner's comprehension.37

Value

Veterinarians should clearly communicate their lifelong care strategies so pet owners can better appreciate the actual expenses they are likely to encounter. The safety nets in place for human healthcare do not exist for pets, so veterinarians must find ways to help make pet healthcare affordable and more predictable. Having this discussion with pet owners helps them plan for the cost of future care.

Why Perceived Value is Critical

Clients may have difficulty comparing practices on the basis of medical expertise, but they can readily differentiate on the basis of customer service and perceived value delivery. In fact, how clients perceive the value of the services and products they receive is often the more important differentiator and affects their acceptance of:

  • Medical recommendations
  • Purchasing behavior
  • Treatment compliance
  • Adherence47,48

Learning how to enhance the clients perception of value for a product or service may require a shift in thinking.

  • Explaining why purchasing a veterinary-prescribed and -labeled branded medication at the clinic is worth the additional price over a generic, non-veterinary-branded substitute purchased at a retailer helps to enhance the perceived value of the in-clinic purchase.
  • Being able to explain that all ovariohysterectomies are not necessarily performed with the same perioperative care and pain management reinforces the value of having the surgery done at your veterinary hospital. This is value delivery.

Communicating the Value of Lifelong Care

The affordability of veterinary care is important because cost can be a limiting factor; therefore veterinarians need to communicate the value of lifelong care.

When owners have not planned for veterinary expenditures, they sometimes have difficulty coming up with the funds needed. In many cases this apparent obstacle to appropriate care can be overcome.

  1. Collaborative discussion between the veterinarian and pet owner is essential.
  2. With a lifelong "maintenance schedule" for their pets, owners can take a more strategic view on setting aside money to cover such anticipated expenses.
  3. Owners also need to be counseled about the unanticipated expenses that might occur (e.g., injuries, visits to emergency clinics and specialists) so they can plan for those as well.

Risk Management Strategies

The safety nets in place for human healthcare do not exist for pets so veterinarians must find ways to help make pet healthcare affordable and more predictable.

A number of risk management strategies can also help to keep veterinary care affordable:

  1. Save money for this purpose
  2. Manage the risk in some other way.

The safety nets in place for human healthcare do not exist for pets so veterinarians must find ways to help make pet healthcare affordable and more predictable.

A number of risk management strategies can also be employed to keep veterinary care affordable:

  1. 1. Pet insurance is an excellent way for clients to plan for unanticipated veterinary expenditures.
    • Research has shown that clients with insurance scheduled 40% more veterinary visits and spent twice as much on veterinary care over the life of their pet.50
  1. With wellness or payment plans, services are often bundled and paid for over a period of time, typically one year.
    • These plans may include multiple visits and even discounts to encourage clients to participate.
    • Such plans need to be designed and closely monitored to ensure that they are actually profitable for practices.51
  1. Third-party payment plans (e.g., CareCredit) can also help to make veterinary care more affordable.
    • In one study, 71% of cardholders using third-party payment said having a financing option positively affected their decisions regarding the level of treatment they provided their pets.52

Differentiate Your Clinic with Customer Service

Today's clients expect those working in a veterinary clinic to be both competent and kind. A differentiated experience, which is defined as a systematic approach to interacting with clients that consistently builds loyalty, is possible when service is:

  • Competent
  • Courteous
  • Compassionate

Loyal clients return and refer.53

The Objective of Customer Service

The objective of improving client service should be "client-centered patient advocacy to extend and enhance the quality and duration of an animal's life," which involves setting service expectations and standards of behavior for every member of the practice staff.54

  1. Ensuring that every client has a memorable experience requires empathetic employees who believe their work and a focus on wellness both matter.
  2. Outstanding service (competence + courtesy + compassion) fosters loyal, referring customers and healthier hospital revenues.55
  3. Furthermore, these subtle indicators of quality are an important differentiator for pet owners in choosing among practices.56

Outstanding service (competence + courtesy + compassion) fosters loyal, referring customers and healthier hospital revenues.55

IMPLEMENTING LIFELONG CARE IN PRACTICE:

THE NEXT STEP

Recognition of the need to redefine a veterinarian's role from that of a problem solver to problem preventer is growing.2 Refocusing on disease prevention and early detection will reintroduce pet owners to the idea that veterinary practices should be their primary destination for all aspects of their pet's healthcare throughout its life.

Through initiatives such as Partners for Healthy Pets, leading animal health organizations are working to broaden the current concept of preventive healthcare to include

  • Nutrition
  • Dental care
  • Behavior
  • Pain assessment
  • Life-stage management
  • Vaccinations
  • Parasite control

Effectively installing this "lifelong care" approach through a personalized, proactive continuum of care leads to increased pet-owner satisfaction, compliance and service utilization, allowing veterinary practices to grow in step with their customers (the "healthy pet, healthy practice" philosophy).2,57

The Partners for Healthy Pets Resources Toolbox

The online Partners for Healthy Pets Practice Resources Toolbox (see sidebar) provides access to a number of practical resources to assist with refocusing a practice on disease prevention and early detection.

The Toolbox has a number of resources to help build communication skills in this regard by:

  1. Communicating the value and importance of the lifelong care concept to pet owners
  2. Highlighting the central role veterinarians and their staff play in enhancing the human–animal bond

If you are interested in discovering potential areas for improvement within your practice, the Opportunity survey developed by Partners for Healthy Pets (see sidebar) is a very practical way to identify gaps in how the veterinary team communicates the importance and value of preventive care; it serves as a great starting point for putting lifelong care into practice.

CONCLUSION

In the face of a decade-long trend of declining pet owner utilization of veterinary services,6 veterinarians now realize the need to shift the focus of veterinary care away from the traditional "reactive care" model to a proactive "lifelong care" approach.

A key step on the road to lifelong care is creating a sense of urgency about and advocating for the benefits of the fundamental principles of lifelong care—prevention, detection and treatment—to bring about the necessary behavior changes on the part of both the veterinary healthcare team and pet owners.

References

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