Role of practice health care plans in pet parasite control

Many veterinary practices offer clients the option of joining a health care plan, where an owner pays a monthly fee or, in some cases, a total yearly sum for routine veterinary treatments selected by the practice.

These are typically vaccinations, microchipping and parasiticides with other services added in. These plans have overall benefits to veterinary practices, therefore making them popular.

• Spreading the cost of preventive and routine health care – the rising cost of living is making pet health care more difficult to afford for many clients, which means vital preventive treatments, such as vaccines and parasiticides, may be missed. Pet health care plans allow the costs of these treatments to be spread out evenly throughout the year with the option to provide an overall discount. It also means that if clients can be persuaded of the overall value of the plan, all preventive treatments that are seen by the practice as valuable to that client’s pets can be included. Many aspects of long-term health care, such as urinalysis, parasite screening and even the cost of consults as a whole, can also be included. They can be varied by age, infection and disease susceptibility, and other lifestyle factors, offering the best preventive care for pets and their owners. A pet health plan provides clients a simple package and predictable expense for preventive care they can budget for.
• Bringing health advice and sales back into practice – a large percentage of preventive products are still bought outside of veterinary practices. This not only leads to loss of revenue, but also means that pet owners may not receive good preventive care advice. This is particularly true of parasiticides, where flea products may be bought, but if clients do not use them at the correct frequency, a loss of flea control may result. If fipronil or imidacloprid products are bought with inadequate advice, it may lead to them being washed off, which will lead to both loss of flea control and potential environmental contamination. Offering a package that includes a wide range of veterinary services for an affordable monthly fee will bring sales of pet products and services into the practice that could be purchased elsewhere.
• Client bonding – preventive health care plans help to bond clients to the practice by providing essential services for a regular fee. They can also be tailored to offer services that will be appreciated by pet owners in the local area or be made bespoke for an individual. This may involve more diagnostic screening on the plan, more consults or other physical services, such as nail clipping. Clients will be more likely to be bonded if they feel an ongoing pet health care plan service caters to their pet’s individual needs.

Practice health plans, however, have recently come under fire for encouraging the use of broad spectrum parasiticides and “blanket” routine use.

By including routine flea, worm and tick treatment in a plan, the temptation exists for simplicity of message, stock management and administration to treat all pets for all of these parasites. This approach will potentially lead to over-treatment and possible increased environmental contamination.

It can also reduce owner compliance and credibility for the veterinary practice, as a risk exists that blanket treatment of all cats and dogs leads to veterinary advice being seen as irrelevant as the same advice is always given.

This, in turn, can lead to the advice being seen as sales and profit driven rather than evidence based.

Routine parasite treatment should, therefore, be advised on the basis of evidence and risk. The question then becomes “are practice health plans and a risk-based approach to parasite control compatible?”

For practice plans to be used as part of a risk-based approach for parasite control, three main areas need to be considered. These are geographic and lifestyle risk, compliance and the role of endectocides.

Geographic and lifestyle risk

Risk-based parasite control programmes allow bespoke advice to be formulated based on regional risk and lifestyle of the pet.

Some parasites with disease and zoonotic potential are ubiquitous, and exposure is practically impossible to avoid.

For UK cats and dogs, this is true of Toxocara and cat fleas. Toxocara worms are transmitted primarily by transplacental and transmammary routes, and as a result, shielded from environmental changes. Environmental contamination with Toxocara eggs, with the potential for zoonotic exposure, has also been demonstrated to be present in public parks across the UK (Airs et al, 2022). Similarly, pets have been found to be infested with cat fleas throughout Britain, with no significant risk factors identified for exposure (Abdullah et al, 2019).

Fleas are able to survive year-round in centrally heated homes and milder winter temperatures, such as those recently seen in the UK, meaning that outdoor life stages can also continue to survive and develop.

Household infestations may establish through the winter through the mechanical transmission of newly emerged adults into the home. Even households with purely indoor cats may be infested due to owners triggering outdoor pupal emergence through their heat and movement, and then bringing newly emerged adults inside on clothing. Once inside, these adults can feed on indoor cats and infestation can be established.

In a similar fashion, cats visiting multiple households may be infested by newly emerged adults outdoors and then bring them indoors into a number of different homes. Year-round prevention is, therefore, required as without it, a significant risk exists of flea infestations establishing (Coles and Dryden, 2014).

Prevention is essential to prevent owner irritation, flea allergic dermatitis in pets and the risk of zoonotic pathogen exposure in owners, including Bartonella henselae and Rickettsia felis.

For these reasons and the zoonotic risk they represent, regular treatment for Toxocara and fleas is essential, and should form the basis of all cat and dog parasite control programmes. Practice health plans provide the opportunity to offer year-round flea and Toxocara treatment in an affordable way as part of an overall health plan. Other parasite prevention is risk assessed on the basis of lifestyle and geographical distribution. Parasites to consider in the UK would include ticks (Ixodes species and Dermacentor reticulatus), tapeworm (Dipylidium caninum, Taenia species and Echinococcus granulosus) and lungworm (Angiostrongylus vasorum).

A vasorum has a highly variable distribution across the UK, with highly endemic local foci sometimes in close proximity to areas where the parasite is absent. E granulosus is also known to be present in endemic foci in Wales and the Western Isles of Scotland, as well as other possible foci in England and mainland Scotland. Ixodes ticks are present across the UK, but with areas of higher density (Abdullah et al, 2016). This means the risk of exposure to all of these parasites has a geographic component.

This risk can be assessed from national distribution maps, testing pets with relevant clinical signs and routine screening for parasites.

Geographic risk for most pets registered at a practice will be the same and these risks should be considered when selecting the main products to be used in a practice health plan. In doing this, geographic risk can be considered and still incorporated into practice health plans.

Lifestyle risk factors will also influence tapeworm, lungworm and tick exposure risk for individual pets, as well as the frequency at which Toxocara preventive treatment will be required.

These lifestyle factors, such as being on raw unprocessed diets, being off lead, living with young children, walking in tall grass or pasture, and the consumption of slugs, can be assessed in a number of ways. These include medical records, clinical examination and lifestyle information from the client. Some risk factors will be common for a majority of pets registered at the practice, such as being in a rural area, or having a large proportion of breeders, families, farmers or working dogs registered at the practice.

Some plan flexibility will be required, though, to incorporate lifestyle risks.

Most pets’ needs, however, can be covered by the use of a small range of products. For pets whose risks are very specific and unusual for the local area, most specific products can be ordered into practices very quickly and this should not be a barrier to practice health plan use.

The author has two or three main plan options for cats and dogs at the practice, but plans can be tailored with any product within reason at no extra cost.

Compliance

Asking questions surrounding lifestyle and owner preferences will also help to maximise compliance – and, therefore, the effectiveness – of any recommended treatment.

Having established which parasites the pet requires preventive treatment for, factors affecting owner compliance or efficacy of the product also need to be considered. Whether pets are shampooed or frequently swim are important points to assess, as they will affect the efficacy of some products and may lead to increased environmental contamination.

Owner preference for tablet, collar or spot-on is also hugely important. The owner may feel more able to apply some forms of medication than others. Offering just two or more options on a practice health plan brings in flexibility in terms of choice of mode of application for clients.

If bespoke parasite plans are carried out, then specific products may need to be ordered in to meet pet needs, but this has the potential to increase client bonding within a practice health plan setup.

Including endectocides on the plan

In a similar way to practice plans, endectocides can be viewed as inevitably leading to over-treatment.

This is true if the parasite control needs of a patient are limited to one or two parasites, but where multiple parasite control is required, endectocides provide an opportunity to limit the number of products clients need to administer. This increases compliance and reduces cost.

In practices where local geographic risk is high for a wide range of parasites, then endectocides are an invaluable product to improve compliance and affordability on a practice health plan.

Incorporating routine parasite testing into a practice health plan

Routine faecal testing for intestinal parasites can also be incorporated into a plan, either annually alongside treatment to monitor efficacy or quarterly/monthly as an alternative to treatment.

If the latter is offered, owners must be made aware that zoonotic shedding of Toxocara eggs may still occur in between treatments. This is a great way to introduce the concept of routine testing to clients in an affordable way.

Testing for other parasites such as Borrelia burgdorferi and A vasorum can also be introduced as a means of monitoring both exposure, and the efficacy of preventive tick and A vasorum treatments, as well as assessing local prevalence.

Conclusion

Risk assessment is essential to ensure parasiticides are not overused and the risk of adverse events occurring as a result is minimised, while also ensuring pet and human health is maintained.

Practice health plans are tools that can be used as part of a risk-based parasite control programme. Inflexible health plans will lead to inappropriate treatment for some pets, as one plan does not fit all.

With some flexibility, however, health plans can be used to implement parasite preventive treatments on the basis of risk assessment, making them more affordable and increasing compliance.

They also offer a unique opportunity to introduce routine parasite screening in an affordable way, which is essential if information is to be obtained on which geographic risk assessments are made.