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Practice Management, Practice to Practice

Promoting Parasite Prevention in Practice


Kelly Soldavin

Today's Veterinary Practice interviewed Madeleine Womble, the Hospital Manager at Central Veterinary Hospital in Knoxville, to learn about how this busy veterinary practice implements effective parasites prevention strategies for their patients.

Each interaction a veterinary team has with a pet owner is an opportunity to provide vital information about a number of wellness issues, one of the most important being parasite prevention.

However, today's world of economic hardships and Internet "dependence" has made the veterinary practice's role in promoting parasite prevention much more challenging.

  • Pet owners are looking for less expensive products—turning to sources, such as online pharmacies, for their pets' prescription fulfillment.
  • Many preventive products are now available over the counter, outside of the veterinary practice.
  • Owners are making fewer appointments to save money and missing out on important conversations about their pets' health.
  • Without a trusted resource, owners are turning to the Internet for facts on pet health; however, is this information correct?

Your approach to parasite prevention may need to change in order for pet owners to:

  1. View your practice team as a key source for information
  2. Consider your products' quality and pricing in line with competitive businesses.


Today's Veterinary Practice reached out through several sources to find someone who has helped implement practice protocols that effectively influence owners to maintain consistent, high-quality parasite prevention for their pets.

Therefore, meet Madeleine Womble—the Hospital Manager at Central Veterinary Hospital (centralvethospital.com) in Knoxville, Tennessee.

030413 p2p madeleine

Madeleine has been with CVH for 14 years, originally joining its team to help with the practice's bookkeeping. Her work grew into a managerial position, launching Madeleine into her current career.

She oversees a veterinary hospital that is open 6 days a week, with 12-hour days Monday through Friday. As her bio on the hospital's website says, "From employment opportunities to special dietary and medicating needs, Madeleine coordinates it all."


The 3 owners of the practice—Drs. Robert Black, William Martin, and Penelope Iannacone—are complemented by 3 associate veterinarians, a licensed veterinary technician, and 10 veterinary assistants who handle responsibilities, such as assisting specific veterinarians, specializing in anesthetic recovery, and caring for the kennels.

At CVH, a client relations manager heads up a 6-member team of client relation specialists who supervise client communication, including scheduling appointments, greeting pet owners, and facilitating prescription refills and check in/out.

In addition to standard veterinary care, the hospital offers hospitalization, boarding, and grooming. After hours cases are referred to an emergency clinic that is 2 miles down the road.

Clients of CVH are treated to a practice that has the personnel and capabilities to offer the best care for their pets. The question is—with so many team members and such a busy schedule, how does CVH implement effective parasite prevention strategies for their patients?


At CVH, parasite prevention begins as soon as the patient comes in the door. When the owner checks in, the client relationship specialist asks:

  • In addition to the reason for the visit, are there any other concerns the client has about his or her pet?
  • What medication or products need to be refilled (specifically parasite prevention)? These refills are then prepared and ready at check out.

If the client declines refills on parasite preventives, the specialist makes a note, alerting the veterinarian that prevention needs to be discussed during the examination.


The appointment schedule at CVH allows veterinarians ample time to talk with clients. The technician or assistant provides support by sharing their own experiences, helping clients realize that the veterinary team understands the challenges of choosing preventives, consistent administration, and budgeting cost.

Much of the conversation about parasite prevention can be covered in the patient's history. Common questions include:

  • How is the current preventive(s) working? Are there any questions or concerns?
  • Has a parasite-related disease or situation, such as a flea infestation in the home, occurred?
  • How often is the preventive administered?

With new clients, additional questions include:

  • What is the pet's preventive history—what has been used and is the pet currently receiving any preventive?
  • When was the pet's last heartworm test?


Madeleine shares, "One of the key things our veterinarians, technicians, and assistants convey to our clients is the fact that we live in an area that is highly endemic for parasites, but that they can easily be killed and repelled by preventives."

She goes on to say, "Many clients are concerned about the cost of preventives, but our team points out that cost of treatment for diseases caused by these parasites is much higher than the cost of prevention. In addition, we discuss the current challenges with obtaining adulticide, which could jeopardize treatment if the owner's pet were to become infected with heartworms."

Madeleine adds, "Thankfully, we have had no issues in securing medication for treatment of heartworm disease."


CVH's wellness testing includes blood analysis for heartworms (for cats, it's included in the test for FeLV). By including heartworm testing as part of the wellness examination, the hospital elevates the importance of parasite control, demonstrating to clients that parasite prevention is integral to wellness care.


Madeleine highlights a critical point in CVH's approach to pet owners: compromise. "We offer all prevention and treatment options to clients; then let them decide how they would like to proceed. Each pet has a customized plan developed that addresses both the pet and owner's needs."

"What we want to avoid," Madeleine says, "is making a client feel 'bad' if he or she is unable or chooses not to follow our recommendations. Instead, we make a note to revisit the topic at the next appointment, hoping that the client will decide to follow our advice then."

CVH offers a selection of 3 to 4 parasite preventives. "No one preventive works for every case. Discussing various options emphasizes that most preventives address more than one parasite and assures clients that they are making informed decisions," notes Madeleine.

With regard to heartworm disease treatment, Madeleine says, "Of the pets that test positive for heartworm infection, most are new patients. And the majority of clients choose to treat their pets."


When a client finishes an appointment at CVH:

  • The veterinary team has discussed parasite prevention, diagnostics, and/or treatment and developed a plan with the client that addresses the pet's specific needs.
  • The client relations specialist is aware of the plan and confirms the preventive chosen and the amount the client would like to purchase.

With CVH's emphasis on client compromise, the hospital works with each client to make prevention affordable. Madeleine shares, "Clients can purchase 1 dose at a time or a year's worth. While we had concerns about whether 1-dose purchasers would return regularly, we have found that these pet owners are very dedicated to buying preventive each month and keeping their pets protected, despite financial challenges that prevent purchase of a 6- or 12-month supply."

CVH also has several protocols in place to keep the hospital competitive with stores and online suppliers that offer prescription and OTC preventive products.

  • CVH's prices are competitive with pharmacies, stores, and other local clinics; this competitive pricing is enhanced by manufacturer coupons and rebates.
  • When clients request written prescriptions, client relations specialists explain the hospital's competitive pricing, and point out that CVH can often offer a better "deal" on preventives.
  • All rebates and coupons are processed in the clinic and mailed for the clients—one less thing clients have to worry about.

Madeleine says, "At the end of each day or week we print reports for the coupons/rebates collected and mail them to the manufacturers in weekly batches. Once a system is established, it's a straightforward process and one that our clients very much appreciate."


Madeleine notes that CVH's relationships with manufacturer representatives are valuable when it comes to providing employee education. "A representative who does his or her job well is always willing to help. When we need education about specific topics or products, these representatives provide this information to our team."

CVH also provides ongoing training for personnel, with parasite preventive protocols discussed on a regular basis.

For both hospital personnel and clients, Madeleine ensures that there are plenty of handouts—often provided by manufacturers for specific products—and printed materials available in the waiting and examination rooms that can be shared, discussed, and sent home with clients for further review.

The CVH website also offers several resources that help promote wellness care, including parasite prevention:

  • A Topic of the Month page provides information on a specific health topic and special incentive pricing for products or services related to it; parasite prevention is addressed at least twice a year.
  • Petly accounts (petly.com; private website that allows pet owners to directly access and manage their pets' health care) allow clients to request appointments, check wellness history, and order prescription refills.
  • Links to further information on topics of interest for pet owners are available.
The existence of these resources is highlighted on the hospital's Facebook page and monthly client newsletter.


Madeleine's thoughts on implementing a successful and effective parasite prevention program made it obvious that a process of simple steps can result in big changes.

  1. Define each team member's role in helping pet owners make the right decisions about parasite prevention for their pets.
  2. Have honest conversations with clients about what does or does not work with regard to their pets' parasite prevention.
  3. Integrate parasite testing and prevention into wellness visits, reinforcing its importance as a key to having a healthy pet.
  4. Develop a preventive program that works for each person and pet, which increases compliance and decreases the possibility a client will purchase products elsewhere.
  5. Become THE source for client questions on pet health care—pet owners should come to you and your clinic for advice rather than relying on dubious Internet information.

"Our hospital is dedicated to providing the highest quality of care for our patients," Madeleine says. "By making sure our employees share that vision, our clients are offered a full range of options for their pets' health care, and the hospital team works with clients to implement best care in light of each individual's situation."


Last year, 12.12.12 became the mantra for an initiative focused on increasing, by 12%, the number of year-round (12-month) doses of heartworm preventive sold in 2012.

Madeleine shared how the program impacted CVH: "12.12.12 reminded our team that we really should be encouraging clients to buy 12 months of preventive at a time. This recommendation was backed up by the great rebates offered by Merial—it was an incentive clients couldn't pass up."

She added, "Clients didn't always understand that year-round prevention is needed in our area. 12.12.12 helped educate our employees on this topic, which allowed them to educate our clients. The program's measurement system showed that our sales of 12-dose heartworm preventive products increased."

"The best part was finding out that the hospital was above average when compared to national statistics with regard to percentage of clients purchasing year-round prevention. I really gained a new appreciation for our team, knowing our patients were reaping the benefits of a job well done by everyone at CVH."