Originally published in the May 2014 issue of Veterinary Practice News Did you know that a pet owner who buys diets from your veterinary hospital returns an average of eight times during the year? In addition to healthy food sales, those eight visits give you opportunities to improve compliance for professional services and products. When your client service representative rings up today’s food purchase, she should check the status of all pets in the family in your practice-management software. Let’s say your employee discovers a second dog is overdue for care. Tell the client, "Let me get Mason’s therapeutic diet for joint care. Did you know that your dog, Rocky, is overdue for preventive care? He needs a preventive care exam, vaccines, heartworm/tick screen, intestinal parasite screen and preventives. Let’s schedule an exam to get Rocky up to date. Which day of the week works best for you? Do you prefer a morning or afternoon appointment?" Once the client responds with a preference, offer two choices. Known as the two-yes-options technique, this phrasing significantly increases the chance you’ll schedule the appointment. Say, "When would you like to schedule Rocky's exam? We have an appointment at 9 a.m. Tuesday or 3 p.m. Wednesday. Which fits your schedule?" Besides updating professional services, your front-office staff may discover product sales opportunities. When she checks recent purchase history in your practice-management software, the client service representative sees that the client is running low on preventives. Say, "Let me get your dental diet for your cat, Opus. I also see that you have one dose left of his preventives. Would you like to refill six or 12 months today?" This phrasing also uses the two-yes-options technique and is stronger than “Do you want to refill his prescription today?” By viewing the product purchase history, your receptionist increased compliance for preventives and ensured continual protection for this patient. Food Callbacks Therapeutic diets can be key to successful long-term management of diseases. According to the American Animal Hospital Association (AAHA) 2003 compliance study, less than 20 percent of dogs and cats eat therapeutic foods that could have significant health and disease-management benefits as prescribed by their veterinarians.1 A University of Minnesota study found that a renal diet extends life in dogs and cats with kidney disease.2 Let’s say you’ve diagnosed kidney disease in a cat. Whenever a diet change is made, a staff member should call the client three days later to check on the food transition. Say, “This is with <your name> with <your veterinary clinic>. Dr. <Doctor's Name> asked me to call to confirm that you’re making the transition from Ollie’s previous food to the new therapeutic diet, , for kidney disease. When switching foods, you should be mixing the two foods, gradually increasing the proportion of new food over one week and reducing the amount of the previous food. Have you begun the transition to get Ollie on his new kidney diet? Is he eating it? Eating this diet is the cornerstone of Dr. ’s treatment plan and will help us better manage Ollie’s kidney disease. Research shows pets with kidney disease can live twice as long after diagnosis if they eat a therapeutic diet.2 I will give you a courtesy reminder to refill Ollie’s food, which should be in three weeks. Would you like me to contact you by email or call?" Using the doctor’s name brings authority to the call. Remind the client that her cat has kidney disease, a serious medical condition that requires ongoing care. Explaining that the therapeutic diet is a cornerstone of the veterinarian’s treatment plan communicates the need for change. The benefit statement of “can live twice as long” motivates the client to follow the doctor’s advice. Just as medications need refills, so do therapeutic diets. If you know the cat will eat the bag or case of food within four weeks, call the client in three weeks as a courtesy reminder. You don’t need to call the client every time she will need to buy food, just when the first refill is needed. Because it typically takes 21 days to change a habit, the diet change will have gained long-term compliance after the first refill. The “F” word A 2012 Association for Pet Obesity Prevention survey found 53 percent of adult dogs and 55 percent of cats to be classified overweight or obese by their veterinarians.3 Too often, veterinary teams are shy to bring up a pet’s obesity when the client also is overweight. Don’t hesitate because avoiding the conversation could have serious medical consequences to patients. According to the Centers for Disease Control and Prevention, 69 percent of adults age 20 years and older are overweight or obese.4 Focus your conversation on the medical consequences of a pet’s obesity and explain its ideal weight. A pet that weighs 12 pounds with an ideal body weight of 10 pounds is considered obese—20 percent over its target weight.5 The veterinarian would tell the pet owner, “Today your pet weighs ____, but should weigh _____. Medical consequences of being overweight can include joint pain and arthritis, heart disease, high blood pressure, kidney disease and diabetes. We both want your pet to live a long, healthy life. Let’s talk about what diet to feed and how much, giving treats and an easy exercise plan." Most dogs and cats don’t receive adequate exercise to maintain good health.6 Dogs spend 60 percent to 70 percent of their days lying down, with no activity.5 A pound is not a pound on a pet. Three extra pounds on a 15-pound Boston terrier equals 30 extra pounds on a 150-pound person. In a 10-pound cat, 3 extra pounds equals 45 extra pounds on a 150-pound person. Implement callbacks for weight coaching. When a client commits herself to a weight-management program for her pet, your team needs to perform medical callbacks to show your commitment as well. Create the expectation in the exam room, explaining that you’ll call to check on progress. Say, "Your dog weighs 70 pounds today. This extra weight could lead to serious and expensive health consequences such as heart disease, arthritis and diabetes. Even losing 10 percent of his weight will have immediate health benefits. We’ll create a plan today for your dog to lose 7 pounds. We’ll use a combination of a weight-management food, healthy treats and walks. Once a month, we’ll call to remind you to stop by with your dog for a weight check. It takes just a few seconds to get your dog’s weight, and we will record it in your pet’s medical record. You’ll be amazed at the changes in your dog’s health and attitude!" Weight checks let you fine-tune feeding recommendations, ensuring that pets get the correct amount of food to achieve weight loss. Bring Foods into Exam Rooms When you offer a product in the exam room, clients perceive it as medicine. When it’s sold at the front desk, it’s retail. For client convenience, they can get food refills from retail shelves in your lobby, but new diets should be brought into exam rooms. In an exam room, you’ll have a client’s complete attention as you explain the reason for the new food, amount to feed and how to do a proper food transition. Let’s say you performed a dental procedure on my 4-year-old cat, Opus. When the technician does the dental discharge appointment, she will explain home-care instructions and share before-and-after dental photos. The technician would say, "Because Opus was diagnosed with Grade 2 dental disease and had his dental procedure today, he now needs to eat for oral health. This therapeutic diet has dry kibble that’s abrasive and will help keep his teeth clean. Because Opus weighs 12 pounds, you should feed approximately 1 cup per day. If he likes to eat twice a day, Opus would get ½ cup at each feeding. I’m going to put a prescription label on the bag so you know the right amount to feed and also have our phone number for when you need a refill. Let me explain how to do the food transition…" Put Rx labels on diets so clients know which pet the food belongs to, how much to feed and where to get refills. Also provide a measuring cup, which are free from pet-food manufacturers. Good nutrition enhances pets’ quality and length of life. A Purina 14-year lifespan study found that a healthy body condition score could add two years or 15 percent to a dog’s lifespan.7 Nutrition is integral to optimal preventive care. Make a specific nutrition recommendation for every pet during preventive care exams. Share these scripts with your team so they can consistently and confidently teach clients the benefits of good nutrition. l Help clients understand how much they are feeding pets Ever wonder how much pet food is really in a scoop? Watch my video, where I measure a bowl of food, medium scoop and small scoop. The results will surprise you! This video shows the importance of measuring food to prevent obesity in pets. Give clients free pet food measuring cups, which are available from manufacturers. Start with puppy and kitten visits so you can establish a lifetime habit of measuring food. Also provide cups for clients with overweight pets and when dispensing a new therapeutic diet. Keep a sleeve of measuring cups in exam room drawers so they’re within arm’s reach. You’re welcome to share this video on your clinic’s Facebook page. References 1. “The Path to High-Quality Care: Practical Tips for Improving Compliance,” 2003 American Animal Hospital Association; pp. 9, 20 and 21. 2. Feline k/d compared to typical grocery adult food. Ross S, Osbourne C, Polzin D, Lowry S, Kirk C, Koeler L. Clinical evaluation of effects of dietary modification in cats with spontaneous chronic renal failure. Presented at: ACVIM 2005 Forum, June 1-5, 2005; Baltimore, Md. 3. Big Pets Get Bigger: Latest Survey Shows Dog and Cat Obesity Epidemic Expanding. February 6, 2012. Accessed 01-02-13 at http://www.petobesityprevention.com/big-pets-get-bigger-latest-survey-shows-dog-and-cat-obesity-epidemic-expanding/ 4. Centers for Disease Control and Prevention, Obesity and Overweight Stats. Accessed 02-21-14 at www.cdc.gov/nchs/fastats/overwt.htm. 5. Associate Veterinary Clinics website. Accessed 04-04-13 at www.associatevets.com/Default.aspx?tabid=234. 6. Canada’s Pet Wellness Report, Canadian Veterinary Medical Association, Hills’ Pet Nutrition; 2012: 7. Purina releases results from the first life span study. DVM Newsmagazine; July 2002. Accessed 04-04-13 at http://veterinarynews.dvm360.com/dvm/article/articleDetail.jsp?id=26745.
