With Insight From:
Jenni Rizzo, DVM
President of the American Heartworm Society and Founder of IntroVet
Dr. Jenni Rizzo graduated from Kansas State University in 2012, and since then has had the opportunity to work in many different facets of veterinary medicine, ranging from exotics, to shelters, to primary and specialty care, to education and outreach. She has served on the board of the American Heartworm Society (AHS) since 2016, is the youngest and first female President of AHS, and is the President and Founder of IntroVet®, an introvert-friendly continuing education community for DVMs and technicians. In her spare time, Dr. Rizzo still practices in Texas and Florida, and travels throughout the United States with her two dogs, Pistol Pete and Biggie Smalls, educating on heartworm disease, leading IntroVet conferences, and exploring National Parks.
The need for a spectrum of care approach
Recent veterinary graduates and current veterinarians have voiced their need for an educational model that better prepares students for what working in a practice is like. Education is not able to mirror the realities of pet owners with limited financial resources, how to work with underserved communities, cover every condition or need that may affect pets, and limits what students may be able to do when treatment or resources are not available within a clinic.1 This creates a gap in the capabilities of veterinary students and veterinarians. Emerging from these anxieties is the spectrum of care approach so veterinary staff are better equipped to provide a wider range of options for pets and their owners.
The reality is that a “one-size-fits-all” approach is often impractical due to a myriad of factors: the pet’s clinical presentation, life stage, any co-existing or preexisting co-morbidities, and crucially, the pet owner’s income, location, cultural background, and personal experiences.2 A 2018 survey revealed that 28% of pet owners experienced a barrier to veterinary care and 23% were unable to provide preventive health care for their pets. What is even more unsettling is the estimate that 17 million pets in underserved communities have never been to a veterinarian for care.3 These statistics emphasize the significant unmet needs within the pet owner population.
The spectrum of care model addresses these needs by envisioning a continuum of care, where one end is the most extensive, expensive, and invasive. The other end represents the least expensive and least invasive option. Cases often fall in between, allowing for a more tailored care plan specific to the circumstances of the pet and pet owner.4 This model accounts for the pet’s quality of life, the client’s limitations and preferences, past experiences that may influence treatment decisions, and resources at a veterinary clinic. When looking at a specific issue—like parasite protection in pets—these factors outline why compliance is challenging for pet owners.
The role of parasite protection
Parasites pose a significant threat to the health and well-being of pets, their owners, and the environment. They can cause discomfort, illness, and even death if left untreated, and some parasites have the potential to infect humans and other animals. Despite these risks, surveys indicate a lack of awareness among pet owners regarding parasitic risks, the frequency of preventive measures, or the financial means to consistently purchase preventive medications.5 “Usually, this comes from a lack of understanding of how pets get parasites, what happens when [pets] are infected, and how it impacts the family. The intestinal parasites of dogs have the potential to infect children or the elderly and make humans really sick,” said Dr. Jenni Rizzo. Engaging in open conversations with pet owners “about why a parasite is going to make their pet sick or what they’re going to do if they get infected” is necessary to showcase the harm of a parasitic infection.
Financial challenges among pet owners
While misinformation regarding parasitic protection—it’s unnecessary during winter, only outdoor pets are at risk, natural remedies are sufficient, or “it won’t happen to my pet”— contributes to a lack of compliance, the most significant barrier to parasite protection is often cost. Alarmingly, 60% of pet owners do not provide heartworm and/or parasite protection for their pets.6 This issue is exacerbated by the escalating costs of veterinary care. The Bureau of Labor Statistics revealed a 7.9% increase in the price of veterinary services between February 2023 and February 2024, a rate more than 2.5 times higher than the average increase in consumer items.6 Furthermore, another study indicated that 91% of pet owners in the United States have experienced financial stress related to their pet, with 33% having sought additional sources of income.7 The phenomenon, coined as “Petflation,” tracked over 19 months by Pet Business Professor, shows a 38.9% growth in the base cost of veterinary services. These mounting financial pressures on pet owners contribute to the struggle of consistent protective medication compliance.8
Rising veterinary costs have also led to a decrease in the frequency of veterinary visits. While dog and cat populations in households experienced a compound annual growth rate of approximately 1.94% and 2.05%, respectively, between 2016 and 2022, the overall number of client visits to veterinarians fell by 2.7%.9
Most pet parents in the United States, when surveyed, believe financial situations should not be a barrier to pet ownership and say they would sacrifice luxuries to provide for their animals. However, the reality is 11% of surveyed owners living below the poverty line reported being unable to afford protective medications.10 When you factor in all the possible expenses for pet care alongside these numbers—annual visits, vaccines, food, supplies, etc.—owners may not be as willing to pay for high cost parasite protection. Financial constraints should not impede pets from receiving essential protection. Rather, options for parasitic protection that balance routine pet costs will ensure more pets are protected without having to cut costs on other veterinary procedures or products.
Implementing spectrum of care with protection compliance
High-cost options are not the only available solution for heartworm and flea protection. Generic versions of established medications offer a more affordable alternative. For instance, ivermectin is a generic equivalent to Heartgard for dogs, and milbemycin oxime serves as a generic option for Interceptor Plus in cats.11
Beyond medication cost, the method of delivery can also influence compliance. Pet owners may prefer oral tablets that can be administered at home, injectable medications administered at the vet that can provide protection for several months, or topical treatments that address multiple parasites simultaneously. “For some clients, it can be hard to remember to give a medication consistently every month. So, for them, a monthly product might not be a great idea. For others, they might have dogs that don’t take oral medications easily. Maybe they spit it out or vomit after dosing. Maybe they fight with their owner or won’t sit still when administered medications,” said Dr. Rizzo, when explaining some considerations for deciding what type of heartworm and flea product to recommend to owners.
Furthermore, rethinking payment structures can significantly improve access to preventative medications. Many veterinary clinics offer payment plans that allow owners to spread the cost of heartworm preventatives over several months. Recurring monthly deliveries of parasiticides, usually in a 3- or 6-months’ supply, also allow owners to better budget each month. “Pet insurance can be another thing that helps clients cover other aspects of veterinary care,” suggested Dr. Rizzo. “Something newer that I don’t think a lot of practices are aware of yet would be wellness plans or companies that exist now to help vet practices allow their clients to make payments over time. The client has an easier time affording vet care and is more likely to accept recommendations for parasiticide care, especially if they’re only paying $30 or $40 a month instead of several hundred upfront.” Encouraging price shopping among local clinics and reputable online pharmacies can also help owners find more affordable options, considering variations in pricing based on location and the veterinarian’s ability to offer different purchasing routes.12
Virbac’s spectrum of care approach aims to increase compliance to emphasize the importance of tailoring a plan that aligns with the client’s budget.13 This doesn’t mean not carrying premium-priced broad-spectrum parasiticides, but rather adding more affordable options for a pet owner who is not able or willing to commit to a high-cost option. “It’s important to have a conversation and find out what their specific concerns are, whether it’s cost or whether it’s something else,” said Dr. Rizzo. A three-step protocol plan, supported by the spectrum of care framework, can look like the following for parasitic protection:
ASSESS LOCAL RISKS: Parasites differ in species and prevalence depending on location. When a pet owner comes in, it is important to assess the geographical location to determine the accurate likelihood of risk for infection.
COMMUNICATION OF RISKS: The veterinarian should then explain these risks to the client. Be open to questions, and different methods of explaining how their pet can be impacted. Building trust between the veterinarian and the pet owner better supports the dialogue and empowers pet parents to feel in control of their pets’ care.14 Dr. Rizzo recommends the Heartworm Society and Companion Animal Parasite Council as valuable educational resources.
RECOMMENDATIONS: Do not just recommend the high-cost combo product, especially if a pet owner expresses concerns about finances. Make a plan that offers lower-cost options. They may not know what is out there and be intimidated by the more expensive options.14
Transparency within veterinary medicine
Demystifying the costs of expenses can help reduce anxiety during a visit, yet only 30% of veterinarians discuss cost with their clients. When pet owners perceive veterinary care as prohibitively expensive or lack understanding of the reasons behind exam fees, they are more likely to leave the clinic without necessary protection for their pets. Transparency regarding the anticipated cost of a visit upfront sets clear expectations for the client and allows them time to prepare. It is recommended to break down the costs of diagnostic tests, compare different treatment plans, explain the rationale behind the costs of various procedures, and outline the pros and cons of each approach. Offering package deals with fixed pricing for routine or common reasons for veterinary visits can also enhance cost predictability.
The benefits of embracing a spectrum of care approach are evident in both the short-term and long-term well-being of pets and their owners. Increased transparency fosters trust in their veterinarian and encourages them to seek veterinary care sooner when their pets are unwell. Earlier intervention can often prevent or mitigate the need for costly emergency visits and can lead to more favorable prognoses for the pet.
The complexities and high costs associated with treating conditions like heartworm further justify the importance of early prevention. When it comes to heartworm in pets, specifically, several medications, surgery in severe cases, and exercise restrictions are necessary for treatment. Costs for heartworm treatment add up quickly into the thousands between the heartworm test, X-rays, echocardiograms, and injections.
“Antibiotics and specific heartworm preventatives are prescribed to treat the larval stages of heartworms and to kill the Wolbachia bacteria that lives symbiotically with the heartworms.15 Two to three months later, a series of three injections is given to kill the adult heartworm. During that time, anti-inflammatories are also prescribed throughout this whole process; dogs must rest and avoid strenuous activity to avoid some of the risks associated with having heartworms,” outlined Dr. Rizzo about the complexity of heartworm treatment. After all these treatments, pets will require a series of follow-ups to confirm the heartworm treatment has been successful. Overall, the treatment plan takes up to a year to complete.15
By applying spectrum of care at the early stages—an annual exam or a new pet exam, as examples—there is a chance to stop heartworm before it starts.
Conclusion
The spectrum of care approach offers a vital framework for enhancing parasitic protection compliance and creating a more inclusive veterinary profession. Emphasizing access to services among all pet owners, regardless of their financial circumstances, is crucial for improving overall pet health. These spectrum of care principles extend beyond parasitic products and can be applied to all diagnostics and treatments in veterinary medicine. Dr. Rizzo mentions it can be hard for clients to believe veterinarians are on their side when they’re sitting on the other side of the exam room table and realizing they can’t afford necessary vet care. “When we can create a plan that works for the family sitting right there in front of us, then it becomes a lot easier for clients to see what we already know, that we do care, and that we’re trying our very best to take care of their pet. In that regard, I think spectrum of care does a lot to create better relationships with clients to create more trust and understanding and to convey empathy.” Spectrum of care ultimately benefits pets, their owners, and the veterinary profession.
References
1. Fingland RB, Stone LR, Read EK, Moore RM. Preparing veterinary students for excellence in general practice: building confidence and competence by focusing on spectrum of care. J Am Vet Med Assoc. 2021;259(5):463-470. doi: 10.2460/ javma.259.5.463
2. Canadian Animal Shelter & Community Medicine Association. Spectrum of Care – What it is and how to put it into Practice. Published online February 24, 2024. https://www.cascma.org/ spectrum-of-care-what-it-is-and-how-to-put-it-into-practice/
3. Provide a Spectrum of Care to Increase Veterinary Access to More Clients. ASPCApro. Published October 2021. https://www.aspcapro.org/resource/ provide-spectrum-care-increase-veterinary-access-more-clients
4. What is the spectrum of care? AAHA. Accessed March 20, 2025. https://www.aaha.org/newstat/publications/ what-is-the-spectrum-of-care/
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6. A big pet peeve: Soaring costs of vet care bite into owners’ budgets. USA TODAY. https://www.usatoday.com/story/news/ nation/2024/04/16/vet-pet-care-cost-rising/73098326007/
7. Gollub H, Lobb J. Survey: 91% of dog owners have experienced financial stress over the cost of pet ownership. USA TODAY Blueprint. Published September 25, 2024. https://www.usatoday.com/money/blueprint/pet-insurance/ cost-of-pet-ownership-2023/
8. Gibbons J. Petflation 2025 – January Update: Stable at +2.0% vs Last Year. Pet Business Professor. Petbusinessprofessor. com. Published February 17, 2025. https:// petbusinessprofessor.com/petmarket/petmarketsegments/ petflation-2025-january-update-stable-at-2-0-vs-last-year/
9. Nolen RS. Facing economic uncertainty, clients delay veterinary visits. American Veterinary Medical Association. Published November 28, 2023. https://www.avma.org/news/ facing-economic-uncertainty-clients-delay-veterinary-visits
10. The Humane Society of the United States: More than a Pet. Accessed March 20, 2025. https://www.humaneworld.org/sites/ default/files/docs/HSUS_More-Than-a-Pet-Harris-Poll-2024.pdf
11. Heartworm Prevention Pills vs. Injections - What’s The Difference? Vettedpethealth.com. Published 2023. Accessed March 20, 2025. https://www.vettedpethealth.com/resources/ heartworm-prevention-pills-vs-injections-whats-the-difference
12. Sy M. How Much Does Heartworm Treatment Cost for Dogs? GoodRx. Published December 16, 2024. Accessed March 20, 2025. https://www.goodrx.com/pet-health/dog/ heartworm-treatment-cost-for-dogs
13. Close the Gap with a Spectrum of Care. Virbac.com. Published 2023. https://vet-us.virbac.com/home/products/parasiticides/ close-the-gap-with-a-spectrum-of-care.html
14. Stolz S. Spectrum of care: protocols to support pet owners’ budgets. DVM 360. Published March 31, 2023. Accessed March 20, 2025. https://www.dvm360.com/view/ spectrum-of-care-protocols-to-support-pet-owners-budgets
15. Treating Heartworms in Dogs. Petmd.com.
