Picking up from the previous post on veterinary spectrum of care,
here is my attempt at summarizing a few of the article’s proposed action initiatives. These appeared (at least to me) to focus on:
3) Research, and
4) Communication, in order to try to improve access to care for animal owners and also overcome barriers that prevent veterinary interventions to these across a wide spectrum of health care needs.
1. Awareness of the concept of spectrum of care
This makes sense…as I suspect many DVMs & clinic staff members just don’t know that this is a rising concern, or if they do they feel powerless to do much about it or otherwise unable to prioritize and dedicate time towards it.
2. Education on:
a. Existing clinical guidelines available for animal health conditions (e.g. Antimicrobial use guidelines such as, https://onlinelibrary.wiley.com/doi/pdf/10.1111/jvim.14627)
b. How to critically evaluate these, e.g. Evidence-based practice and use of things like the Appraisal of Guidelines for Research and Evaluation II (AGREE II)
c. Development and the practice of skills to quickly assess these guidelines for approaches along this spectrum and ideally reduce dollar resources spent on ineffective tests or treatments.
Tools to help DVMs with this offbeat ‘what’s the evidence’ way of thinking, might include websites such as, Choosing wisely
or bestbets for vets.
It’s also critical to keep in mind that ‘evidence’ can come in many forms and levels, and although sometimes all we have is clinical experience as our form of evidence…this (IMHO) should not be discounted. The key is to recognize and be transparent about this (e.g. lowest level of evidence ) and not be satisfied to settle with this for the future. There is much value (again- at least for me) in sorting out where we are (baseline) and looking towards what we need or would help.
As in ‘do research’, and do it in (or for) the vet primary care or general practice setting. This will hopefully aid veterinarians faced with these issues, i.e. those that are actually in private practice, aka the hardworking DVMs in the field. This style of research should also focus on the outcomes that we think matter most to the majority of pets and owners (e.g., quality of life, cost). Even if we don’t have all (or very many) of the needed answers for spectrum of care, once again that shouldn’t translate into ‘it’s no use to try’.
Much the same thing here…as in ‘communicate’, and do so with all involved groups to figure out what is needed and what is do-able. This type of stuff really does ‘take a village’ and that means, pet-owners, DVMs, clinical staff, baby vets (such as my students here at AVC ), folks in the animal health industry, practice owners, etc. should all get involved to problem-solve.
The bottom-line is, if ‘we’ think this is important stuff for our animals and the profession, then let’s trip the light fantastic and get started bringing these efforts into veterinary curriculums and hopefully from there into clinical practice and to animal-owners. In terms of New Year’s resolutions (for 2019), I think I’ve got a much better shot at this one than 5 minutes of daily meditation.