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Power of practice: using clinical data to advance veterinary medicine E. M. Lund What if a system existed for generating pet health insights that could transform how veterinarians deliver care, how academics prioritise research and how students are trained? What if this system generated data every day of the year across all nations in the developed world? The basics of this system already exist, in the form of first-opinion (primary care) veterinary practice. With the increasing adoption of electronic pet health records, there is great potential for opportunities to use the clinical experience of pets in first-opinion practice to increase the quality of veterinary healthcare, research and professional education. The majority of pets seen by veterinarians are seen in first-opinion or primary care practice settings. Despite this, much of our understanding of pet health is driven by research conducted in tertiary care or referral practice. Tertiary practice is also the foundation for the majority of professional veterinary training. Trends in pet health can go unrecognised by the veterinary profession in the absence of comprehensive surveillance and disease monitoring of primary care practice populations. Rigorous methods to capture and aggregate clinical information are a critical step in realising this potential. In a study summarised on p 48 of this issue of Veterinary Record, Robinson and

E. M. Lund, DVM, MPH, PhD, Banfield Pet Hospital, 8000 NE Tillamook, Portland, Oregon 97213, USA e-mail: [email protected]

46 | Veterinary Record | January 10, 2015

others (2014) developed and evaluated methods for capturing the clinical content of veterinary consultations in first-opinion veterinary practice. In Robinson and others’ study, differences were found in the median age of the various species studied (cats, dogs and rabbits). Information on differences in population demographics such as this can be used in research prioritisation to ensure that common diseases in first-opinion practice are a high priority for funding. Also reported by Robinson and others (2014) and by Shaw (2008) is the finding that significantly more problems are discussed during preventive care visits. Preventive care visits represented nearly a third of all encounters. Such results, which highlight the necessity for communication skills, and the type of communication skills that veterinarians need to help pet owners understand the best care for their pets, can be used to inform veterinary curricula. Clinical recommendations for veterinary care can be supported through risk-based communication. With validated data generation methods which help to characterise first-opinion practice, the profession can improve the quantity and quality of population research. Understanding pet health at a population or epidemiological level has the power to determine risk factors for specific diseases as well as detect outbreaks or trends over time. Since 2011, Banfield Pet Hospital has generated an annual report from millions of pets seen in over 880 practices in its USA primary care hospital network (Banfield

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Research Image: Banfield Pet Hospital

M., LUND, E. M. & POLZIN, Pet Hospital 2014). D. J.(2014) Risk factors associThese reports ated with the development documented of chronic kidney disease in cats evaluated at primary care trends in chronic veterinary hospitals. Journal of and infectious the American Veterinary Medical diseases, life span Association 244, 320-327 and preventable KEARSLEY-FLEET, L., O’NEILL, D. G., VOLK, conditions. The H. A., CHURCH, D. B. & population of pets BRODBELT, D. C. (2013) seen by Banfield has Prevalence and risk factors for canine epilepsy also been studied to of unknown origin in assess risk factors for the UK. Veterinary Record disease, for example, doi: 10.1136/vr.101133 OKAFOR, C. C., LEFEBVRE, feline kidney S. L., PEARL, D. L., YANG, disease (Greene and M., WANG, M., BLOIS, S. others 2014) and L., LUND, E. M. & DEWEY, canine urolithiasis C. E. (2014) Risk factors associated with calcium oxalate (Okafor and others urolithiasis in dogs evaluated 2014). In the UK, at general care veterinary hosVetCompass (Royal pitals in the United States. Clinical data can contribute to veterinary knowledge in a range of ways and help in the Preventive Veterinary Medicine Veterinary College assessment of disease risk. This figure shows the distribution of positive Lyme disease 115, 217-228 2014) has similarly used test results in dogs in the USA, using data collected by Banfield Pet Hospital in 2012 O’NEILL, D. ( 2 01 3 ) pet health data from Surveillance: pointing the way first-opinion practice to to improved welfare for companion animals. Veterinary Record doi: 10.1136/vr.f4519 identify opportunities for providing more assess risk factors for disease. Risk factors for Robinson, N. J., Brennan, M. L., Cobb, M., & enlightened veterinary care. As people’s canine epilepsy (Kearsley-Fleet and others Dean, R. S. (2014) Capturing the complexity of first bonds with their pets deepen over time, 2013) and feline hyperthyroidism (Stephens opinion small animal consultations using direct observation. Veterinary Record doi:10.1136/vr.102548 pet health becomes increasingly tied to and others 2014) have been illuminated ROYAL VETERINARY COLLEGE (2014) VetCompass. human health and wellbeing. For the using data from a first-opinion practice Accessed November 21, future, in addition to the insights that can network of nearly 200 sites (O’Neill 2013). 2014 be gained from population research for SHAW, J. R., ADAMS C. L., BONNETT B. N., With these insights and improved LARSON, S. & ROTER D. L. (2008) Veterinarianpet care, there are opportunities to use the understanding about the major threats client-patient communication during wellness appointpower of population data to inform the to pet health, the profession can begin ments versus appointments related to a health problem strategy for veterinary research, as well as to to set goals and develop programmes in companion animal practice. Journal of the American Veterinary Medical Association 233, 1576-1586 influence the curricular focus for veterinary for improving pet health much like the STEPHENS, M. J., NEILL, D. G., CHURCH, D. B., professional education. USA or the UK has done for people MCGREEVY, P. D., THOMSON, P. C. & BRODBELT, The veterinary profession has a through national programmes like D. C. (2014) Feline hyperthyroidism reported in primary-care veterinary practices in England: prevalence, responsibility to continually advance the Healthy People 2020 (US Department of associated factors and spatial distribution. Veterinary boundaries of pet healthcare. Using firstHealth and Human Services 2014) and Record doi: 10.1136/vr.102431 opinion practice as a source of insights to Change4Life (UK Department of Health UK DEPARTMENT OF HEALTH (2014) Change4Life. drive these advancements is imperative to 2014). Unsurprisingly, as some of the Accessed November 21, 2014 meeting the challenge. disease threats are shared (for example, US DEPARTMENT OF HEALTH AND HUMAN being overweight and obese) there are SERVICES (2014) Healthy People 2020. www.healthyReferences opportunities for intervention strategies to Accessed November 21, 2014. BANFIELD PET HOSPITAL (2014) State of Pet Health. be shared by people and their pets. Accessed November 21, As a profession, understanding pet 2014 population health trends can help us to GREENE, J. P., LEFEBVRE, S. L., WANG, M., YANG, doi: 10.1136/vr.g7763

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Power of practice: using clinical data to advance veterinary medicine E. M. Lund Veterinary Record 2015 176: 46-47

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Power of practice: using clinical data to advance veterinary medicine.

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