Do it yourself or send for help? Considering specialty referral from a general practitioner perspective

General practice veterinarians (GPs) are often faced with the question of which services they should provide themselves and which are more appropriately the province of board-certified specialists. The growing availability of specialty care, the expectations of many pet owners for advanced care resembling that which they receive, the expanding availability of new and more technologically sophisticated interventions, and many less easily defined shifts in the economic and cultural context of veterinary medicine all add to the pressure to limit services in general practice and refer more patients to specialists. However, the criteria for making decisions about referral are often ill-defined and controversial. Furthermore, most GPs are trained by specialists in secondary or tertiary care institutions, providing them with a perspective that may not reflect the realities of the general practice environment.While each referral decision for a specific patient must be made in the unique context of that case, reflection and discussion concerning relevant general principles can help GPs build a rational foundation for making such decisions. The principles and methods of evidence-based medicine and the expanding concept of a spectrum of care can usefully inform decision-making about referral. It is also critical that all stakeholders contribute to discussion of these questions and to the training of veterinarians so that the next generation will be prepared to shape and embody the role of GP in a manner that best meets the needs of patients, pet owners, and veterinarians themselves.

How do veterinarians mitigate liability concerns with workforce shortages?

The challenge of meeting pet healthcare demands with inadequate staff resources creates legal and ethical considerations for the veterinary profession. Inadequate staffing can result in access to care issues that impact companion animal health, public health, and the human animal bond. An overburdened work environment may also result in liability issues related to standard of care, client dissatisfaction, and subsequent complaints. The following recommendations may ameliorate the legal and ethical impacts to include: a focus on how to optimize current resources (human and technology); improve client communications and medical record-keeping strategies; promote preventive care; develop and memorialize clinical standard operating procedures; and prioritize staff well-being to prevent burn out. These recommendations should be considered good practices when functioning under optimal conditions but are even more valuable to implement effectively in an overburdened companion animal medicine environment.

Enhancing Primary Care Learning in a Referral Hospital Setting: Introducing Veterinary Clinical Demonstrators

With the majority of veterinary graduates entering primary care practice (PCP), there is increasing recognition of the importance of preparing students to practice across a broad spectrum of care (SoC). The traditional model of veterinary training focused on the referral hospital environment, can make this challenging. In 2018, Bristol Veterinary School recruited five primary care (PC) veterinary surgeons as veterinary clinical demonstrators (VCDs) who collaborated with rotation-specific specialists to help enhance student focus upon day-one skills and to emphasize SoC relevance of the referral caseload. To evaluate the initiative, two separate online surveys were disseminated to clinical staff and final year veterinary students. The survey was completed by 57 students and 42 staff members. Participants agreed that VCDs helped students feel prepared for a first job in primary care practice (students 94.7%; staff 92.7%); helped students to focus on the primary care relevance of referral cases (students 96.5%; staff 70.8%); helped students develop clinical reasoning skills (students 100%; staff 69.3%), practical skills (students 82.4%; staff 72.5%), and professional attributes (students 59.6%; staff 71.4%). Thematic analysis of free-text comments revealed the benefits and challenges associated with implementing the role. The data gathered helped to guide the role's ongoing development and to provide recommendations for others who may be looking to implement similar educational initiatives to help prepare graduates to practice across a spectrum of care.

Barriers to and facilitators of pet grooming among clients served by a subsidized grooming service program

Grooming is an important aspect of basic hygiene care for most companion animals. The consequences of not receiving routine grooming care can pose significant risks to animals' health and wellbeing. The current study examined barriers and facilitators of maintaining pets' grooming needs among clients of a subsidized grooming service program in New York City (N = 167), as well as the impact of a tailored nail-trimming demonstration on clients' confidence trimming pets' nails. Ninety-two percent of the sample reported experiencing at least one barrier to maintaining their pet's grooming (e.g., income, transportation) and nearly half (46%) experienced three or more barriers to providing grooming. Ninety-one percent endorsed that at least one supply/support (e.g., brush/comb, behavioral support) would be beneficial in maintaining their pet's grooming needs at home and more than half reported that three or more supplies/services would be beneficial. Differences in the prevalence of specific barriers to grooming were found across income groups, service locations, and service settings. Clients who received nail-trimming demonstrations, on average, reported statistically significant increases in confidence trimming nails following their appointment. We discuss the implications of these findings for improving animal welfare and veterinary professionals' capacity for preventing grooming-related omissions of care and increasing communities' capacity to support pet owners' access to essential pet care supplies and supports. Future research is needed to determine (a) how and for whom grooming demonstrations and subsidized services are most effective, (b) whether an increase in pet owner confidence following nail trimming demonstrations is associated with maintaining nail trimming at home over time, and (c) whether providing clients with supplies and supports is an effective way of preventing and/or ameliorating future grooming-related omissions of care and hygiene-related health concerns observed by veterinarians, animal control professionals, shelter staff, and law enforcement.

Impact of a Spectrum of Care Elective Course on Third-Year Veterinary Students' Self-Reported Knowledge, Attitudes, and Competencies

Veterinary services' rising cost is an increasing barrier to pet care. Spectrum of care (SpOC) refers to evidence-based veterinary medicine options along the socioeconomic spectrum. To meet growing pet owner financial constraints and pet care needs, training to equip veterinarians with competencies to provide SpOC as Day One graduates is argued to be added as part of the veterinary curriculum. Objectives of our prospective pre- and post-survey study were to (a) determine baseline self-reported knowledge, attitudes, and competencies (KACs) surrounding SpOC in third-year DVM students; (b) develop and assess impact of a SpOC course on student self-reported SpOC KACs; and (c) obtain student feedback on the course and future SpOC training. Enrolled students (n = 35) completed the pre-survey (n = 35) and post-survey (n = 33). Results indicated that students were aware of the need for SpOC training within the veterinary curriculum, and positive changes occurred in self-reported KAC from pre- to post-survey. Students tended (p = .08) to predict better outcomes in SpOC cost-barrier scenarios from pre- (34%) to post-survey (76%), such as reduced perceived likelihood of euthanasia (63%-39%) and unsuccessful outcomes (40%-27%). Most students (31/33, 94%) predicted the course would benefit them in clinical practice and had preferred future training preferences (online modules [70%], seminars [60%], webinars [58%]). Data indicate benefits in student self-reported KACs following the SpOC course, warranting formal course inclusion, with tracking of students into clinical practice to document objective KAC impacts and perhaps similar course rollout to other institutions.