Common decisions made and actions taken during small-animal consultations at eight first-opinion practices in the United Kingdom

• Published in: Preventive veterinary medicine Vol. 139; no. Pt A; pp. 1 - 9
• Main Authors: Robinson, N.J., Brennan, M.L., Cobb, M., Dean, R.S.
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01.04.2017
• Subjects: Animals; Anti-Bacterial Agents - therapeutic use; Cat Diseases - diagnosis; Cat Diseases - therapy; Cats; Decision Making; Direct observation; Dog Diseases - diagnosis; Dog Diseases - therapy; Dogs; Evidence-based veterinary medicine; Humans; Interventions; Logistic Models; Practice-based research; Primary care; Professional-Family Relations; Rabbits; Referral and Consultation; Small-animal practice; Treatment; United Kingdom; Veterinarians - psychology; Veterinary consultation; Watchful waiting; Decision-making; Direct observation; Veterinary consultation; Watchful waiting; Practice-based research; Treatment; Interventions; Small-animal practice; Evidence-based veterinary medicine; Primary care
• ISSN: 0167-5877; 1873-1716
• DOI: 10.1016/j.prevetmed.2016.12.002

•Data were gathered during direct observation of small animal consultations.•The decisions made and actions taken for all health problems were recorded.•At least one action was taken for 69% of health problems discussed.•Characteristics of the problem affected whether an action was taken.•Future research should look at how decision-making affects patient outcomes. In order for veterinary surgeons to undertake an evidence-based approach to making decisions about their patients, it is important that new evidence is generated to support the clinical decision-making process. Many of the decisions are likely to be around the actions taken to treat or manage health problems discussed during the consultation, and little is currently known about the factors which affect the type of action taken. The aim of this study was to determine the decisions made and actions taken for health problems discussed during first-opinion small-animal consultations, as well as identifying factors which may affect the decision-making process. Data were gathered during direct observation of small-animal consultations conducted by 62 veterinary surgeons in eight first-opinion practices in the United Kingdom. For each patient presented, data were gathered on all health problems discussed during the consultation. The decision made (whether an action was taken or not) and the action taken where applicable (e.g. therapeutic treatment with antibiotics) was also recorded. A three-level multivariable logistic-regression model was developed, with problem (Level 1) nested within patient (Level 2) nested within consulting veterinary surgeon (Level 3), and a binary outcome variable of action versus no action. At least one action was taken for 69% (n=2203/3192) of all problems discussed. Therapeutic treatment was the most common action taken (n=1286/3192 problems; 40.3%), followed by management advice (n=1040/3192; 32.6%) and diagnostic work-up (n=323/3192; 10.1%). The most common therapeutic treatment was antibiotics (n=386/1286; 30%), while the most common management advice given was dietary advice (n=509/1040; 48.9%). The three explanatory variables remaining in the final model were whether the problem was a presenting or non-presenting problem, the type of diagnosis made, and the body system affected. Explanatory variables which did not remain in the final model were patient signalment, problem history, consultation type, clinical examination type, and who raised the problem (veterinary surgeon or owner). For over two-thirds of problems discussed, an action was taken which suggests these problems may be seen as important by the veterinary surgeon and/or pet owner. No action was taken for almost a third of cases which could represent ‘watchful waiting’, which has been highlighted as important in human healthcare. Future research should focus on the common actions taken, further exploring the complex decision-making process, and examining the effect of the decisions made on long-term patient outcomes.