Development of New Canine and Feline Preventive Healthcare Guidelines Designed to Improve Pet Health

Why the Guidelines Are Needed

The new Canine and Feline Preventive Healthcare Guidelines advance the trend in all the medical professions toward increased reliance on clinical guidelines as a strategy that can improve the quality of care that patients receive.¹ Valid clinical guidelines combine scientific evidence with expert opinion. As such, they remain one of the best strategies for changing professional behavior and implementing best practices in a clinical setting. Well-designed guidelines have the potential not only to improve quality of care but also to increase pet owner satisfaction and facilitate informed client decision making, without compromising healthcare outcomes.

The value of preventive care and early intervention in human and dental medicine has been well established and acknowledged by the general public. The veterinary profession has not been as effective in communicating this benefit to pet owners, which has contributed to a decade-long trend toward declining numbers of pet owner visits to veterinarians.² Recent survey data indicate that the mean number of patients seen per week by companion animal veterinarians decreased by 13%, from 76 in 2000–66 in 2009.³ American Animal Hospital Association data show that from 2001 to 2009, the median number of active clients per full-time veterinarian decreased by 17%, from 1,299–1,070. A National Commission on Veterinary Economic Issues survey found that more than half of veterinarians had fewer patient visits during 2010, compared with a year earlier.⁴ Remarkably, these declining trends have occurred despite substantial growth in the pet dog and cat population in the United States, by >36% over the 10 yr period ending in 2006.²

Recent market research has identified several reasons for the decrease in use of veterinary services.^2,4 These include proliferation of self-help pet care by owners who search for pet health information on the Internet instead of relying on a veterinarian. Also cited were the difficulties associated with transporting cats to the veterinary clinic and resistance to examination or treatment. Most importantly, current data indicate that inadequate understanding by pet owners of the need for routine examination of their pets is a key client-driven factor for the declining use of veterinary services. By providing a blueprint for preventive healthcare, the new Canine and Feline Preventive Healthcare Guidelines directly address the lack of understanding by the pet-owning public of the critical relationship between regular health evaluations and the well-being of their pets.

Other realities of veterinary practice underscore the need for clinical guidelines that actively encourage routine preventive care. Poor client compliance with veterinarians’ healthcare recommendations is well-known and broadly undercuts the benefits of interventions such as heartworm testing, dental care, feeding therapeutic diets, senior pet health screenings, and vaccination.⁵ To a great extent, lack of compliance can be preempted and corrected by pet-owner education, a key benefit of regular clinic visits. To address that issue, the Canine and Feline Preventive Healthcare Guidelines emphasize the importance of communicating future healthcare recommendations and setting client expectations for follow up visits.

The impact of sporadic use of preventive pet healthcare may also be a contributing factor to the increase in the prevalence of some common preventable canine and feline diseases that has recently been reported. These include diabetes mellitus, dental disease, parasitism, and otitis externa.⁶ It has been shown that early diagnosis and treatment, the principal benefits of regular examinations, can dramatically slow progression of such conditions as renal disease, osteoarthritis, and periodontal disease.^7–9 Disease-sparing outcomes as a result of early intervention can best be achieved by regular clinic visits to diagnose disease and monitor the effects of treatment.

It is noteworthy that many pet owners, especially cat owners, associate veterinary care primarily with vaccinations and treatment of overt disease.² Few clients fully appreciate the critical role of preventive care in maintaining a long, rewarding relationship with their pets. This is a clear signal that veterinarians need to do a better job of convincing their clients that regular clinic visits are more important for ensuring lifetime pet wellness than occasional visits solely for vaccination or treatment of acute disease. The new guidelines provide a reference for this type of veterinarian-client dialogue.

The importance of disease prevention as the preferred alternative to disease treatment is being increasingly emphasized by our schools of veterinary medicine. In 2010, the North American Veterinary Medical Education Consortium recommended closing curriculum gaps in preventive medicine with a renewed focus on primary care, wellness, and disease prevention in clinical courses.¹⁰

The Development Process: Ensuring Clinical Relevance

The AAHA-AVMA Preventive Healthcare Guidelines Task Force, a panel of individuals with demonstrated expertise in companion animal medicine, was given the mission of developing guidelines that emphasize preventive healthcare in canine and feline practice. The task force was sponsored by the Partnership for Preventive Pet Healthcare, a consortium of leaders from the veterinary medical profession and the animal health industry. Developing the Canine and Feline Preventive Healthcare Guidelines was part of an action plan for implementing the partnership's mission: to ensure that pets receive the preventive healthcare they deserve through regular visits to a veterinarian.

Task force members were selected for their prior experience in developing clinical guidelines and their expertise in areas pertinent to preventive care. To develop the canine and feline guidelines, the task force relied primarily on existing clinical care guidelines (Appendix), themselves written by expert panels, which reflect the best available scientific and clinical evidence in their respective areas of veterinary medicine. These foundation guidelines are consensus statements for vaccinations, care during various life stages, pet nutrition, dental care, heartworm and parasite control, and pain management. Thus, the new canine and feline guidelines integrate several specialized clinical guidelines into unified statements of best practices for each of the two pet species.

A virtue of the Canine and Feline Preventive Healthcare Guidelines is that they are specific without being overly prescriptive. Veterinarians have latitude in applying the recommendations in their own practices. For example, although various general recommendations are indicated, specific details are often left to the practitioner's discretion depending on individual patient needs, risk assessments, and newly emerging information. Whereas some medical guidelines are lengthy and highly detailed, the new Canine and Feline Preventive Healthcare Guidelines are concise and can be readily applied by clinicians and their healthcare teams.

Enhancing the Quality of Practice and Well-being of Patients

The most important contribution of the new Canine and Feline Preventive Healthcare Guidelines may be their potential to enable pet owners to better understand the value of preventive veterinary care. Pet owners who realize that preventive care preserves their relationship with their pets are much more likely to become regular users of veterinary medical services, regardless of economic conditions. Instead of visiting a veterinarian only occasionally or as a secondary or final recourse, dog and cat owners who subscribe to the concept of preventive healthcare become regular users of veterinary services throughout their pets’ lifetime. This shift in client behavior can be especially important for reversing the current underutilization of veterinary services, particularly by cat owners.

By translating evidence-based medicine into actionable best practices, the new guidelines specify how companion animal medicine can be applied well beyond vaccinations and acute care, the narrow perspective held by many pet owners today. The guidelines can also function as templates for pet owner education, providing a complete pet health-care agenda for veterinarians to discuss with their clients. The net result will be a reduction in the prevalence and impact of the chronic diseases that shorten and detract from the lives of pets that do not receive regular preventive care. That is an outcome that all partners in the veterinarian-client-pet relationship can embrace. The AAHA-AVMA Preventive Healthcare Guidelines Task Force is pleased to provide an important new resource to help our profession realize that vision.

Veterinary Practice Guidelines

AAHA-AVMA CANINE PREVENTIVE HEALTHCARE GUIDELINES

AAHA-AVMA FELINE PREVENTIVE HEALTHCARE GUIDELINES