title: Investigating preventive-medicine consultations in first-opinion small-animal practice in the United Kingdom using direct observation.
abstract: Preventive-medicine consultations account for a large proportion of the veterinary caseload and previous research has suggested these consultations are fundamentally different from those in which the animal is presented for a specific health problem. There has been recent controversy around some aspects of preventive medicine for cats and dogs, and the full health benefits of the preventive-medicine consultation remain unclear. The aim of this study was to compare characteristics of the consultation and the problems discussed during the consultation between preventive-medicine consultations and other types of consultations. Data were gathered during direct observation of small-animal consultations in seven first-opinion practices in the United Kingdom. Data collected included type of clinical examination performed, patient signalment, and details of all problems discussed (including whether the problem was presenting or non-presenting, new or pre-existing, who had raised the problem, body system affected and whether an action was taken). A two-level multivariable logistic-regression model was developed, with canine and feline patients at Level 1 nested within consulting veterinary surgeons at Level 2, and a binary outcome variable of preventive-medicine consultation versus specific health-problem consultation. A total of 1807 patients were presented, of which 690 (38.2%) presented for a preventive-medicine consultation. Dogs were the most frequently presented species (n=1168; 64.6%) followed by cats (n=510; 28.2%), rabbits (n=86; 4.8%) and patients of other species (n=43; 2.4%). The five variables remaining in the multi-level model were whether multiple patients were presented, patient age, clinical examination type, weighing and number of problems discussed. Species, breed, sex, neutering status and practice did not remain in the final model. Many non-presenting problems, including both preventive-medicine problems and specific-health problems, were discussed and acted upon during all types of consultations. Dental and behavioural non-presenting problems were discussed more frequently during preventive-medicine consultations compared with specific health-problem consultations. Preventive-medicine consultations represent an opportunity for veterinary surgeons to discuss other aspects of preventive medicine, and to detect and manage new and ongoing health problems. A greater evidence base is needed to understand whether detecting and managing underlying disease during the preventive-medicine consultation has a positive impact on lifelong patient health and welfare.
authors.affiliation: Centre for Evidence-based Veterinary Medicine, School of Veterinary Medicine and Science, The University of Nottingham, Sutton Bonington Campus, Loughborough LE12 5RD, UK. Electronic address: natalie.robinson@nottingham.ac.uk.
authors.forename: N J
authors.initials: NJ
authors.lastname: Robinson
authors.affiliation: Centre for Evidence-based Veterinary Medicine, School of Veterinary Medicine and Science, The University of Nottingham, Sutton Bonington Campus, Loughborough LE12 5RD, UK.
authors.forename: M L
authors.initials: ML
authors.lastname: Brennan
authors.affiliation: School of Veterinary Medicine and Science, The University of Nottingham, Sutton Bonington Campus, Loughborough LE12 5RD, UK.
authors.forename: M
authors.initials: M
authors.lastname: Cobb
authors.affiliation: Centre for Evidence-based Veterinary Medicine, School of Veterinary Medicine and Science, The University of Nottingham, Sutton Bonington Campus, Loughborough LE12 5RD, UK.
authors.forename: R S
authors.initials: RS
authors.lastname: Dean
mesh_terms: D000818:Animals; D002415:Cats; D004285:Dogs; D004739:England; D016015:Logistic Models; D057805:Pets; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011315:Preventive Medicine / Q000379:methods*; D011817:Rabbits; D012606:Scotland; D018634:Veterinarians / Q000706:statistics & numerical data*
keywords: Direct observation; Evidence-based veterinary medicine; Practice-based research; Preventive medicine; Primary care; Small-animal practice; Vaccination; Veterinary consultation