title: Common decisions made and actions taken during small-animal consultations at eight first-opinion practices in the United Kingdom.
abstract: 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.
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: 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. Electronic address: rachel.dean@nottingham.ac.uk.
authors.forename: R S
authors.initials: RS
authors.lastname: Dean
mesh_terms: D000818:Animals; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002371:Cat Diseases / Q000175:diagnosis / Q000628:therapy*; D002415:Cats; D003657:Decision Making; D004283:Dog Diseases / Q000175:diagnosis / Q000628:therapy*; D004285:Dogs; D006801:Humans; D016015:Logistic Models; D011368:Professional-Family Relations; D011817:Rabbits; D012017:Referral and Consultation; D006113:United Kingdom; D018634:Veterinarians / Q000523:psychology
chemical_list: D000900:Anti-Bacterial Agents
keywords: Decision-making; Direct observation; Evidence-based veterinary medicine; Interventions; Practice-based research; Primary care; Small-animal practice; Treatment; Veterinary consultation; Watchful waiting