VETERINARY practices are being encouraged to contribute their understanding and data to further develop evidence-based medicine.
Recently launched is a toolkit, available to the 650 members of the Evidence Based Network managed by RCVS Knowledge. Membership of the network is available through the RCVS Knowledge website or for further information e-mail ebvm@rcvsknowledge.org.
Dr Rita Jorge, head of research, explains that 85% of research is thought to be of little direct use to veterinary surgeons in practice. A seminar last October has led to a greater understanding that information is required about “what vets see every day”. Topics are critically appraised via the global network and by use of the toolkit. A workshop for farm vets is being planned to understand the caseload in practice and to identify the most important questions to be answered.
Currently there are over 150 members of the Dairy Cow Health and Production Knowledge Group and more veterinary surgeons in cattle practice are invited to participate. A “Skills Day” will take place on 30th October 2015 and a seminar in London from 1st to 3rd November 2016. Jon Reader of Synergy Farm Health received a grant from RCVS Knowledge to analyse the caseload in one first opinion practice. The findings were presented by Andrew Davies at the latest BCVA congress.
Just how challenging is it for practices to collate and collect data as a part of practice management? A paper is available within Cattle Practice (22: 183): “A quantitative analysis of the caseload in first opinion veterinary practice: livestock, UK setting”. The period collated was from February 2013 to January 2014 and the question is: what happens now? How practical is it for practices to collect data and how much use is it?
Rita Jorge is enthusiastic about the study findings and is in no doubt that practice-based information will advance evidence-based medicine and fulfil the mantra that EBM assists clinicians to make good decisions in good time.
At the BCVA congress delegates were introduced to the FLYMO system for time spent by a veterinary surgeon on farm (fertility, lameness, youngstock, mastitis, other). Other includes TB, sick, education, consultancy, nutrition and obstetrics. Sick animals are further categorised into specific conditions.
Each veterinary surgeon completes the information before leaving the farm and a bespoke software program (Herdkeeper) is used to collate and analyse the data. Analysis can include individual herds or groups and includes costings and business-related aspects. Veterinary spend data analysis shows the ratio of professional fees to medicines for all species and for individual species.
Paraprofessional activity for mobility scoring (149 sessions) and foot trimming (69% of work) is also recorded with details of foot lesions and other conditions. The paper indicates that by using the software the practice data may be analysed “with great ease”.
During the year 1,329 holdings were visited. Practice clients included 38% beef, 23% ovine and 16% dairy. Medicines contributed 55% towards the total income of the practice. Dairy herd work accounted for 79% of practice turnover.
DEFRA TB activity contributed 10% of practice turnover and 30% of professional fees. DEFRA TB and pre-movement testing funded by the farmer accounted for 66% of all beef work carried out and 33% of dairy. The dairy TB work is comparable to 32% of dairy fertility work.
Ovine holdings numbered 25% of practice farms but only contributed 5% of the practice turnover and the beef herds 10%.
Cattle practice in the south-west of England is heavily influenced by bovine TB and the practice effort required to meet demand has been costed and monitored. Practices in lower demand TB areas will show a different workload. If TB work is removed then fertility visits to dairy herds would account for 50% of all work.
The many clinical categories are detailed by number of visits for each condition. Of particular interest is the medicine usage analysis and it is noted that 64% of injectable antibiotics were used for the treatment of respiratory conditions in youngstock. Vaccines account for 20% of dairy usage and 42% of ovine medicines.
Dry cow therapy and milking cow treatments account for 26% of all dairy medicine sales and only 1% of professional call-out fees. Only 13% of beef and 10% of dairy clinical conditions were respiratory but 64% of all antibiotics were dispensed for respiratory symptoms. The data suggest that, with both mastitis and respiratory conditions, there is a high proportion of dispensing occurring without clinical examination of the animals.
Jon Reader and Andrew Davies emphasise that it is important that the accuracy of any data being entered into the system can be trusted. Veterinary surgeons need a tool that allows data to be captured easily and quickly. Apportioning time spent to the FLYMO categories overcomes the tendency to allocate all the time for a visit to one topic (typically a fertility visit to a dairy herd), whereas accurate data indicate the many other sick cows attended to at these visits. An easy-touse on-farm tool is essential.
This study also highlights the actual incidence of disease, which varies in detail from other studies. An example is a 16% incidence of digital dermatitis within the practice compared to 5% recorded elsewhere. Clearly local conditions will apply as well as accuracy of detection.
There is considerable potential for the use of practice data if the process is able to fit within the daily framework of a veterinary practice. Already Synergy is investigating the information to better allocate veterinary surgeon time and enable individuals to contribute more effectively to practice performance.
Within the topic of evidencebased medicine, the success of treatments and interventions is a logical report to develop from practice data. This approach would go way beyond limited field trials of products for marketing authorisations.
Within a single farm the effectiveness of therapy can be detailed but also collectively to possibly direct practice approaches to disease. The field trial and research studies that are then adopted as a general scheme for national application may be an historical conversation.
If a veterinary practice is able to assess local disease control accurately and authoritatively this would provide greater confidence to the members of the practice to promote management schemes and greater confidence for the farmers to adopt veterinary recommendations.
People with existing recording approaches or new ideas are challenged to test these against the Herdkeeper tool. The toolkit, workshop, skills day and seminar may be embraced by veterinary surgeons to provide the evidence for their day-to-day work.
