MANY of you will have heard of
VetCompass, the RVC’s research
project that gathers anonymised
data from primary-care veterinary
practices. Fewer will be aware how
truly ground-breaking this project
is, or of its potential to revolutionise
veterinary care not only in the UK
but right across the world.
In 2008, the
BBC investigative
documentary
Pedigree Dogs
Exposed
suggested that
inbreeding and
adherence to breed standards could
be making pedigree dogs inherently
unhealthy. The fall-out from the
programme resulted in three separate
reports, all of which agreed with the
documentary’s conclusions.
One of the three reports, by
Professor Sir Patrick Bateson, went
further. It identified a major problem:
while there clearly were welfare issues
with pedigree dogs, there was simply
not enough evidence to prove it.
One of the Bateson Report’s most
significant recommendations was
therefore to expand an RVC project
called VEctAR – a practice-based
disease surveillance project being
developed at the RVC by Professor
David Church and Dr Dave Brodbelt.
It was at this point that a number
of events coalesced. As a result of the
BBC documentary and subsequent
reports, the RSPCA funded vet and
epidemiologist Dan O’Neill to carry
out a PhD at the RVC to study the
disorders of UK dogs and cats. In
order to have validity, this study
required large amounts of reliable data.
Working with Church and Brodbelt,
O’Neill decided to use the PhD to
develop VEctAR into a far wider-
ranging data collection system. This
project was named VetCompass.
It would not only support O’Neill’s
own PhD but he also wanted it to act
as a foundation for the development
of a not-for-pro t database to support a broad range of research to improve
companion animal welfare.
At around that time I met Dr
Brodbelt. He offered Medivet the
chance to get involved in VetCompass.
As we were in the process of
developing our own practice
management system (PMS), the timing couldn’t have been better.
We could see immediately the enormous benefits of VetCompass
to the way we work – and for
veterinary medicine as a whole. A
lot of the evidence we rely on day to
day is derived from cases referred to
specialists, which by its nature is heavily
biased. Once you start to look at
broader data you get a totally different
and much more accurate picture. We
wanted to contribute to that.
In order to get going at a viable level,
VetCompass needed the quantity of
data that a large
group like Medivet was able to provide.
At the time, our
PMS was one of the
largest Microsoft
projects of its kind being developed
in Europe. We were able to merge and
standardise our anonymised clinical
data with VetCompass from the outset,
and research could begin straight away.
Since then, VetCompass has continued
to expand as new practices and groups
have joined.
Critical to the success of
VetCompass are VeNom (veterinary
nomenclature) codes, or standardised
veterinary terms. Working with Dan
O’Neill and Dave Brodbelt, we decided
to integrate VeNom codes into our
PMS at the development stage. It made
sense to use these codes for a number
of reasons, outlined below.
Collaborative working
Our vets work collaboratively across
the group: there’s a lot of discussion
and movement of cases between our
vets. In order for us to contribute our
data to VetCompass we needed to start
using VeNom coding, but this was
useful to us too, because we wanted
our vets to be speaking the same
language to each other.
In larger practices or groups where
cases are often seen by multiple vets, standard terms make it easier and
quicker for the next vet to review the
history of the patient and get straight
to the diagnoses.
At Medivet we have seen other,
unanticipated, benefits from our
collaboration with VetCompass. We
always knew that by developing our
PMS using VeNom terms, we would be
able to analyse our own data in a way
that we previously couldn’t.
Subsequently, of course, it has
become a requirement from the Royal
College to carry out clinical audits for
clinical governance.
Now, for example, when we audit
all our renal failure cases, it’s simply a
matter of asking our IT department
to pull all diagnostic terms that relate
to renal cases from our database.
The VeNom terms have made it very
simple for us to do this.
Dan O’Neill has also reported many
other management benefits to the
VeNom coding system, not least that
recording standardised terms can save
a lot of time when filling in insurance
claims, for example.
Advances in
evidence-based medicine
Collecting data in this way also allows
us to monitor and improve our own
work. We’re using the data to improve clinical feedback
and develop
strong, evidence-
based medicine
within our group.
We’ve been lucky
too that Dan O’Neill, Dr Brodbelt, Professor Adrian Boswood and
Maddy Mattin, who are all involved in
VetCompass, have provided us with
CPD based on the work they have
been doing.
This has given us unprecedented
access to current thinking about
treatment and diagnostics based on real
data from hundreds of thousands of
animals and millions of episodes of
care.
Our relationship with the data we
collect is becoming more fluid. We are
able to make full use of this valuable
resource to improve clinical outcomes
but also to look at efficacy and adverse
reactions.
Long-term
benefits
VetCompass
doesn’t just
benefit those
practices which
are already
participating. The
data collected so
far are providing
the material
for a number of PhD and MSc
research projects, including studies
on degenerative mitral valve disease,
inherited and acquired disorders, and
canine cancer (for more information
on these, visit www.rvc.ac.uk/
VetCompass/research-projects).
Funding bodies for these studies
include the RSPCA, Dogs Trust,
Petplan Charitable Trust, the Kennel
Club Charitable Trust and RCVS
Knowledge.
Dan O’Neill recently completed his
PhD: Epidemiology of disorders reported in
dogs attending general practice in England.
A VetCompass paper from the PhD
on the prevalence of disorders in dogs
generated wide public debate and was
featured in the Sunday Telegraph and the
Mail on Sunday, and Dan was awarded
a BSAVA prize at this year’s congress
for presenting a study on longevity and
mortality in cats in England.
Dan has always been clear that
VetCompass is a resource for the
whole veterinary community. He
believes we are only at the start
of a wave of research using the
VetCompass database which will add
significantly to the sum of knowledge
available to vets working right across
the UK – the latest VetCompass paper
to be published, for example, gives
information on the prevalence and
survival of dogs with diabetes mellitus.
Dr O’Neill wants VetCompass to
provide the resources to help improve
diagnosis and treatment, the primary
objective of VetCompass being to
improve animal welfare.
Optimal evidence-based veterinary
medicine integrates current scientific
knowledge with each vet’s unique
clinical expertise and insight on his or
her own patients.
VetCompass can contribute valuably
to this knowledge base by providing
relevant evidence derived from the
clinical experience of thousands of
veterinary colleagues.
VetCompass findings will support
the development of new clinical
benchmarks for the way we do things
in practice. Dan believes VetCompass
will also help improve standards of
pharmacovigilance because the system
makes it easier to identify adverse
reactions, as well as lack of therapeutic
efficacy.
A growing project
At this point, there is an interesting
contrast between the success of
VetCompass and the results for a
similar project for the NHS which
has taken over a decade, has cost
billions of pounds to date, and has
still not been implemented. Dr O’Neill
believes that the reason VetCompass
has succeeded is because it began at a
manageable scale.
VetCompass is constantly evolving,
but I have seen it grow organically in a
steady, logical direction – and the team
is actively looking for new practices
and groups to join up. Dan expects
that in two years’ time, it will look quite
different from what it is now.
This inbuilt flexibility is borne out by a large amount of international
interest in the project. The concept of
VetCompass has always been that it
will become a worldwide project, and
this will allow epidemiological data to be collected across countries and
continents.
VetCompass Australia has recently
been set up, and there is interest
from Germany, Spain, Denmark,
New Zealand and a number of other
countries.
It’s a bold claim but those of us
involved in VetCompass see it as
the foundation stone for improved
evidence-based veterinary medicine
that will support the veterinary
profession, not just in the UK but
across the world.
