Australian Veterinary Practices Research Articles

Anaesthetic practices and attitudes to patient safety in a sample of Australian veterinary practices

ObjectiveTo survey anaesthetic practices and attitudes towards veterinary patient safety in Australia. Study designThis was a cross-sectional sample population from Australian veterinary practices, including first opinion small animal, mixed animal and referral small animal practices. The survey included practices’ anaesthetic management, monitoring equipment and topics regarding patient safety. ResultsResponses were obtained from 310/1700 (18%) veterinary practices, with 208 respondents from small animal practices (67%), 71 mixed animal practices (23%) and 31 referral small animal centres (10%). Overall, 61% of respondents reported always having a dedicated staff member monitoring the anaesthetic, who was most commonly a certified veterinary nurse (89%). In 22% of the practices, some of the staff monitoring an anaesthetic did not have any qualification. Completion of anaesthetic plans for each animal prior to an anaesthetic was reported by 24.5% of respondents and labelling of syringes was completed in 80% of practices. Pulse oximetry (98%) and temperature (88%) were the most common clinical variables monitored. The use of capnography (46%) or an electrocardiogram (48%) was also reported by the respondents. Emergency drugs, airway and ventilation equipment are available in 96%, 88% and 59% of practices, respectively. A defibrillator was available in 11% of practices with only 54% respondents being confident in using it. Of the respondents 60% were aware of anaesthesia safety interventions and clinical guidelines regarding patient safety during anaesthesia. Conclusions and clinical relevanceDespite practices showing a relative improvement over the years in the standard of anaesthesia care, most of them are still not meeting international guidelines. Areas where changes could lead to improved safety practices could include: a trained person dedicated to monitor anaesthesia, pain scoring evaluation in patients recovering from anaesthesia, an increased use of standardised handover checklists, record keeping and an increase in open discussion of adverse events by the veterinary team.

Retrospective Analysis of Heartworm (Dirofilia immitis) Prevention Medication Compliance and Economic Value in Dogs in Veterinary Practices in Australia.

Background: Canine heartworm (HW) is endemic in Australia. Prevention usually involves monthly topical or oral preventives, or annual injections of extended-release moxidectin (ProHeart SR-12*1), hereafter referred to as injectable moxidectin (IM). Poor compliance can leave dogs susceptible to infection. This pharmacoeconomics study used retrospective transactional data from 52 Australian veterinary practices to examine the economic value of compliance, revenue, and patient retention associated with veterinarian-sourced canine HW prevention.Methods: This longitudinal descriptive study utilized anonymized transaction records of 228,185 dogs identified to have visited a veterinary practice at least twice in the period 2010–2015. Purchase compliance against a benchmark of 12 months HW protection per year was measured for IM or monthly HW (MHW) preparations each year and for consecutive years. The average annual cost per dog by preventative modality was also determined.Results: Between 2010 and 2015, of the 228,185 dogs identified, 73.0% recorded either zero or one purchase of HW preventive from their veterinary clinic; 18.7% recorded at least two IM purchases, and 10.6% purchased MHW prevention at least twice. Single-year purchase compliance was 92.8–96.9% for IM vs. 26.9–36.5% for dogs receiving MHW products. Consecutive-year purchase compliance was 76.7% for IM and 24.4% for MHW medications. Dog owners spent $AU108.29/dog/year (Australian dollars) on IM vs. $AU131.96/dog/year on MHW prevention products, which may have treated other parasites concurrently, although repeat MHW purchasers only purchased enough to cover an average of 7.2 months per year. Dogs recording at least two HW prevention transactions generated more revenue for veterinary practices/dog/year compared to dogs with less than two. Finally, dogs receiving IM, especially those that started at <15 months old, had the highest retention rate in this population.Conclusions: In the 5 years from 2010 to 2015, 73% of dog owners who visited a veterinary practice at least twice made less than two purchases of HW preventatives from the veterinary practice. For those with at least two preventative purchases, 76.7% of dogs receiving IM and 24.4% of dogs prescribed with MHW products purchased enough doses to provide continuous protection over the observation period.

Is canine heartworm (Dirofilaria immitis) endemic to South Australia?

Canine heartworm (Dirofilaria immitis) was reported as endemic to South Australia over 25 years ago, but the current status of canine heartworm infection in South Australia is unknown. We surveyed South Australian veterinary practices to collect evidence about canine heartworm cases, prevention, screening and treatment practices. In total, 141 veterinary practices operating in South Australia (92.3% response rate) completed a 12-question telephone survey. Five confirmed cases of heartworm and one suspected false-positive case were reported from separate practices over the 2016-17 financial year. All confirmed cases had recently relocated to South Australia from interstate. Incidence of canine heartworm was estimated at 0.00% (95% confidence interval (CI): 0.00-0.0006) and prevalence at 0.002% (95%CI: 0.00-0.004) using conservative estimates of the South Australian dog population. Attitudes and protocols regarding heartworm differed significantly between metropolitan and rural veterinary practices. All metropolitan practices recommend systematic medicated prevention against heartworm, while some rural practices (20.7%) recommend prevention only when travelling interstate (P < 0.001). Although there is a minor source of heartworm from introduction of infected dogs into South Australia, there is no evidence that the infection is transmitted to other dogs within the state. Therefore, it is unlikely that heartworm is currently endemic to South Australia as reported in the past. This new evidence provides a strong case to refine current prevention practices to reflect the current negligible risk of heartworm infection within South Australia.

Animal welfare implications of treating wildlife in Australian veterinary practices.

To evaluate the extent, costs, demands and expectations of Australian veterinary practices in the treatment of wildlife, to identify potential risks to animal welfare based on the current situation and to propose recommendations for improvements. A survey was sent to all veterinary practices across Australia identified through the website Yellow Pages®. The survey was designed as a cross-sectional study. Data were collected using an online self-completed questionnaire and analysed using IBM SPSS 19.0. Of the 902 veterinary practices contacted, 132 (14.6%) completed the questionnaire. Most practices (82%) saw less than 10 wildlife patients per week, with birds and marsupials most commonly admitted. Vehicular trauma, trauma (other) and predation made up the majority (82%) of presentations. However, wildlife cases were only examined immediately upon presentation in 20% of practices, with 74% reporting they only attended to wildlife whenever they had spare time. The majority (90%) of veterinary practices never or rarely received reimbursement for their wildlife work, indicating most is performed pro bono. Several barriers to treatment were highlighted, including time and a lack of knowledge/skills. Private veterinary practices play a more significant role in wildlife treatment than has been previously thought. The effect of perceived barriers on willingness to treat wildlife requires further research. Further investigation into educational resources to aid veterinary assessment of wildlife should also be considered.

Antimicrobial labelling in Australia: a threat to antimicrobial stewardship?

Antimicrobial resistance is a public health emergency, placing veterinary antimicrobial use under growing scrutiny. Antimicrobial stewardship, through appropriate use of antimicrobials, is a response to this threat. The need for antimicrobial stewardship in Australian veterinary practices has had limited investigation. A 2016 survey undertaken to investigate antimicrobial usage patterns by Australian veterinarians found that antimicrobial dose rates were varied and often inappropriate. Doses of procaine penicillin in horses and cattle were often low, with 68% and 90% of respondents, respectively, reporting doses that were unlikely to result in plasma concentrations above minimum inhibitory concentrations for common equine and bovine pathogens. Frequency of penicillin administration was also often inappropriate. Gentamicin doses in horses were largely appropriate (89% of dose rates appropriate), but 9% of respondents reported twice daily dosing. Amoxycillin and amoxycillin-clavulanate were administered at the appropriate doses, or above, to dogs and cats by 54% and 70% of respondents, respectively. Here, we explore the potential reasons for inappropriate antimicrobial dose regimens and report that antimicrobial labels often recommend incorrect dose rates and thus may be contributing to poor prescribing practices. Changes to legislation are needed to ensure that antimicrobial drug labels are regularly updated to reflect the dose needed to effectively and safely treat common veterinary pathogens. This will be especially true if changes in legislation restrict antimicrobial use by veterinarians to the uses and doses specified on the label, thus hampering the current momentum towards improved antimicrobial stewardship.

Antimicrobials used for surgical prophylaxis by equine veterinary practitioners in Australia.

Antimicrobials are widely used in Australian veterinary practices, but no investigation into the classes of antimicrobials used, or the appropriateness of use in horses, has been conducted. The aim of the study was to describe antimicrobial use for surgical prophylaxis in equine practice in Australia. Cross-sectional questionnaire survey. An online questionnaire was used to document antimicrobial usage patterns. Information solicited in the questionnaire included demographic details of the respondents, the frequency with which antimicrobials were used for specific surgical conditions (including the dose, timing and duration of therapy) and practice antimicrobial use policies and sources of information about antimicrobials and their uses. A total of 337 members of the Australian veterinary profession completed the survey. Generally, the choice of antimicrobial was appropriate for the specified equine surgical condition, but the dose and duration of therapy varied greatly. While there was poor optimal compliance with British Equine Veterinary Association guidelines in all scenarios (range 1-15%), except removal of a nonulcerated dermal mass (42%), suboptimal compliance (compliant antimicrobial drug selection but inappropriate timing, dose or duration of therapy) was moderate for all scenarios (range 48-68%), except for an uninfected contaminated wound over the thorax, where both optimal and suboptimal compliance was very poor (1%). Veterinarians practicing at a university hospital had higher odds of compliance than general practice veterinarians (Odds ratio 3.2, 95% CI, 1.1-8.9, P = 0.03). Many survey responses were collected at conferences which may introduce selection bias, as veterinarians attending conferences may be more likely to have been exposed to contemporary antimicrobial prescribing recommendations. Antimicrobial use guidelines need to be developed and promoted to improve the responsible use of antimicrobials in equine practice in Australia. An emphasis should be placed on antimicrobial therapy for wounds and appropriate dosing for procaine penicillin.

Demographic and preliminary employment data of the first two graduate cohorts from a rural veterinary school.

To report initial career experiences and graduate employment destinations 1 and 5 years following graduation of the 67 graduates from the first two graduating classes of the veterinary science program at Charles Sturt University. Online survey of graduates from the 2010 and 2011 cohorts undertaken 12 months following course completion and descriptive data on graduate practice locations 5 years post-graduation. Questions covered general demographic information, issues relating to work-life balance and factors influencing vocational choices. Descriptive statistics and qualitative responses are reported, with comparisons between continuous variables by two-sample t-test and between categories by Chi-square analyses. Significance was set at P < 0.05. Graduates' locations 5 years after graduation were obtained from veterinary registration details and staff contact with graduates. Complete survey responses were received from 39 graduates of whom 34 were employed in regional areas, 1 in a very remote area, 3 in major cities and 1 overseas. Hours worked and salary received were consistent with other survey data, with new graduates working in regional practices earning slightly more than those working in metropolitan practices. At 5 years following graduation, the majority (56/61, 92%) remained in rural or regional Australian veterinary practices, with a further five graduates overseas and one lost to follow-up. This study supported the selection criteria and educational approaches at CSU in establishing most of the new graduates in rural and regional mixed veterinary practice.

A qualitative study to explore communication skills in veterinary medical education.

Objectives:To explore and gain an understanding of what “clinical communication skills” mean to veterinarians working in private practice and what implications this might have for veterinary medical education.Methods:Qualitative research methods were used to purposefully sample a range of veterinary practitioners from a pool of South Australian veterinary practices who were interviewed to determine their understanding of what communication skills mean in the context of veterinary practice. Interviews were conducted with fourteen veterinary practitioners. Participants were sampled from a range of ages, veterinary schools of graduation plus urban and rural locations. Interview transcripts were analysed for themes, definitions and contexts.Results:Participants’ accounts included a number of skills which they considered to be “communication”. Some of the definitions of these skills parallel communication skills and competencies for human medicine on which communication skills training incorporated into veterinary curricula to date have largely been based. However, the veterinarians in this study also raised interesting contextual differences unique to the veterinary profession, such as communication with the animal, selling service, discussing money in relation to decisions for care, and communicating about euthanasia.Conclusions:Veterinary practitioners require high level communication skills. Education and training in veterinary medicine may be better tailored to reflect the unique context of the veterinary profession.

Veterinary infection control in Australia: is there control?

There is little information relating to infection control procedures in Australian veterinary practices. This review summarises the findings of international studies in the area of zoonoses and infection control, and discusses potential reasons for the apparent complacency about these issues in veterinary practice. It is the authors' opinion that legislative changes governing veterinary practice in Australia should be implemented. The curricula in veterinary schools should also emphasise infection control. These measures would significantly improve safety issues associated with the control of zoonoses in veterinary practice.

The cat flea (Ctenocephalides f. felis) is the dominant flea on domestic dogs and cats in Australian veterinary practices

This study was undertaken to determine the flea diversity on urban dogs and cats in Australia in 2009-2010. A total of 2530 fleas were recovered from 291 animals (151 dogs, 69 cats and 71 uncategorised dogs or cats) from veterinary clinics across five states of Australia. The majority of specimens were from coastal areas. The cat flea (Ctenocephalides felis felis) was the most frequent flea species identified (98.8%, 2500/2530). The only other flea species identified was the stickfast flea (Echidnophaga gallinacea) from Western Australia. Sequencing of the cytochrome oxidase subunit II mtDNA revealed a single haplotype across Australia within a subset of C. f. felis (n=19). Our study demonstrated dominance and haplotype homogeneity of C. f. felis on dogs and cats. Although Ctenocephalides canis was recovered from a feral fox, it was not identified from the sample of fleas analysed. This suggests that, under current conditions, it is unlikely that foxes are reservoirs of C. canis for domestic dogs or cats residing in coastal Australia, as previously speculated.

Prevalence of obesity in dogs examined by Australian veterinary practices and the risk factors involved

A study was undertaken to determine the prevalence of obesity in dogs examined by veterinary practices across Australia, and to determine the risk factors involved; 1700 practices were asked to...

The use of sutures in Australian veterinary practices

One hundred and twenty six respondents at a continuing education course in February 1986 provided information on suture use in their practice. The 100 responses from four Australian states were subject to analysis of suture type and size used for various procedures and correlated with practice type, location and state. The use of gut and nonabsorbable sutures in cassettes was pervasive. Superior materials and sutures in individual foil packets were used commonly only for a more complicated procedure (enterotomy).