VCPR- What is sufficient knowledge for presumptive diagnosis? (Proceedings)


VCPR- What is sufficient knowledge for presumptive diagnosis? (Proceedings)

Aug 01, 2010

The regulatory agencies that license and regulate us include the requirement that we maintain a valid veterinary client patient relationship (VCPR). A taskforce for the Wisconsin Veterinary Medical Association struggled with defining the phrases in the VCPR for our examining board:
     • Medically appropriate and timely visits
     • Personally acquainted with keeping and care of animals
     • Recently seen
     • Sufficient knowledge to initiate a general or preliminary diagnosis

It was difficult because one size doesn't fit all for any of these phrases for either our clients or the individual veterinarians responsible for those clients. As practitioners we will do well to make sure we have defined those for each dairy that we hold the VCPR. The new dairy animal care certification program asks the producers if they have a valid VCPR as the very first question. We will have the opportunity to define VCPR for our clients as we work through the FARM animal care certification program and establish the appropriate values for each client.
     • Recently seen, medically appropriate, and timely visits" is specific by dairy. How we deliver it in a sound business plan for both ourselves and the producer is yet to be discussed but is found as the plan for regular supervision of cows currently under treatment which will be developed as part of an expansion of our fertility programs.
     • "Personally acquainted with care and keeping is the application of production medicine and health care by management group. We need to systematically identify the predisposing risk factor for each management group and monitor the impacts on animal health using their health records.
     • Defining sufficient knowledge for a presumptive diagnosis allows us to concentrate on the medical aspects our health care offering. The knowledge we can glean from our records is:
           o Knowing the pattern of conditions (epidemiology)
           o Using shifts in patterns to trigger diagnostics or shifts in care package risk factors
           o Knowing the outcomes of conditions treated

The cow side recordings established the basis for routinely determining both the epidemiology of conditions and treatment outcomes. Establishing the pattern of clinical cases is an extension of the process used to routinely monitor KPIs except now the plan is to be thorough and not to stop with a few key monitors. For business reasons this needs to be done efficiently and regularly if we are to deliver real time sensitive information specific to the dairy.

For a condition such as mastitis we start with a measure of the incidence rate and then dissect that amorphous mass into information so we understands what is happening when to whom
     • By stage of lactation at the first case
     • By cause of the infection
     • By severity of the case
     • By sub clinical mastitis history
     • By clinical mastitis history

Table 1 list of 10 mastitis cow with pattern information included. Only records required was a recording of the mastitis case at the time of treatment and including the recording of the culture and SCC
It is nothing more complex than integrating the information of interest for the list of cows that have had mastitis in a period of time as a "summary command". Table 1 demonstrates such a listing which could have been for a month, quarter, or year. Efficiently, the information can be tabulated in the vertical columns while the individual identity of cows can be maintained horizontally. Table 2 demonstrates the mastitis pattern for a real dairy for a year by tabulating the vertical columns.