Ask the Vet
Ask the Vet: The veterinary-client-patient relationship
By Tom Inglis
What is it and why is it important?
By Tom Inglis
Some perceive the term Veterinary-Client-Patient Relationship (VCPR) as formal and rarely used or understood. It does not have to be that way. Simply stated, a VCPR involves a veterinarian and poultry producer developing and maintaining a working relationship.
Together, they promote bird health, prudent use of antimicrobials and bird welfare. It is a relationship built on trust, mutual respect and both parties sharing information and knowledge for mutual benefit.
A valid VCPR is similar to the rapport we have with our family doctor. (One difference is that the flock owner/manager intercedes on behalf of the birds.) Any discussions with your physician as well as your records are strictly confidential. Your doctor commits to providing you with health care based on your needs. Similar to veterinary medicine, the emphasis is on disease prevention but, when needed, diagnosis and appropriate treatment as well.
What determines a legitimate VCPR?
Each veterinary body has its own definition of VCPR. The Antimicrobial Prudent Use Guidelines (2008) of the Canadian Veterinary Medical Association states that VCPR exists when these three conditions have been met:
- The veterinarian has assumed responsibility for making clinical judgements concerning the health of the birds. The client has agreed to follow the veterinarian’s instructions.
- The veterinarian has sufficient knowledge of the specific flock of birds to initiate at least a preliminary diagnosis of the medical condition of the birds. This means the veterinarian has recently seen and is personally acquainted with the keeping and care of the birds.
- The veterinarian is readily available for follow-up evaluation or has arranged emergency coverage in the event of adverse reactions or failure of the treatment regimen.
A legitimate VCPR is considered to exist only if medical records of the veterinary practice contain sufficient evidence of relevant and timely interactions between the veterinarian, animal owner and animal patients (e.g., specific flocks of birds). Accordingly, when the provincial or territorial regulatory body audits a practice, prescribing and/or dispensing of a medication must be supported by evidence of a VCPR.
A valid VCPR must exist before a veterinarian can prescribe or dispense a medication. Interactions that support the existence of a valid VCPR include:
- Farm visits
- Consultations (in-person, telephone, social media)
- Laboratory reports
- Analysis of production records; commentary
- Post-mortem reports; surveillance data
Having a valid VCPR will be critical going forward. That’s because in December 2018 Health Canada is introducing changes that will require veterinary stewardship (veterinary prescriptions) in the use of medically important antimicrobials (MIAs) in feed and water for livestock and poultry.
What does it mean for veterinarians?
The pending increase in veterinary oversight of MIAs will have an immediate impact. More prescriptions will be required and in a timely manner, especially for use of MIAs in feed. Professional ethics dictate that a veterinarian cannot write a veterinary prescription for a flock of birds without a valid VCPR.
Aside from veterinary prescriptions, a valid VCPR provides the interaction with a client that permits veterinary medicine to be practiced as it should. A valid VCPR makes the veterinarian a valued participant in problem solving, improving bird health (which, in turn, reduces undue bird suffering from disease) and food safety.
Veterinarians can contribute fully when they are familiar with the production units, history, performance goals and current challenges. All of this can only be achieved by working closely with clients in a valid VCPR.
What does it mean for producers?
Outcomes vary with any collaboration based on a number of factors. The same is true for the veterinary-producer interaction. Logistics for farm visits is a challenge in a country as big as Canada! Nevertheless, these are examples of realistic outcomes of a valid VCPR as compared to not having one:
1. Support in problem solving
An example could be a problem of reoccurring outbreaks of coccidiosis at a certain time-point in the grow-out. By reviewing barn data together, the farm manager and veterinarian conducted post-mortems and serology. They came up with these findings:
Outbreaks occur in bottom but not top floors, suggesting heating and ventilation to be a factor.
Serology revealed sub-clinical infectious bursal disease virus (IBDV) infection had occurred with subsequent immune-suppression. The coccidiosis outbreaks were secondary to IBDV.
The species of coccidia present was not sensitive to the anticoccidial used in rotation.
With the above-mentioned findings the poultry producer and veterinarian could develop strategies to solve the problem. This would not happen with each working alone, hence the value of the VCPR.
2. Information transfer
Licensure of a veterinarian requires that they complete a minimum number of hours of continuing education each year. Most fulfill this by giving presentations and attending meetings of peers. Thus, in the interaction between producer and veterinarian, discussions may address these examples:
What is the latest in infectious bronchitis virus (IBV) findings (i.e., what has been found for my area, new vaccines, etc.)? A similar discussion could occur around recent challenges with reovirus.
Should pullets be vaccinated against infectious larngotracheitis (ILT) and, if so, what is the program? Note: This discussion would only apply to provinces that have the disease. This discussion would require knowledge of the history of the farm, production cycle, etc. – information only available within a VCPR.
3. Bird welfare and euthanasia training
Provincial marketing boards require that management of each production unit have personnel trained to know when euthanasia of a bird is necessary to prevent undue bird suffering. They must also use approved techniques to perform the task. Changes in personnel require on-going training for assessment of bird welfare and validation of procedures for euthanasia. Management and veterinarians working together to ensure trained employees deliver bird welfare is a very important outcome of a valid VCPR.
4. Compliance with increased veterinary oversight of MIAs
This year will mark the implementation of Health Canada regulatory and policy initiatives pertaining to antimicrobial use and resistance. Growth promotion claims will be removed from feed premixes that contain MIAs. Certain drugs that were available over-the-counter will now require a prescription. As a result, point of purchase may change according to provincial and territorial regulations.
Use of all medications containing MIAs will require a veterinary prescription as of December 1, 2018, regardless of whether they are administered via feed or water. Thus, most medicated feeds that presently do not require a veterinary prescription will require one.
This is a major change for poultry producers, the feed industry and veterinarians.
As noted previously, a valid VCPR must exist before a veterinarian can prescribe or dispense a medication.
Therefore, it is crucial that veterinarians and poultry producers establish a valid VCPR that will meet the requirements of a third-party audit as soon as possible.
Going forward, things will be difficult if not impossible without a valid VCPR.
Tom Inglis is managing partner and founder of Poultry Health Services, which provides diagnostic and flock health consulting for producers and allied industry. Please send questions for the Ask the Vet column to firstname.lastname@example.org.