Wild, Isabella
(2018)
Disseminating evidence to equine practitioners.
MRes thesis, University of Nottingham.
Abstract
Abdominal pain is a significant welfare concern in equids and is frequently seen as an emergency in first opinion veterinary practice. Although there is a wealth of research into the condition at referral level, there is a paucity of studies with relevance to the primary assessment of the colic case. Furthermore, there is a wide variation on techniques used by veterinary practitioners, most based on anecdotal evidence or clinical experience. This has highlighted the requirement of development of evidence in this area to assist with the primary assessment of the colic case.
The aim of the project was to explore methods of disseminating evidence-based materials in equine veterinary practice. There were three phases: Phase 1 assessed methods of dissemination of evidence for practitioners, Phase 2 generated consensus statements on the primary assessment of colic and Phase 3 developed methods of dissemination, based on the outcomes of Phases 1 and 2.
The aim of the first phase was to identify barriers to knowledge transfer in equine practice. Semi-structured interviews were conducted with seven equine veterinary practitioners on how they accessed information, barriers they faced, and their preferred options for knowledge transfer (Appendix I). Interviews were recorded, transcribed, and analysed using thematic analysis. Based on these outcomes, an online questionnaire on knowledge transfer in equine practice was developed and distributed. Analysis of the interviews identified three main areas: practitioners’ experience, time constraints and accessibility, with an overarching theme of practice culture. Preferred methods of knowledge transfer included apps and web-based resources, but several practitioners also relied on hard copy resources. The importance of concise, visual information was highlighted. There were 129 participants in the online survey. The main barriers identified were lack of time (76.4% participants) and difficulty accessing articles (65.2%). The resources accessed most frequently on a daily basis were apps (14.3%) and online papers (12.1%), and on a weekly basis were textbooks (29.7%) and online papers (23.1%). The preferred methods of knowledge transfer were websites and online publications (89.2% and 84.3% survey participants likely/very likely to use these). This study was the first step to understanding how information is accessed in practice, and how resources can be developed to maximise uptake.
The aim of the second phase was to develop consensus statements on the primary assessment of horses with clinical signs of colic. Statements on the primary assessment of horses with colic, previously generated in multi-stakeholder workshops, were circulated to veterinary practitioners through an online consensus survey. Statements were accepted (>75% agreement) or rejected (<25% agreement). Statements which did not reach consensus (25-75% agreement) were reviewed, amended and redistributed up to three rounds. Two hundred and thirteen veterinary practitioners participated in the consensus survey. One hundred and forty statements met consensus, seven were rejected and 127 did not reach consensus. All (100%) participants agreed the minimum physical examination in every case should include: pain assessment, heart rate, capillary refill time, mucus membranes, gut sounds and rectal temperature. The areas with greatest consensus were regarding physical examination and abdominal ultrasound. Notably, statements on the common diagnostic test, rectal examination, had poor consensus. The number of statements did not reach consensus, highlighted a requirement for more evidence in these areas.
The aim of the third phase was to develop methods of disseminating information on the primary assessment of colic, based on outcomes of Phases 1 and 2. Veterinary websites and health campaigns identified in the survey in Phase 1 were reviewed and assessed, and using this and review of medical campaign websites, a new website and campaign logo and branding was developed. The ‘VetReact’ campaign and materials provided freely accessible online resources for veterinary practitioners on key components of primary assessment (clinical signs, history-taking, physical examination and diagnostic tests) and differentiation of critical cases, in addition to links to owner resources, other veterinary websites and primary evidence. This was built as a ‘go-to’ resource website, from which hard copy resources could be downloaded.
Recommendations were presented in an easy to read format, with a simple format to ensure ease of use and accessibility. The website was launched in March 2017, through equine media and talks at veterinary schools. The website and materials are continuing to be developed and promoted.
This research represents a component of a larger scale project, the Nottingham Colic Project. It has specifically focused on developing and disseminating information to practitioners. The project materials are designed to assist with the primary assessment of colic cases and identification of critical cases at an early stage, with the overall goal of reducing the morbidity and mortality from colic and improving the welfare of the horse.
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