Pet-Specific Care for the Veterinary Team. Группа авторов

of practices, clientele, and treatment plans early in their career or education, veterinarians will be more comfortable offering those plans to their clients.

      Organized veterinary medicine also has a role to play. Clinical guidelines that include all options should be developed for the major health conditions of dogs and cats (see 9.3 Guidelines). The full spectrum of care choices should be elucidated and discussed, understanding that more sophisticated and expensive treatments may yield more favorable outcomes, but that more cost‐effective, lower‐probability‐of‐success options should also be included and offered, if needed. In the absence of clinical guidelines provided by national organizations, state or local organizations could produce such documents, and they could even be generated by individual practices. The most important aspect is that veterinary health professionals collectively agree upon a set of options to offer for the most commonly encountered health concerns.

      Lastly, it should be recognized that some conditions do not have low‐cost options available. In these circumstances, it is doubly important for the owner to understand that financial limitations are valid reasons for not pursuing treatment. Humane euthanasia is always an option when quality of life concerns are present. This may feel unsatisfactory at the moment but by incorporating incremental care philosophies into a practice, clients will feel they are an integral part of healthcare decisions, which in turn helps bind them to a practice regardless of ultimate outcome for this pet.

TAKE‐AWAYS

       Incremental care is a philosophy that holds that there are medical options falling along the entire cost spectrum for most health conditions and that all the available options should be discussed with pet owners.

       This is in contrast to “gold standard care,” in which only the most effective and (usually) most expensive treatment options are, at least initially, presented.

       This philosophy recognizes that responsible pet ownership is demonstrated when a veterinary care team is contacted and is not dictated by the subsequent healthcare decisions, which may be constrained by financial or other factors.

       By engaging in a conversation about the range of possible options, pet parents are more likely to consider themselves a partner in their pet's care, as opposed to a customer simply paying for a service.

       It is recognized that there are some conditions that do not have low‐cost options available and therefore humane euthanasia must always be considered an acceptable course of action if quality of life could deteriorate to an unacceptable level.

MISCELLANEOUS

      2.2.3 Cautions

      Licensing boards and legislatures are inconsistent in their approach to standards of care in veterinary medicine (see 9.5 Better Understanding Standard of Care). Be sure to understand the current interpretations of standards before offering any healthcare option that may be considered “substandard.”

Recommended Reading

      1 Stull, J.W., Shelby, J., Bonnett, B. et al. (2018). Barriers and next steps to providing a spectrum of effective health care to companion animals. Journal of the American Veterinary Medical Association. 253 (11): 1386–1389.

2.3 Prevalence and Incidence

       Samuel Stewart, DVM, DACVECC and Chand Khanna, DVM, PhD, DACVIM (Onc), DACVP (Hon)

       Ethos Veterinary Health, Woburn, MA, USA

BASICS

      2.3.1 Summary

      Prevalence and incidence are both terms used to describe the occurrence of a disease over a period of time. Prevalence is defined by the number of individuals alive with a disease, while incidence is defined by the number of newly diagnosed cases of a disease divided by the population at risk of developing that disease. Incidence is often not able to be described in veterinary medicine as the population at risk of developing a given disease process is generally not known and would require a pet census. Additionally, it assumes that there is a steady rate of disease occurrence over a specified period of time, which is not always true of disease states. In veterinary studies prevalence is more commonly used as it does not require definition of the at‐risk patient population.

      2.3.2 Terms Defined

      Epidemiology: The study of how diseases occur in given patient populations and why.

      Incidence: The rate of newly diagnosed cases of a given disease process in a specified period of time.

      Prevalence: The number of cases of a disease process that occur in a specified period of time.

MAIN CONCEPTS

      2.3.3 Introduction

      Epidemiology is the study and analysis of diseases in a given population of people or animals. It focuses on factors of disease, such as cause, risk factors, frequency, and distribution/pattern. The purpose for the study of these factors is the goal of achieving control of the disease process (i.e., means to reduce its occurrence) or to define the size of a market before developing and commercializing an innovation for disease.

      Prevalence and incidence are terms commonly used when describing the study of epidemiology. Prevalence is the actual number of cases that are alive and affected by a specific disease in a given period of time. Incidence is the calculated risk of an individual acquiring a disease in a given period of time. Both variables can be defined as disease occurrence within a certain amount of time (rate) or within a specified population (proportion).

Prevalence and incidence are expressed as fractions, which allows for the estimation between the probability of disease and the various factors that can influence that probability. The numerator of the fraction represents the number of patients that have the disease (for prevalence) or the number of newly diagnosed cases of disease (for incidence). The denominator represents the size of the population from which the individuals were drawn (for prevalence) or the size of the at‐risk group of individuals (for incidence). The denominator can also be expressed in relation to time (e.g., cases of disease/population time).

      2.3.4 Key Differences

      Prevalence can be expressed over a period of time, referred to as period prevalence, and can also be expressed at a specific point in time, known as point prevalence. Point prevalence does not provide as good a measurement of disease as period prevalence as it is only accounting for cases alive with that disease at a given point in time and does not look at new cases and deaths over a defined time period.

      Incidence refers to the number of newly diagnosed cases of a given disease. It is expressed as a fraction of the number of new cases of disease divided by the population at risk of developing the disease (e.g., 100 cases per 100 000 people = 0.001). In essence, incidence allows for determination of an individual's probability of being diagnosed with a disease during a given period of time.

      There are two ways in which incidence can be expressed: incidence risk and incidence rate. Incidence risk (also known