Improve Outcomes in Arthritic Pets
From the Field shares insights from Banfield Pet Hospital veterinary team members. Drawing from the nationwide practice’s extensive research, as well as findings from its electronic veterinary medical records database and more than 8 million annual pet visits, this column is intended to explore topics and spark conversations relevant to veterinary practices that ultimately help create a better world for pets.
In 2017, Banfield Pet Hospital and the North American Veterinary Community (NAVC) partnered to release the first annual Veterinary Emerging Topics (VET)® Report. Our 2017 and 2018 reports focused on antimicrobial usage patterns among veterinarians treating common canine and feline infections, respectively. For the 2019 report, we shifted gears to examine management of osteoarthritis (OA) in overweight pets.
Efforts in the veterinary and pet care industry to address the overweight pet epidemic have thus far proven unsuccessful, with Banfield’s 2017 State of Pet Health Report finding 1 in 3 pets in the U.S. is overweight or obese—and witnessing a 169% increase in overweight cats and a 158% increase in overweight dogs over the past 10 years.
As veterinary professionals know all too well, these pets are at higher risk of developing comorbidities like OA.1 Given the close relationship between excess weight and OA,2 we believe a focus on this condition and the importance of weight management in the treatment process is important to evaluate. There exists an opportunity to evolve how we have conversations about excess weight in pets—and to improve the outcomes of treating OA by reinforcing the importance of weight loss in these pets.
As part of the report, patient medical records from both canine and feline OA cases were reviewed. In addition, an online survey of veterinarians was conducted to better understand the practices in the diagnosis and management of newly diagnosed OA pets, as well as perceived barriers to providing recommended care. The Banfield study also looked at diagnostic and therapeutic practices in general veterinary practice. While guidelines and therapeutics exist, we found that following and incorporating these into the management of OA in a general veterinary practice is challenging for both the veterinary team and the pet owner.
Managing OA, particularly in pets with excess weight, is not new to the veterinary profession; however, we found several opportunities exist to improve the care these affected pets receive. Quality medical management of OA requires a multi-faceted diagnostic and treatment plan—a combination of diagnostic testing, multi-modal pain management, and weight management all needs to be considered to most effectively improve patient outcomes.
Dispense pain medications for OA pets! Almost half of the pets diagnosed with OA did not receive pain medications at the time of diagnosis. Identifying barriers to treatment—for example, cost or the owner not recognizing their pet is in pain—and finding solutions to reduce them can improve a pet’s comfort, increase mobility, and demonstrate the value of therapeutic management to the pet owner.
Tools for early identification or recognition. Client education materials, activity monitors, and validated quality of life (QoL) or chronic pain index instruments may facilitate client understanding of normal vs. abnormal for an older dog—and encourage initiation and continuation of the management plan.
Almost half of the pets diagnosed with OA did not receive pain medications at the time of diagnosis.
Incorporate a nutritional component. Nutritional management is an important component of the multi-modal approach to managing OA patients. Recent surveys indicate that pet owners want their veterinarian to provide diet or other nutritional recommendations for their pets.3,4
Veterinary technicians gathering a clear diet history at each visit, including treats, is an important part of weight management. Consider utilizing veterinary technician appointments to check on progress.
Weight management. Helping pet owners get their pets to a healthier or ideal weight is an integral component in management of these pets. Research has found that, in obese dogs, losing as little as 6.1% of their weight can lead to improvement in the clinical signs of OA.6,7 Veterinary technicians gathering a clear diet history at each visit, including treats, is an important part of weight management. Consider utilizing veterinary technician appointments to check on progress.
Patient management as a team effort. Every pet you encounter provides an opportunity to notice changes its owner might not notice—or consider normal—in their aging pet.
With the above opportunities in mind, an inward assessment of how a hospital team manages OA pets and how they can modify their approaches has the potential to improve the quality of veterinary care offered to their owners. A tool adapted from a human healthcare quality model,7 the Five Domains of Quality, can also be applied by veterinary hospital teams to enhance the quality of care, assess interventions, and improve patient outcomes (FIGURE 1).
1. German AJ. The growing problem of obesity in dogs and cats. J Nutr 2006;136(7 Suppl):1940S-1946S.
2. Frye CW, Shmalberg JW, Wakshlag JJ. Obesity, exercise and orthopedic disease. Vet Clin Small Anim 2016;46:831-841.
3. Association of Pet Obesity Prevention. 2017 pet obesity survey results. petobesityprevention.org/2017. Accessed February 8, 2019.
4. Mars Petcare. New survey weighs up potential reasons behind the pet obesity crisis. mars.com/global/our-news/our-stories/new-survey-weighs-up-potential-reasons-behind-the-pet-obesity-crisis. Accessed February 8, 2019.
5. Marshall WG, Hazewinkel HAW, Mullen D, De Meyer G, Baert K, Carmichael S. The effect of weight loss on lameness in obese dogs with osteoarthritis. Vet Res Commun 2010;34:241-253.
6. Impellizeri JA, Tetrick MA, Muir P. Effect of weight reduction on clinical signs of lameness in dogs with hip osteoarthritis. JAVMA 2000;216:1089-1091.
7. Committee on Quality of Health Care in America, Institute of Medicine. Crossing the quality chasm: a new health system for the 21st century. Washington, D.C.: National Academies Press; 2001.