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How the evidence-based veterinary medicine manifesto for better animal health was developed
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A draft manifesto for evidence-based veterinary medicine for better health was published in Vet Record in August 2019 (VR, 3 August 2019, vol 185, pp 128-131) (see right).

It was the outcome of a panel debate and audience participation at the Evidence Live conference, held in Oxford in July 2019.

This debate had considered the evidence-based medicine manifesto for better healthcare1 that was used in human healthcare, and whether there was a need for a similar manifesto for veterinary use, whether it was suitable for veterinary professionals and, if so, what amendments were needed.

We invited feedback from vets and, based on comments received, amended the draft version to the final version (http://doi.org/10.1136/vr.m3409).

Agreement of what changes were made was reached by a panel that consisted of Marnie Brennan, director of the Centre for Evidence-based Veterinary Medicine, University of Nottingham, Rachel Dean, director of clinical research and excellence in practice, VetPartners, Chris Gush, executive director, RCVS Knowledge, and Suzanne Jarvis, representing Vet Record.

Proposed Evidence-based veterinary medicine manifesto for better health

It is proposed that veterinary professionals and other stakeholders should act according to the following principles to improve evidence-based veterinary medicine:

  • Vet professionals are the advocates of animals – patients not clients are the primary focus of what we do

  • Expand the role of health professionals, policymakers and clients in research

  • Increase awareness and the systematic use of existing evidence

  • Make research evidence relevant, replicable and accessible to end users*

  • Reduce questionable research practices, bias and conflicts of interests

  • Ensure drug and device regulation happens and is robust, transparent and independent

  • Produce better usable clinical guidelines†

  • Support innovation, quality improvement,‡ and safety through the better use of real-world data

  • Educate professionals, policymakers and the public in evidence-based healthcare to enable informed decisions

  • Identify and encourage the current and next generation of leaders in evidence-based medicine

* Vets, vet nurses, owners, farmers, professional organisations, policymakers, etc

† Use a common, clear language for guidelines, protocols, checklists

‡ Define and use a common language for consistency for innovation and quality improvement

Suggestions for change:

  • ‘Vet professionals are the advocates of animals – patients not clients are the primary focus of what we do.’

    The greatest number of comments were received on this first call to action. First, many people said that, as phrased, the call was divisive, as it suggests the client is not part of the decision-making process. It was agreed that although a veterinary professional’s principal concern must be to advocate for animal health and welfare, the client view – be they pet owner, farmer, consumer or one of the many other stakeholders that vet professionals encounter – must be part of the picture. The role of the client was added to this call.

  • ‘Vet professionals are the advocates of animals – patients not clients are the primary focus of what we do.’

    Another area of debate was around the use of the word ‘patient’. Some respondents felt this was too pet-centric, while others pointed out that an animal receiving veterinary attention wasn’t necessarily receiving treatment, for example, an animal on the way to slaughter. One respondent suggested using ‘animals under my care’, but this was considered too close to the wording used in the RCVS code of professional conduct, and so could potentially exclude veterinary nurses and those working outside the UK. The panel made the decision to go with the unambiguous ‘animal’.

  • ‘Vet professionals are the advocates of animals – patients not clients are the primary focus of what we do.’

    As written, this first call was not a call to action. This was because being an advocate for animals spanned all the calls and was not restricted to this call only. The decision was made to introduce this element to the introduction so that it now reads: ‘As advocates for animals, veterinary professionals and others should act according to the following principles to improve evidence-based veterinary medicine.’ It was removed from the first call.

  • ‘Expand the role of health professionals, policymakers and clients in research.’

    Some respondents questioned the inclusion of policymakers and clients in this call to action. While clients and policymakers should not have undue influence on research, to cut them out of identifying relevant areas of research seemed like a missed opportunity, they argued. The phrase ‘ensure research is relevant’ was added to the call to clarify the role of clients and policymakers.

  • ‘Increase awareness and the systematic use of existing evidence.’

    One of our endorsers suggested making this call stronger. The panel agreed and the following wording was used to replace it: ‘Increase awareness of the value, and the need for systematic use, of the best-available evidence when making clinical decisions.’

  • ‘Reduce questionable research practices, bias and conflicts of interests.’

    The suggestion was made to change this call to be more positive, and make it about increasing the quality of research. However, the panel felt strongly that this call should not be altered in this manner. In many cases questionable practices will not be a deliberate attempt to deceive but, nevertheless, the panel agreed they must be identified and addressed to improve the evidence that is generated by research.

  • ‘Ensure drug and device regulation happens and is robust, transparent and independent.’

    The way this call to action was written implied that drug regulation does not happen, so this was rewritten to make it clear that it is device regulation that is needed, but also calls for improved regulation of drugs. The new call reads: ‘Improve drug regulation so that it is more robust, transparent and independent and initiate device regulation.’

  • ‘Make research evidence relevant, replicable and accessible to end users.’

    Some respondents suggested that the role of the client should also be incorporated in this call. Most clients will not have direct access to the evidence that has informed the recommendations made, so it was considered helpful to make this addition so as to encourage involving the client fully in the decision-making process by discussing this evidence with them.

  • ‘Produce better usable clinical guidelines.’

    One respondent suggested that by using the word ‘usable’, it implied that previous guidelines were unusable, so the word ‘usable’ was changed to ‘quality’. This was another call where consideration for the client and other stakeholders was added on the suggestion of endorsers, again with the view to make guidelines as relevant as possible.

  • ‘Support innovation, quality improvement and safety through the better use of real-world data.’

    Some of the endorsers questioned the use of the term ‘real world’ here. The intention of this call to action is to encourage more use of data generated in practice or in a practical setting rather than in laboratory or theoretical situation, so the panel agreed to change ‘real world’ to ‘veterinary interactions’.

  • ‘Educate professionals, policymakers and the public in evidence-based healthcare to enable informed decisions.’

    One endorser pointed out that students should be added to this call. This was agreed and the addition made.

  • Manifesto should contain ‘welfare’.

    We received several comments that suggested inclusion of the word ‘welfare’ to highlight that vets are not just concerned with the health of animals in their current care, but also their welfare. While it could be argued that welfare should be considered at all points, it was considered helpful to make this explicit. This was agreed and the manifesto adjusted accordingly.

  • Terminology.

    Several comments were received from the USA, which highlighted that the word ‘vet’ does not necessarily mean veterinarian. As the manifesto is not restricted to one country it was agreed to change ‘vet’ to ‘veterinarian’ or ‘veterinary’, as appropriate.

  • Data.

    We received suggestions that there should be a call encouraging making raw research data freely available. While the panel supported the idea, there are not many veterinary resources available as yet, and so it decided that this may be one to add in the future when there are more options.

  • Discouraging unevidenced practice.

    Another endorser suggested a call to action should be added about discouraging practices that are counter to EBVM principles. Again, while the panel supported the sentiment of the suggestion, it was suggested that if you follow the other calls then you would be doing this naturally. However, this will be kept on file and considered when the manifesto is updated in the future. ●

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