October 05, 2018

The Equine Referral Experience

In a recent survey, veterinarians reported important considerations when referring cases to specialty care.
By Natalie Stilwell, DVM, MS, PhD
Equine VeterinarianIn a recent article published in the Journal of Veterinary Internal Medicine, faculty at the University of Guelph examined factors related to the equine referral experience. They surveyed equine referring veterinarians (rDVMs) to determine their satisfaction with their most recent referral case and which factors contribute to referral satisfaction.

Study Design
A pilot form of the questionnaire was reviewed by 2 equine rDVMs and an equine specialist and distributed to members of the Ontario Association of Equine Practitioners. The authors then distributed the final, shorter form of the questionnaire to rDVMs through the American Association of Equine Practitioners and Equine Clinicians’ Network listservs. Veterinary diplomates were also approached via their respective colleges to respond to a modified version of the questionnaire for specialists.

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Participating rDVMs were asked to answer 5 global questions to gauge their satisfaction level with their most recent equine referral experience. The 5 scores were compiled to calculate an overall referral satisfaction score (RSS) for each respondent. Finally, rDVMs and specialists were asked to rate 21 factors that influence where an rDVM decides to refer a case, as well as the top barriers to referral.

Results
A total of 187 equine rDVMs and 92 specialists completed the questionnaire. Respondents were mostly female, with a median age of 48 years for rDVMs and 45 years for specialists. Sixty percent of specialists were board certified in internal medicine, while the remaining respondents indicated specialties in surgery, radiology, theriogenology, emergency and critical care, and sports medicine and rehabilitation.

Referring DVMs indicated a median RSS of 80 out of 100 for their most recent referral experience; most were satisfied with the quality of care provided, ease of arranging for the horse to receive care, and expertise level of the attending clinician. However, the high cost of specialty care and possible competition from the specialty practice negatively affected rDVMs’ satisfaction level with referral. Referral experiences were also negatively impacted by the amount of time it took to receive discharge statements. Those rDVMs who referred more cases with a specialist per year were more satisfied with their most recent referral than were rDVMs who referred fewer cases. This suggested that respondents preferred referring to specialists with whom they had established working relationships.

Both rDVMs and specialists considered high cost, quality of care, and poor communication between the specialist and rDVM to be important barriers to the referral process. However, rDVMs were more concerned than specialists about being excluded from case management. Specialists were more likely than rDVMs to consider a lack of collegiality and poor service from the specialist as top barriers for referral.

Moving Forward
Responding equine rDVMs were generally satisfied with referral care. However, many expressed concern about the high cost of specialty care and lack of involvement from the referral hospital, highlighting the need for inclusive and timely communication between the rDVM and specialist during the referral process.

 
Dr. Stilwell received her DVM from Auburn University, followed by a MS in fisheries and aquatic sciences and a PhD in veterinary medical sciences from the University of Florida. She provides freelance medical writing and aquatic veterinary consulting services through her business, Seastar Communications and Consulting.
 

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