Evaluation of a structured individualised protocol as a potential cost‐effective diagnostic and therapeutic approach to chronic diarrhoea in the dog

Abstract

Diagnostic investigation and management of chronic diarrhoea in dogs can be cost‐prohibitive to many owners. The objectives of this study were to evaluate evidence‐based, individualised diagnostic and therapeutic protocols for management of dogs with chronic diarrhoea, where financial constraints dictate a budget‐limited approach and where more expensive approaches are deferred until simple affordable protocols are unsuccessful. Twenty‐two client‐owned dogs with chronic (minimum 2 weeks duration) untreated small, large or mixed small/large bowel diarrhoea were enrolled in a budget‐limited step‐wise management protocol (maximum expenditure $300 over 6 weeks), with diagnostic testing and therapeutic trials managed in an individualised and evidence‐based fashion. Success was defined as complete resolution of diarrhoea for a minimum of 1 month. Dogs that failed to respond to a budget‐limited protocol were then enrolled for complete, referral‐level management. Four dogs exited the project early (one death due to caval syndrome, three lost to follow‐up). Thirteen out of the remaining 18 dogs had complete resolution of diarrhoea utilising a budget‐limited approach (success rate 72.2%, confidence intervals 46.5–90.3%) and five dogs were moved on to a referral‐level investigation, with complete resolution of diarrhoea in four out of five. Seventeen out of the 18 dogs therefore responded to a protocol based on a budget‐limited approach followed by extensive investigation only if needed, for an overall success rate of 94.4% ( CI 72.7–99.9%). Comprehensive investigation of chronic diarrhoea can be deferred while simple affordable diagnostics and therapeutic trials are conducted in stable canine patients and, often, an extensive management approach will be unnecessary.

Veterinarians’ Self-Reported Behaviors and Attitudes toward Spectrum of Care Practices

“…This "best" may be based solely on experience as many common diagnostic and treatment options, including "gold-standard" ones, do not have strong evidence for their efficacy or good data on their success rates. There is a growing field of work being carried out to find evidence for the most effective SoC protocols for a variety of circumstances [23,[27][28][29][30] to expand the options and provide reassurance for veterinarians when practicing using SoC options.…”

Investigating and treating chronic diarrhoea in dogs. Part 2: specific disorders of the small and large intestines

“…It is important that treatment decisions come with informed understanding of the risks and benefits of the different options. Bryan and others (2019) showed that the use of structured treatment protocols for dogs with chronic diarrhoea may help to reduce the number of dogs requiring high‐cost investigations. Such an approach is best suited to stable patients, with normal serum albumin concentration, acceptable body condition and where specific breed‐associated disease is not suspected.…”