Tuesday, 7 August 2018

Libby Smith's experience of setting up an equine weight clinic

I'm thrilled to be asked by BEVA to write a blog on Westover's recently launched Equine Weight and Condition Club. RVN's within equine practice are such an under-utilised resource in comparison to their small-animal counterparts, introducing the idea of nurse-lead clinics to make use of the wealth of knowledge RVN's have is the perfect opportunity to create greater challenge within practice, whilst tackling one of the biggest health issues our profession faces.

Although we aim not to dissuade those with thin horses being interested in our service (following medical workup), this clinic is primarily aimed at dealing with the rising number of overweight and obese horses we see within practice. I can't stress enough how much easier it is to launch a service like this with a "whole-practice" approach. Within first-opinion practice, the ambulatory vets are those in most contact with clients, and therefore it's critical the nursing team can rely on those vets to upsell this service at any and every call they attend with an overweight horse. The flip-side of this is those that do embrace nurse-lead weight consults see their own workload reduced, as they can refer clients to nurses to discuss all things weight-related, freeing themselves up to do more challenging work. I'm sure many vets can relate to the difficulty of being stuck at a consult way beyond the scope of time left for a vaccine discussing variables like diet.

That's not to paint a picture that we are fortunate to gain every upsell the vets send our way - sadly as many will already realise, the issues surrounding obesity do not gain the sort of recognition or concern from clients that we would like, and therefore we don't get the volume of consults booked in that we would ideally like to see. By ensuring weight remains a high profile issue and not being deterred from discussing it we hope in time to secure a wider audience.

The most effective consults are held at the horses' location as opposed to the practice, as it removes subjectivity about grass quality and grazing management, and is particularly important if you have a predominantly leisure-horse caseload who may not all have transport. We aim to have an objective assessment of the horses’ condition and weight, as well as an open discussion about factors that may limit compliance to a diet and exercise plan: these plans must be bespoke in order to be successful, so if a client can only ride once a week due to work commitments or a horse is recovering from injury we need to take this into account. We weigh their current diet to the gram, usually creating great amusement amongst owners who prefer a “handful” method! We also discuss our starting point in terms of exercise and management. Much like the subjectivity over grass quality, you may have to be quite probing - I'm still amazed at how many feel a 20 minute walk around the block constitutes a physical challenge!

This consult is predominantly fact finding, so unless emergency measures need to be put into place we usually return to create a written plan incorporating diet, exercise and management changes to be sent to the client within 24 hours. This bides us time to consider all the variables at play in order to create the most effective plan possible.

Maintaining regular contact with our client's is also pivotal to our vision of the Westover weight programme. There is significant evidence in human medicine that those enrolled in group meetings see greater weight loss than those trying alone, so mimicking this feels like the obvious step. We are trying to create a forum group, giving clients the opportunity to discuss their difficulties with others going through the same. Although this is challenging whilst numbers are low, once you get a handful starting at the same time this soon adds additional value to the programme for minimal staff input. This forum is interspersed with regular information-based emails from myself as an RVN tackling weight related subjects –research articles on grass intake whilst grazing and how to use a grazing muzzle effectively as examples. This is a great way to engage with your client’s more, as well as upselling more services like nurse-lead clipping clinics or EMS blood sampling. This is all an additional revenue stream nurses can provide that is new to the practice.

The main struggle we face is retaining re-sees in cases receiving other ongoing veterinary intervention, or in cases that have improved to now be at a non-critical state.  This relates to both the vets and clients perception of what a weight consult offers. If a horse has a vaccine and the vet puts a weigh band around the horse, this is enough for some clients, but I hope in time to alter this mindset and show that we could offer them so much more in terms of advice and support. Similarly, much like Weight Watchers offers it's gold membership to those who reach their target weight as a nod to the idea weight loss is a lifestyle, and not a one-off diet, I hope that by continually banging the drum that it's important to frequently re-assess our horses' health status and condition, client's will see the benefit of a re-examination even when their horse has dramatically improved to help formulate the most appropriate plan moving forward.

Understandably, starting anything new like this is a daunting task, and I'm well aware that this was made easier for me in a supportive, open-minded practice. My advice to anyone else interested in starting something similar in their own practice is to try and make your enthusiasm rub off on at least one other member of the clinical team, so you have one other person to upsell the service and to bounce ideas with when you meet a challenging patient. For the nurses out there that may be asked if they’d like to take part in something like this, grab the opportunity for autonomy with both hands and you’ll never look back!

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