Spectrum of Care or Incremental Care

As documented in the Access to Care report, there is a large gap between the health care that pets need and the care they are receiving. This creates a compelling and immediate need for veterinarians to provide effective health-care options for pets and find solutions to overcome barriers preventing the delivery of those options. The 2024 AAHA Community Care Guidelines provide a collaborative, community care-centered approach to bridging the gaps in access to care for all pet owners. The approach includes leveraging available community resources to establish partnerships between private practice clinics and nonprofit clinics, spay/neuter clinics, shelters, and animal welfare organizations. A key tenet of the Guidelines is the commitment to keeping pets with their families whenever possible instead of surrendering them to a shelter for re-homing or even euthanasia. As you will see in this Module, animal welfare organizations serve as essential partners in implementing a community care network.

The 2024 AAHA Community Care Guidelines also promote the adoption of a spectrum of care philosophy, which encompasses a wide range of tools and strategies, from basic interventions to more advanced options, empowering practices to meet the diverse needs of their clients. The Initiative for Accessible Veterinary Healthcare (IAVH) has identified that one way to improve access to veterinary care and control related costs is to reduce the resources spent on unnecessary or ineffective tests and treatments. Spectrum of care, or incremental care, is defined as patient-centered, evidence-based care that provides good outcomes for pets belonging to owners with limited resources [Brown CR et al. Spectrum of care: more than treatment options. JAVMA 2021 (Oct 1);259:712-717 ]. This involves providing multiple options for a variety of medical conditions that may not be the “gold standard”, but still represent acceptable care that is responsive to client expectations and financial limitations.

The spectrum of care (SoC) approach requires a goals-of-care discussion with the pet owner to understand what will be considered a successful outcome and what options are most likely to achieve that outcome. Veterinarians should have the knowledge and skills to offer a wide spectrum of care options for a given condition and communicate the relative effectiveness and costs of each option to the client. SoC is the first step to improving pet welfare for clients having difficulties accessing care that can prevent pet relinquishment to shelters or euthanasia and preserve the human-animal bond. Outpatient treatment options for parvo pups that provide high survival rates is an example of a SoC evidence-based alternative to expensive, intensive care in a hospital setting.

Although veterinarians may choose different parameters when dealing with a client with significant financial limitations, the following are suggested by the Program for Pet Health Equity for objective patient evaluation for incremental care options:

• Do I have the skills/resources/equipment to adequately and humanely treat and manage the case?
• Is there a good prognosis? Is it treatable? Is it manageable? Are there multiple problems?
• If it isn’t treatable or manageable, is there a simple palliative option that can extend and provide good quality of life?
• Is the problem an ongoing or chronic condition?
• Can the owners afford follow-up care or management?
• Can the owners provide overnight monitoring at an emergency clinic if it is necessary?
• Is this animal in critical condition?
• Would significant amounts of money make a difference in a positive outcome?

Read this short article on access to care as the social justice issue for veterinary medicine. The article encapsulates the need for access to care, how incremental or spectrum of care can address this need, and how the AlignCare program supports incremental care provided by nonprofit and for-profit clinics.