OBJECTIVES To determine whether veterinarians in primary care practices (PCPs) and board-certified clinicians (BCCs) approach treatment of dogs with immune-mediated haemolytic anaemia (IMHA) similarly, and whether practitioners with more experience treat similarly to those with less experience. We hypothesised those in PCPs would show more variation in their approach to similar cases than BCCs. METHODS A cross-sectional study was conducted by distributing a questionnaire to BCCs and veterinarians in PCPs. The questionnaire included direct questions and a number of clinical scenarios intended to capture approaches to common treatment problems. RESULTS Questionnaire responses were received from 241 veterinarians, including 216 in PCPs and 25 BCCs. Veterinarians in both settings used similar tests for diagnosis of IMHA, but BCCs performed more tests to exclude underlying causes of 'associative' disease. All veterinarians reported use of similar initial dosages of glucocorticoids (median 2 mg/kg per day in both groups, p = 0.92) but those used by more experienced practitioners were higher than those with less experience. Most veterinarians made allowances for the weight of dogs, using lower prednisolone dosages in a clinical scenario involving a 40 kg dog compared to a 9 kg dog (p = 0.025 for PCP, p = 0.002 for BCC). BCCs reported greater use of combinations of immunosuppressive drugs (p<0.0001) and of antithrombotic drugs (p<0.0001); use of antithrombotic drugs was also less common among more experienced practitioners compared to less experienced. CONCLUSIONS Approaches to treatment of dogs with IMHA differ between BCCs and those in PCP. These differences may affect design and implementation of future research studies and clinical guidelines.

中文翻译：

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英国初级保健和转诊兽医实践中免疫介导溶血性贫血犬的诊断和管理方法的横断面研究。


目的 确定初级保健实践中的兽医 (PCP) 和委员会认证的临床医生 (BCC) 对免疫介导的溶血性贫血 (IMHA) 犬的治疗方法是否相似，以及经验丰富的从业者是否与经验较少的从业者进行类似的治疗。我们假设，与 BCC 相比，PCP 中的人员处理类似案件的方法会表现出更多差异。方法 通过向 BCC 和 PCP 中的兽医发放调查问卷来进行横断面研究。调查问卷包括直接问题和一些临床场景，旨在捕获常见治疗问题的方法。结果 收到 241 名兽医的问卷答复，其中 216 名是 PCP，25 名是 BCC。两种情况下的兽医都使用类似的测试来诊断 IMHA，但 BCC 进行了更多测试以排除“相关”疾病的根本原因。所有兽医均报告使用了相似的糖皮质激素初始剂量（两组中位数为 2 mg/kg/天，p = 0.92），但经验丰富的从业者使用的剂量高于经验较少的从业者。大多数兽医考虑到狗的体重，在涉及 40 公斤狗的临床情况中使用较低剂量的泼尼松龙，而对于 9 公斤狗则使用较低的泼尼松龙剂量（PCP 的 p = 0.025，BCC 的 p = 0.002）。 BCC 报告更多地使用免疫抑制药物 (p<0.0001) 和抗血栓药物 (p<0.0001) 的组合；与经验不足的医生相比，经验丰富的医生使用抗血栓药物的情况也较少。结论 BCC 和 PCP 中患 IMHA 的犬的治疗方法有所不同。这些差异可能会影响未来研究和临床指南的设计和实施。