Definitions and Section 1: Community Care Guidelines Overview

Top 3 Takeaways

1. Veterinary medicine in a community care context aims to ensure that pets remain with their families whenever possible, thanks in part to equitable access to veterinary care.

2. Community care is a creative way of thinking about health care that mobilizes resources within a community and consists of four core principles: recognition of the urgency of the issue, collaboration, family-centered health care, and redefining the gold standard of care.

3. By working together, nonprofit practitioners and private practitioners can create a much-needed network of services that better meet the needs of everyone in a geographic area.

Overview

The veterinarian’s oath requires that veterinarians use their skills to improve animal health and welfare while benefiting society.¹ AAHA recognizes that traditional private small animal practices do not presently serve all companion animals in need of care in North America, while simultaneously acknowledging that the current situation results from systemic issues that are often out of the control of individual private practitioners. In the United States, more than one in four families have difficulty accessing veterinary care for their pets, most often because of financial barriers.² AAHA joins with others in the veterinary profession and animal welfare to address the access-to-care dilemma with innovative resources, so that all pets receive high quality care and pet caregivers receive the support they need.

What Is Community Care?

Community care is a creative way of thinking about health care access that mobilizes all available resources in a community. It is a collaborative, noncompetitive paradigm that places the family (people and their animal companions) at its center. Private practitioners are key to the success of community care. The community care model proposed in these guidelines seeks to resolve the dichotomy that private practices often face of either providing care or turning a patient away. Community care consists of the following core principles:

1. Access to care is an urgent issue the veterinary profession must address, both to fulfill its obligations to people with pets and to alleviate moral distress.
2. Family-centered practice recognizes that the family unit consists of both human and companion animal members and offers a spectrum of care that considers the unique needs and circumstances of each patient and their family.
3. Community care redefines the “gold standard” as veterinary care that integrates spectrum of care, connects to and listens to the pet caregiver’s needs, and ensures high-quality services regardless of race, gender, ability, socioeconomic status, and other factors.
4. Private and nonprofit practitioners play an equally important role within a collaborative network of providers.

Defining Spectrum of Care and Access to Care

Spectrum of care (SOC) is the practice of providing a continuum of acceptable care that considers available evidence-based medicine while remaining responsive to client expectations and financial limitations.^3,4 SOC uses the range of available diagnostics and treatments to provide better access to care for families.⁵ Contextualized care is an aspect of SOC that considers the family’s circumstances in the decision-making process. For example, SOC may mean treating a dog with parvovirus as an outpatient using the Colorado canine parvovirus protocol for a family that cannot afford the cost of hospitalization.⁶ SOC also means recognizing when early referral and/or diagnostics and procedures may have more favorable clinical and financial outcomes, such as referring sooner to a veterinary dermatologist for recurrent ear infections.⁷

Access to care means that pet caregivers have the “economic, physical, social, mental, and emotional resources necessary to secure, communicate with, and benefit from the services of a trusted veterinary service provider as needed to optimize the health and welfare of animals in their care.”⁸ Access to care requires affordable and consistently available services for clients irrespective of race, socioeconomic status, location, culture, language, gender, and ability.⁹

Addressing access-to-care challenges requires community-based solutions that do not compromise business capacity, create additional emotional burdens, or increase demands on time. In short, collaborative models for the provision of community care must also support veterinary professionals and reduce moral distress. By connecting with others invested in positive outcomes for pets and their families, veterinarians can contribute to a network of solutions for a community.

Definitions

Access to care — Access to care means that people living with pets have the “economic, physical, social, mental, and emotional resources necessary to secure, communicate with, and benefit from the services of a trusted veterinary service provider as needed to optimize the health and welfare of animals in their care.” Access to care requires affordable, accessible, and consistently available services for clients irrespective of socioeconomic status, location, culture, language, gender, age, and ability.¹⁰

Community care — A health care system that enables care for all pets in a community across the socioeconomic spectrum and is accomplished by a diverse collection of service providers within a collaborative network.

Community medicine/practice — Organizations/veterinary practices that provide care for animals living in underserved communities/families.

Financially fragile — Clients with the inability to come up with $2,000 in an emergency.¹¹

Incremental care — A stepwise approach to patient management based on medical and family priorities that avoids situations of not helping at all and/or turning patients away. Incremental care is one strategy used in a continuum of care (see Spectrum of care definition).

Moral distress — Emotional and psychological distress caused by “the feeling of not being able to do what you believe to be ‘the right thing’ because of constraining personal, professional, organizational or client factors.”¹²

Nonprofit practitioners/nonprofit practice — A 501(c)(3) organization and/or an organization dependent on donations from the community, whose mandate is to provide veterinary services to animals without the primary goal of making a profit. These practices typically focus on promoting animal welfare and providing affordable or free veterinary care to underserved communities.

Private practitioners/private practice — A business entity owned by an individual or company that provides veterinary services with the goals of generating revenue and helping community pets and people.

Social determinants of health (SDOH) — SDOH are nonmedical factors in people’s environments that influence health outcomes and include “economic policies and systems, development agendas, social norms, social policies, racism, climate change, and political systems.” There are five domains: (1) economic stability; (2) education access and quality; (3) health care access and quality; (4) neighborhood and built environment; and (5) social and community context. Examples of SDOH include safe housing, polluted versus clean water, and discrimination.¹³

Spectrum of care (SOC) — The practice of providing a continuum of acceptable care that considers available evidence-based medicine while remaining responsive to client expectations and financial limitations.^14,15 SOC uses the range of available diagnostics and treatments to provide better access to care for families with pets¹⁶ and considers the pet caregiver’s circumstances in the decision-making process. Thus, access to care is the goal and spectrum of care describes the tools and strategies used to achieve that goal.

Underserved communities — Groups of people or geographic areas that have limited access to resources or opportunities, including those historically excluded due to socioeconomic status, gender, sexual orientation, language, disability, age, race, and ethnicity.

**Additional note on terminology: “Pet owner” is the term commonly used in the veterinary profession to describe the human–companion animal relationship; however, this term falls short in acknowledging that many people view their pets as family members, not property. Although “owner” is still used in certain circumstances throughout this document, this term is replaced wherever possible with “pet caregivers,” “families,” and “clients,” which more aptly describes the human–companion animal–veterinary relationship. “Family” and “families” denote any individual or group of individuals, regardless of biological or legal relationships, who live in a bonded relationship with one another. This term is inclusive of individuals with pets as well. “Patient” is used to denote the pet for whom care is sought.

The 2024 AAHA Community Care Guidelines for Small Animal Practice are generously supported by CareCredit, Hill’s Pet Nutrition, IDEXX,  Merck Animal Health, and Pawlicy Advisor.