14 Shared Strategies to Maximize Human and Animal Health

This textbook has outlined numerous scenarios in which the health of human beings and other animals is closely aligned. The majority of the health conditions discussed are considered preventable. Key prevention roles for human health care providers, veterinarians, and public health professionals are outlined in each section.

These professionals traditionally have worked in parallel, seeing different parts of the human-animal medicine picture and responding to the issues that fell within one particular domain (see Chapter 1). However, the growing convergence of human and animal health and interest in a “one health” approach to human-animal disease issues suggest that more direct communication and cooperation among veterinarians, physicians and other human health care providers, and public health officials will become increasingly important to better prevent disease threats. This chapter presents steps to facilitate such cooperation. Some of the case scenarios are based on actual cases. They illustrate the concept of veterinarians and human health care providers making formal patient referrals to each other, just as specialty consultation referrals are routinely made between members of the same profession. Although local public health authorities may be a conduit for information flow between human health care providers and animal health care providers in a community, there is a role for direct communication as well. In doing so, care must be taken to both convey necessary information and also respect patient privacy considerations, including HIPAA (see Chapters 2 and 3). The use of standardized forms may facilitate such communication. Forms shown in the case scenarios that follow are suggested examples of communication templates for transmitting information.

The focus of many of the chapters of this book has been the clinical recognition of shared environmental health risks facing both human beings and other animals. Enhanced clinical awareness, communication, and improved history taking can gather important information about environmental health risks. A preventive risk assessment checklist can add to such information. Home or other site visits provide an opportunity to gain detailed information about clinically relevant environmental risks. This chapter outlines mechanisms for preventive risk assessments geared toward maximizing the health of human beings and animals living in proximity.

REFERRALS FROM HUMAN HEALTH CARE PROVIDERS TO VETERINARIANS

At times a busy physician or other human health care provider may suspect that a patient’s clinical condition may be affected by contact with animals in the home or vicinity. However, clinicians are limited by time and experience at addressing such issues in depth. At such times the health care provider can advise the patient to consult his or her veterinarian. A direct referral from the health care provider to the veterinarian may facilitate this process. One example is an immunocompromised patient who reports having companion animals. Such a patient is in need of a detailed discussion of zoonotic disease risks (see Chapter 10). Studies have shown that human health care providers do not feel comfortable providing in-depth counseling about zoonotic disease risk reduction and believe veterinarians are best suited to do so.¹ Mechanisms by which human health care providers could make direct referrals of patients to a veterinarian for zoonotic disease risk reduction assessment and counseling are therefore appropriate. Box 14-1 shows the possible components of such a referral visit.

BOX 14-1 Components of a Medical Referral Visit for Preventive Risk Reduction Counseling by a Veterinarian

• Inventory animal contacts in home and around home.

• Review animal husbandry practices.

• Review biosafety measures taken.

• Identify specific infectious disease risks.

• Provide counseling on disease risk reduction.

• Provide a summary of recommendations to human health care provider (see Box 14-3).

Many medical insurance plans pay for preventive medicine counseling sessions, but whether a veterinarian’s services would be compensable at this point by such human health insurance plans is not clear. However, if such consultations become increasingly frequent, this situation could change. In addition, some pet insurance policies may cover such referrals from a human health care provider as preventive visits under either a wellness rider (e.g., routine care, including vaccinations and parasite testing) or the illness portion for medical coverage if the pet was suspected of having or exhibiting clinical signs of a zoonosis.²

Case Scenario: Referral for Zoonotic Disease Counseling and Risk Reduction

A nephrologist is providing ongoing care for a patient (Mr. Doe) who has been on dialysis in the past but who just recently received a kidney transplant. The patient is now taking a number of immunosuppressive medications to prevent transplant rejection. At a follow-up visit, the patient asks whether there is any risk of infection from the animals in the house. The physician suspects that the risk of zoonotic disease could be increased but is interested in having the family veterinarian review this issue and provide recommendations. The physician is particularly concerned about the patient’s cat, since she knows that toxoplasmosis can be a severe disease in immunocompromised persons. The physician asks Mr. Doe’s permission to contact the family veterinarian to request a consultation, and Mr. Doe agrees. The physician writes a note of referral to the veterinarian that does not mention the patient’s medical condition (Box 14-2).

BOX 14-2 Referral of Patient to Veterinarian for Zoonotic Risk Reduction Counseling

Human-Animal Medicine Consultation Referral Form

Anytown Nephrology Associates

48 Medical Drive, Anytown, State, 10001

Phone 000-000-0000, Fax 111-222-3333

Patient Name: Mr. John Doe

Date of referral: November 7, 2009

To: Preventive Family Veterinary Associates

Referring Provider: Alan O. Pathic, MD

Reason for referral: Zoonotic disease risk reduction with Mr. Doe’s permission

Services requested: Please provide counseling on zoonotic risk reduction, including the types of pets in the house and risks associated with each type.

The veterinarian evaluates the patient’s exposure to the patient’s pets, other animals that may be in the household, and other potential animal exposures. It is not necessary for the veterinarian to know details about the patient’s medical condition. Preventive services are provided to the pets during the visit. The veterinarian writes a consultation letter back to the physician (Box 14-3).

BOX 14-3 Sample Consultation Letter Sent from Veterinarian to Physician Regarding Zoonotic Disease Risk Reduction

Human-Animal Medicine Consultation Report (Zoonotic Disease Prevention)

Preventive Family Veterinary Associates

100 Urban Street, Anytown, State, 10001

Phone 000-00-000, Fax 111-222-3333

To: Alen O. Pathic, MD

Anytown Nephrology Associates

48 Medical Drive, Anytown, State, 10001

Dear Dr. Pathic,

Thank you for referring Mr. Doe to me for zoonotic disease risk assessment and preventive counseling in regard to reducing his risk of zoonotic disease. He was seen in our office on December 12, 2009. His evaluation consisted of an inventory of animal contacts in the home and peridomestic environment, a review of animal husbandry and biosafety practices in the home, and a discussion of specific risk reduction measures. I also examined his puppy and cat and performed their preventive care. I am writing this summary evaluation with Mr. Doe’s permission.

Mr. Doe and his wife live in a one-story single-family dwelling on a city lot. There is a lawn outside and a park nearby. They recently acquired a puppy in addition to their cat and iguana.

The puppy is currently 9 weeks old and is a Labrador–German Shepherd cross. According to the records Mr. Doe provided, the puppy received its core vaccinations at 6 weeks of age, along with deworming, and did not reportedly have any health problems when they acquired it from the city animal shelter. It is eating a puppy diet of dried food, but Mr. Doe also reported that he likes to feed it “special puppy treats.” It has a bed in the kitchen, and Mr. Doe reports that he likes to sit in a chair and read a book with the puppy in his lap. He also reports that he likes to let the puppy lick his face. Handwashing after handling the puppy is inconsistent. The puppy is still being housebroken. Mr. Doe and his wife take turns cleaning up after the puppy and dispose of the waste in the trash. During the past week, Mr. Doe reports that the puppy’s feces have “been a little loose” but without blood or mucus. Mr. Doe takes the puppy for a short walk twice a day in the backyard. If the puppy defecates on the lawn, he picks up the feces with a plastic bag. The puppy’s physical examination was unremarkable. I did not see evidence of abnormal behavior or other signs of illness. A fecal flotation test was negative for ova and parasites, and I submitted a fecal sample for culture. I administered core vaccination boosters and deworming and scheduled a rabies vaccination to be provided when the puppy is 12 weeks.

The cat is a domestic short-hair that is 2 years old and has been previously seen by a veterinarian. Mr. Doe reported that it is allowed in the kitchen on counters and is an indoor-outdoor cat, spending several hours visiting the neighborhood park before returning for an evening meal of a commercial wet diet. There is a litterbox in the corner of the kitchen that Mr. Doe and his wife take turns cleaning every 3 days. The cat also appeared healthy and was negative for feline leukemia virus and feline immunodeficiency virus but positive for roundworms. It was dewormed and provided its core vaccinations. Because I recommended that the cat not go outdoors (see below), we trimmed the nails.

The pet iguana lives in a conservatory room off the living room, and it sometimes likes to sit on a person’s shoulder. Mr. Doe’s wife is responsible for cleaning and feeding the iguana.

Mr. Doe denies other pets or animal contacts, including petting zoos, other farm exposures, caged birds, or fish.

Mr. Doe is obviously attached to his puppy and cat, and they provide him with a great deal of emotional comfort and satisfaction.

In general, the risk of zoonotic disease from these animals is low. However, there are several important risks that should be addressed:

1. Puppies are at increased risk of infection with a number of zoonotic disease agents, including Salmonella, Giardia, and Cryptosporidium. Therefore it would be better for anyone at increased risk of infection to avoid any contact with puppy feces and to use careful handwashing precautions around the animal. I communicated this to Mr. Doe. Allowing the puppy to lick one’s face is not advisable, and Mr. Doe was counseled about this. I recommended that they discontinue feeding the special puppy treats because the ingredients included raw meat, which can be a source of Salmonella or E. coli.

2. Overall, many authorities consider that the positive health benefits of a pet such as the family cat, in terms of the human-animal bond, greatly outweigh any risk of infection. To reduce disease transmission risk, I have recommended that they move the litterbox from the kitchen. We discussed methods to train the cat to stay off kitchen counters and to keep the cat indoors only. I also recommended that an immunocompetent person take responsibility for changing the cat litter, removing solids daily, and washing the box on a weekly basis. These steps will greatly reduce any potential risk of toxoplasmosis. Another risk to consider is Bartonella infection, although this disease in human beings is generally associated with kittens. Nevertheless, I trimmed the cat’s nails and provided a flea prevention treatment that will reduce this risk further.

Only gold members can continue reading. Log In or Register to continue

Share this:

• Click to share on Twitter (Opens in new window)
• Click to share on Facebook (Opens in new window)

Related

Related posts:

1. Allergic Conditions
2. The Built Environment and Indoor Air Quality
3. Public Health and Human-Animal Medicine
4. Zoonoses

Stay updated, free articles. Join our Telegram channel

Join