Despite our knowledge of the proper management and care of dairy cattle, along with decades of herd health and production medicine practice, there seems to be just as much — if not more — disease on dairies today.
According to the last three National Animal Health Monitoring System surveys, producer-reported rates of clinical mastitis and lameness have steadily increased. The problem is we often don’t know whether best management practices are consistently and effectively being implemented on our clients’ dairies.
This calls into question the validity of the veterinary-client-patient relationship (VCPR) that establishes the veterinary supervision needed for prescription and extra-label drug use. Veterinarians can play a vital role in helping producers capitalize on opportunities to improve health management and hopefully decrease disease incidence.
TWO KEY CHANGES NEEDED
Improvements in the well-being, health and productivity of dairy cattle in our care will likely require two key changes in the industry. First, health needs to be managed more like reproduction and milk production. It needs to be based on evidence derived from the herd rather than perceptions of the individual cow. This will require accurate, consistent health records and the tools to quickly and easily evaluate them. Second, dairy veterinarians need to be more engaged in health management services, including health-data recording to ensure the consistent, effective implementation of best management practices. This will be a change in how we do business. We need to establish the value of these services in our clients’ minds and make time to provide them. These two points are highlighted by a recent study of dairy health management. In the summer of 2012, veterinary student interns, supported by Pfizer Animal Health (now Zoetis), assessed health management practices on 105 dairies with over 80,000 cows. Using a tool developed at Washington State University as part of a project funded by the U.S. Department of Agriculture (USDA), the interns observed the diagnosis, treatment and recordkeeping practices for mastitis, metritis, pneumonia and lameness. They compared observations with stated and recorded disease identification and drug use, as well as reviewed drug labels to assess the appropriateness of therapies, product labeling and completeness of health records.
Participating dairies all had ongoing relationships with their veterinarians and believed they had good records.
With an average herd size of 860 cows, the study group reported a mean milk production of 82 lbs. per cow and an average bulk tank somatic cell count of 186,000 cells/mL. They could easily be called “well-managed” dairies. However, the study identified opportunities for veterinarians to work with their clients to improve health management and reduce the risk of drug residues in meat and milk.
QUALITY HEALTH RECORDS ARE ESSENTIAL
We have long spoken of the importance of “good” records to effectively manage a dairy. To be considered good, health records must support three key functions on the dairy: individual cow management decisions, outcome-based health management decisions at the herd level and residue avoidance/regulatory compliance. The Pasteurized Milk Ordinance specifies what constitutes a complete treatment record to avoid drug residues (see sidebar). Using this standard, not one dairy in the study had complete treatment records.
Unlike milk production and reproduction records, health-data recording is defined by each user, resulting in substantial variation between farms and even within a farm. Therefore, records generally lack the accuracy and consistency needed for efficient summary and analysis of outcomes (evidence health management is working).
Although nearly 90 percent of dairies in the study used an on-farm dairy management software program, only about half used it to record the diseases evaluated. And even when disease episodes were recorded, critical information such as treatment often wasn’t.
The primary reason health records are user-defined is because of inconsistent disease definitions across the industry. Veterinarians should encourage consistent recording of all clinical disease episodes, regardless of treatment or severity, as a first step. However, a different definition of metritis between dairies does not preclude them from both recording metritis the same way. It will be a challenge to standardize disease definitions but relatively easy to accomplish standard disease recording.
Veterinarians can help implement standard health-data entry protocols on clients’ dairies guided by “The 3 Simple Rules of Good Recording” (see sidebar). Of 243 Washington and Idaho dairies responding to a survey on health records, 80 percent indicated the veterinarian was a valuable resource for information on how to keep health records. However, only 30 percent indicated their veterinarian helped them decide how to keep health records.
The most effective solution for quality computer-based health records is for dairy management software to handle health events the way it currently does for breedings. When a breeding is entered, the user is prompted for the necessary information (e.g., breeding code, sire used, technician) to evaluate the outcomes of reproductive management.
Common dairy management software has functions to track milk and meat withdrawal times of treated cows, but fewer than half of dairies make use of those features. Often this is true because the system doesn’t allow accurate recording of treatments as given on the farm or no one knows how to use those features. As a part of health management on the dairy, veterinarians should become more familiar with these software functions and help clients utilize them to their full potential.
ELIMINATING PROTOCOL DRIFT AND ‘CREATIVE’ DRUG USE
Less than half of the dairies evaluated had written treatment protocols and only half of those were actually applying treatments as written. Too often we have found that what is being done by workers is different from what management or the veterinarian intended. Prescription and extra-label drug use must be done by or with the supervision of the prescribing veterinarian. Protocol drift indicates inadequate supervision. Active evaluation and feedback identify potential problems in health management, allowing timely intervention to reduce protocol drift and residue risk while improving health and productivity. Current, written treatment protocols are an indication of quality health management and a valid VCPR with your client dairies. The dairy health management assessment tools used last summer can help (see Resources).
Another challenge identified by the study was “creative” drug use. We found that 17 drugs other than intramammary antibiotics were being used to treat cows with clinical mastitis. Most were parenteral antibiotics given to cows with severe disease signs. Furthermore, nearly 60 percent of dairies treated metritis with an antibiotic not labeled for that use. Extra-label drug use is allowed by your prescription if the labeled product is not clinically effective, but you need solid evidence to support this decision. Because user-defined health records are not standardized, available dairy management software generally does not provide analysis of the outcomes of health management
in the same way it does for reproduction. As a result, treatment decisions are usually based on perceptions of people rather than outcome-based evidence from the cows. Much of the creative drug use observed is due to misconceptions of the uninformed, just trying to do what is perceived to be the best for their cows.
Conception rate and pregnancy rate, further analyzed by sire, technician, breeding code, times bred and even day of the week, allow us to narrow down investigations of problems and monitor input processes. Arguably this approach is much more powerful than simply managing based on the percentage of cows in the dry pen. Yet the percentage of cows in the hospital pen (or cows out of the tank) and monthly counts of disease are the most commonly identified measures of health management on the dairy.
We can improve health management with more precise metrics and novel ways of using health data. Incidence of new disease reflects prevention failure, whereas incidence of recurrent episodes is more representative of treatment failure. Further slicing and dicing by risk groups, such as pen, parity, etc., could refine our understanding. Routine evaluation of therapeutic outcomes such as retreatment, recurrence and removal rates should allow for more evidence- based treatment decisions.
Routine evaluation of the distribution of recorded health data allows dairy veterinarians to efficiently supervise health management remotely: The distribution of metritis and retained placenta across days in milk monitors adherence to established case definitions. The distribution of treatments over time (day, month or week, depending on animal numbers) monitors adherence to treatment protocols. Further assessing treatment distribution by technician allows monitoring individual employee adherence to treatment protocols and established case definitions.
MAKE HEALTH MANAGEMENT A PRIORITY
As part of a USDA-funded project, Washington State University has developed the web-based HEALTHSUM Dairy Health Database to provide health-data management and evaluation services to veterinarians. This tool is intended to add value to your practice and position you as the health management professional for your dairy clients.
For more information, visit goodhealthrecords.com. As pregnancy diagnosis work is lost to blood tests and farm-employed palpators, dairy veterinarians need to capitalize on these opportunities to become more engaged in health management on the dairy. Too much has been done as a conversation over the backs of the cows or at the end of herd checks before leaving for the next dairy. The value of complete health management services needs to be established, and veterinarians need to reassert their role on the dairy management team.
Sidebar: PMO AND TREATMENT RECORDS
The Pasteurized Milk Ordinance (PMO) states that cow ID, date treated, drug and dose administered, milk discard time and withdrawal time prior to slaughter constitute a complete treatment record. These records can be maintained in the computer, as a written record, or both. This information should be recorded in the context of the disease being treated.
Though not required by the PMO, residue investigations will attempt to determine the ailment being treated. More importantly, to effectively manage health we need to know disease, not treatment, incidence.
The 3 Simple Rules of Good Recording
1.Record ALL disease episodes identified, regardless of severity, duration or treatment. 2.Use a single, specific term to record each disease.
• Record diseases and their treatment, not just treatments.
• Differentiate clinical from subclinical disease, screening tests or prophylactic treatments.
3.Record CONSISTENT disease remarks.
• Same INFORMATION in the same ORDER using the same ABBREVIATIONS.
The goal is to have an accurate accounting of all clinical disease identified and how it was managed through consistent records that can be efficiently analyzed by computer.