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financial aspects of those risks, including pet health insurance (see 10.16 Pet Health Insurance).

      For most pets, family history, genotype, and breed predisposition are significant contributors to disease susceptibility (see 11.4 Heritable Health Conditions – by Breed). This is true whether the pet is purebred, hybrid, or mixed‐breed. In many instances, when a pet is mixed‐breed and the parents have not been identified with certainty, it may be difficult to discern any type of predisposition without performing breed composition genetic testing. Whether purebred, hybrid or mixed‐breed, both genotypic and phenotypic testing are important to detect disease susceptibility (see 3.11 Integrating Genotypic and Phenotypic Testing).

      Exposure risks constitute another significant contributor to disease susceptibility. For example, a pet exposed to many other pets will be at increased risk for infectious diseases and, potentially, parasite transmission. A pet that is taken for walks in wooded areas may be exposed to ticks that are enzootic to the region and may introduce tick‐related infections to the pet.

      Susceptibility to medical problems is also influenced by life stages and preexisting conditions. For example, an umbilical hernia is more likely to be congenital and evident in a juvenile pet, while most cases of hypothyroidism present during adulthood. Regarding preexisting conditions, a pet with early evidence of hip dysplasia will be more likely to develop osteoarthritis later in life.

      A pet's gender as well as its neuter status also influence risk (see 4.2 Gender‐Related Considerations). Some diseases are sex‐limited in nature (such as prostatic disease in males or pyometra in females), but there are also sex predispositions for a variety of disorders. For example, there may be a modest sex predisposition in females regarding cutaneous lupus erythematosus, while adrenal sex hormone imbalance (also known as alopecia X) may be more commonly diagnosed in males. This is different from disorders that are transmitted genetically on the sex chromosomes. For example, hemophilia is more often clinically evident in males because the condition is transmitted on the X chromosome as a sex‐linked recessive condition, and since males only have one X chromosome (they are said to be hemizygous; the other is a Y chromosome), they are more likely to manifest the condition. Neuter status also affects risk. Bitches spayed before their first estrus have a reduced prevalence of mammary cancers; neutered males have a lowered risk for prostatic hyperplasia. New guidelines even suggest the most appropriate age for neutering on a pet‐specific basis.

      Geography also plays a significant role in disease susceptibility, partially because it influences infectious diseases that are present in the area or the vectors that are associated with their transmission. Accordingly, when creating health plans, it is important to take into consideration whether or not the pet may travel outside its residential region.

      Even conformation and nondisease traits can be associated with predisposition to disease. For example, cats with white fur may be at higher risk for developing squamous cell carcinoma; color dilution alopecia is more common in dogs with diluted coloring patterns, such as “blue” Dobermans, etc.

      1.1.5 The Need

      It makes sense for veterinary teams to embrace a pet‐specific care model, in which diseases that can be prevented are prevented, especially through comprehensive vaccination and parasite control protocols, diagnostic screening is done as part of a sensible surveillance system, preferably even identifying animals in a subclinical state when there are the most options available for management, and finally, treating animals over an appropriate time period and according to evidence‐based guidelines, and helping to facilitate owner compliance. In this manner, acute diseases may be treated over days or weeks, while chronic problems, such as osteoarthritis, atopic dermatitis, diabetes mellitus. and many others. are managed on a continuum of care over the remainder of the pet's life (see 9.7 Continuum of Care and Convergence Schedules).

      To be successful in this regard, standards of care are critically important for hospitals (see 9.4 Standards of Care). While personal freedom for veterinarians to treat as they wish is aspirational, it may not allow practices to deliver consistent quality of care to pets and their owners. At least when it comes to basic preventive care, there is value in determining protocols for vaccination and parasite control, and care pathways for the best evidence‐based approaches to the most common chronic conditions managed by the practice, such as osteoarthritis, atopic dermatitis, periodontal disease, etc. Diligence is particularly important for these chronic diseases, since how these conditions are managed when an animal is young will greatly affect its quality of life as it gets older.

      A suitable starting point is to consider what risk factors might influence the decision‐making process through use of health risk assessments (see 2.7 Risk Assessment), which involve client‐focused questionnaires, taking a thorough medical history, and performing a skilled physical examination. The process can then continue by evaluating which strategies should be employed for prevention, early detection, appropriate treatment, and optimized compliance for an individual pet. Ongoing monitoring of the process is critical to determine gaps in the anticipated quality of care provided by the hospital.

      Our major preventive strategies include vaccination, parasite control, optimal nutrition, and physical activity for each life stage, behavior counseling, sensible exercise programs, breeding recommendations (to help prevent hereditable conditions), optimal reproductive control, oral hygiene, and even counseling on pet selection to minimize the risk that a pet will later be relinquished to a shelter, abandoned, or euthanized for nonmedical reasons.

      Currently, many pet owners only associate the need to see a veterinarian with vaccination or serious illness. This failure to grasp the true value of preventive medicine and regular pet‐specific care and the positive impact both can have on pets and pet owners can adversely affect the health of pets and the financial health of veterinary practices.

      Diagnostic screening tests should provide baseline values and facilitate long‐term monitoring to establish trends that may help to identify subclinical disease. Without early detection and management, many of these conditions can lead to a significant decrease in a pet's quality of life. Such periodic testing of otherwise healthy animals is indicated to help identify affected individuals before clinical manifestations become evident. Selecting appropriate tests can be facilitated by performing health risk assessments periodically and screening for conditions that might be considered higher risk because of breed predisposition, family history, lifestyle, or geographic considerations.

      Early therapeutic intervention tends to offer the best chance of successful long‐term management of many conditions. Clearly distinguishing between curing a medical condition and long‐term management is important when discussing the many benefits of intervention and management of disease states with pet owners.

      Early intervention in primary conditions can also reduce the risks of secondary problems. Periodontal disease is among the most common conditions affecting dogs and cats, yet it is often ignored by pet owners or undertreated by veterinary teams. When existing periodontal disease is comprehensively managed, the risk of debilitating sequelae is often reduced (see 4.9 Periodontal Disease).

      In addition, prevention, detection, and treatment of pain (as well as ensuring compliance and adherence) should be provided to all patients. Through this process, patient quality of life, pet owner satisfaction, and perceived value of veterinary care are more likely to improve while patient stress, recovery time, and potential for exacerbation of co‐morbidities will likely decrease.

      1.1.6 Fundamental Drivers of Pet‐Specific Care

      To

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