Veterinary telemedicine is likely here to stay. This article takes an in-depth look at its pros and cons, and how it could be improved.
The COVID-19 pandemic marked the beginning of a new phase of veterinary medicine. Previously, telemedicine took the form of telephone or e-mail communications between veterinary surgeons to discuss cases, or with clients to provide test results, formulate treatment plans, or address other concerns.1 However, the pandemic presented an urgent need for the widespread use of telemedicine. Many, if not all, veterinary clinics had to offer some level of telemedicine service to comply with the COVID-19 guidelines on social distancing imposed by the government in their country or state. Since then, veterinary telemedicine has expanded beyond its original use, becoming a seemingly permanent feature of veterinary medicine. While telemedicine undoubtedly has benefits, veterinary professionals also have concerns regarding its safe and appropriate use.
HOW DOES TELEMEDICINE APPEAL TO PET OWNERS?
Life has become very convenient for consumers in terms of access to products and services, with smartphones and other portable devices allowing instant answers to questions and one-tap purchasing. Most of us are accustomed to the recreational use of technology, which allows us to make personal appointments, do research, or browse online shops, all from the comfort of our sofa or while riding the bus. Additionally, telehealth has long been a feature of human medicine, and its use has grown substantially in response to and following the COVID-19 pandemic, with electronic and telephone consultations now being commonplace.2 Therefore, its no surprise that clients may appreciate the same convenience from veterinary services, and may soon come to expect it.
WHY MIGHT CLIENTS WANT TO AVOID IN-PERSON VETERINARY VISITS?
Aside from convenience, there are several other reasons why a client may prefer to use telemedicine rather than visit the veterinary clinic. If they have a pet who is generally very nervous, or who experiences extreme stress or anxiety at the veterinary clinic, a telemedicine consultation from home where the animal feels safe and secure is likely to be preferable to an in-person visit. Similarly, certain issues such as a pet being over- or underweight, or displaying challenging behaviors, may make the client feel sensitive or defensive, especially if they have perceived judgment from veterinary staff before.
Clients may also avoid visiting the clinic due to busy schedules, transportation issues, frailty, concerns about veterinary costs, or a perception that the pets health issue is minor, so they dont want to waste their time or ours. Ultimately, this could lead to a delay in clients seeking veterinary help in the absence of a telemedicine option.
WHAT DO VETERINARIANS LIKE ABOUT DELIVERING A TELEMEDICINE SERVICE?
The benefits of telemedicine are not just centered around clients. Telemedicine allows veterinarians to use their time more efficiently, leading to less fatigue and improved well-being,3 and it also allows for the flexibility and comfort of remote work. Veterinary leaders and clinic owners who embrace telemedicine also experience improved staff and client retention, as well as client satisfaction, and increased revenue.3
WHAT ARE THE LIMITATIONS OF VETERINARY TELEMEDICINE?
While the general view of telemedicine among veterinarians is positive,4,5 there are some concerns. A major issue is whether or not it is safe to prescribe treatment for a patient without a physical examination. While clients can be guided on how to show gum color or demonstrate skin tenting, this cannot be a reliable substitute for a hands-on veterinary physical examination. Similarly, although superficial wounds, skin lesions, and other minor ailments may be witnessed via a webcam, theres a risk of missing complicating factors that arent as clear. For these reasons, the use of telemedicine in an emergency situation, other than to triage, would not be appropriate and could delay critical treatment.
Other potential drawbacks of telemedicine may include technological or internet connection issues, which can cause delay and frustration, and less social pressure on the client to behave with the same courtesy they would in person.
Theoretically, telemedicine may make veterinarians feel powerless; if they are unable to prescribe, examine, operate, or administer treatment, this means there will be a large number of cases for which the appropriate next step is to visit the veterinary clinic, which may lead to client frustration. Consequently, there is a widespread calling from veterinarians for more clarity regarding the legal framework for telemedicine use.6
WHEN IS TELEMEDICINE USEFUL AND APPROPRIATE?
Telemedicine carries particular strengths that make it a beneficial modality in specific situations. For example, it can be used as an out-of-hours triage service to determine whether an in-person appointment is needed, and within what timeframe. With an initial specific list of primarily closed questions, a true emergency case will not be substantially delayed from getting required treatment, while cases that can wait or be resolved remotely will not attend the clinic, easing the burden on out-of-hours staff.
Additionally, remote appointments may not have the same time constraints, meaning vets can dedicate more time to giving comprehensive advice on complex or routine topics, including general puppy and kitten care, behavior issues, dental care, obesity, and diet.
WHAT LEGISLATION OR GUIDANCE IS IN PLACE REGARDING VETERINARY TELEMEDICINE?
Consistent themes exist in the legal framework for veterinary telemedicine as provided by governing bodies worldwide. In the UK, the Royal College of Veterinary Surgeons launched its Under Care Review in 2019, and released its updated guidance earlier this year.7 The update clarifies that an animal is under care of a veterinary surgeon if they are given, and accept, responsibility for the health of an animal, and that any veterinary surgeon with an animal under their care must have a 24/7 provision in place for in-person examination and treatment, either by themselves or as formally arranged with another practitioner.7 The new guidance also states that to safely prescribe medications, a veterinarian must perform a clinical assessment, which may or may not include a physical e-amination, depending on the clinical particulars and risks.7
The American Veterinary Medical Associations policy on telemedicine states that veterinary telemedicine should only be conducted within an existing Veterinarian-Client-Patient Relationship (VCRP), with the exception for advice given in an emergency until that patient can be seen by a veterinarian.8 This in turn impacts appropriate prescribing, since a VCRP is required by law before a veterinarian can prescribe treatment. In Western Australia, the guidelines for providing telemedicine services again focus on the establishment of a Veterinarian/Client/Patient Relationship and the veterinarian’s clinical judgment on whether a physical examination is required.
WHAT IMPROVEMENTS COULD BE MADE TO CURRENT TELEMEDICINE SERVICES?
Several improvements could enhance the current state of veterinary telemedicine. The relationship between telemedicine services and veterinary clinics could be improved by more effective and open communication, especially if clients use different service providers. Currently, there may be an element of secrecy, perhaps encouraged by the client if they do not want to appear disloyal. However, the sharing of clinical notes and other relevant communications between telemedicine services and physical veterinary services is paramount to the safe, thorough, and efficient delivery of veterinary care.
In order to manage client expectations, avoid frustration, and prevent delays in emergency treatment, its recommended that pre-appointment information be provided to clients, stating that telemedicine may not be appropriate in life-threatening emergency cases of collapse, loss of consciousness, excessive bleeding, etc. This information should also include contact details of the designated facility for in-person assessment.
Perhaps the ultimate goal for veterinary telemedicine is that every clinic adopts telemedicine alongside in-person veterinary services, thereby easing the in-house workload through triage, and dealing with minor issues while ensuring consistency of clinical notes and provisions to visit the clinic in person if required.
SUMMARY
Despite its potential risks and pitfalls, veterinary telemedicine is becoming increasingly popular with clients, and is viewed favorably by many veterinary staff. Using the guidance available from veterinary governing bodies, as well as their own clinical judgment, veterinary surgeons can experience the benefits of telemedicine without taking undue risks.9
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