Remote prescribing animal medicines by telemedicine

RE: Remote prescribing animal medicines by telemedicine

Arlo Guthrie — Fri, 17 May 2019 10:08:50 GMT

Latest update ... two new online consultation providers have started up:

https://www.vetnurse.co.uk/b/veterinary-nursing-news/archive/2019/05/17/two-more-online-veterinary-consultation-providers-join-the-field.aspx

Thoughts?

RE: Remote prescribing animal medicines by telemedicine

Sal the 1st — Fri, 09 Nov 2018 19:43:18 GMT

I am thinking along the lines of the client that has managed to avoid paying at every practice they have been to who then uses a remote provider (who has been paid and therefore has no reason to suspect the client won't pay elsewhere and no inkling they will rip somebody else off). The new provider decides that they do need to see a vet and sends them onto x practice where the client once again dodges payment. I have never understood why a practice that has been stiffed by a client is not allowed to fore warn the next practice the client tries to register at but at least when you request a history from another practice sometimes you can get a pretty shrewd idea of how the land lies from what crops up in the notes

RE: Remote prescribing animal medicines by telemedicine

Arlo Guthrie — Fri, 09 Nov 2018 08:43:49 GMT

[quote user="Sal the 1st"]Thank you for writing that up. It has probably created more questions from me tho. If I am reading that right the remote provider can send their 'client' to any veterinary practice if they are not able to provide a hands on service? This is one of the bits that concerns me.Remote provider decides that client needs to take their pet for a physical examination - so does that mean they would be making a formal referral and providing a full case history in advance of the visit? or will it be that client with a clapped out pet who has already spent what money they had on one or maybe more remote consults rocks up with no clinical history, no advance notice and we are expected to sort it out.?[/quote]

I think that is unclear at the moment ... one of those things that needs to be clarified in the next proposal. But patient histories was a recurring theme in the Council debate (most concerned about the way that the immediacy of telemedicine does not allow for the sharing of patient histories, but one person arguing that ECC has been working successfully without patient histories for years).

[quote user="Sal the 1st"]This is also a classic route of inheriting another practices bad debtor where people just move from practice to practice leaving their debts behind them - safe in the knowledge the previous practice won't be able to discuss with the next one on the list they have just been stung for a 3 or 4 figure sum. [/quote]

I'm not sure I see this being a way that patients would transfer from one traditional practice to another - because they are two such different models.

[quote user="Sal the 1st"]What about supercession? where the clients animal is already registered and under treatment. Will the remote prescriber be obliged to contact the original clinician? [/quote]

Really an extension of the patient history question, no? Unclear at the moment.

[quote user="Sal the 1st"]On the flip side I wonder if remote prescribing may result in practices holding less stock in their dispensaries other than say injectables and a few emergency supplies and charging realistic prices for surgery and diagnostics rather than the couple of quid below the next nearest practice which seems to be the case now. Will it end up with the whole dispensary on just one shelf and written scripts for everything else? Can see that one being popular with the wholesalers.[/quote]

I think one of the issues raised by the debate is which drugs it would be safe and appropriate to prescribe remotely, I suspect very, very, very few. Perhaps parasiticides? What do you think, Sal? What other drugs have a huge safety margin and are used for things which might realistically be diagnosable over a video screen?

RE: Remote prescribing animal medicines by telemedicine

Sal the 1st — Thu, 08 Nov 2018 23:17:42 GMT

[quote user="Sal the 1st"]

in the interests of transparency I would be interested to find out any relationship the vets carrying out this trial may have to any members of the RCVS Council.

[/quote]

'Jo also noted that the trial proposal was to use commercial organisations which have a financial interest in a positive outcome, which would render the results biased and unreliable.'

And there we have it

RE: Remote prescribing animal medicines by telemedicine

Sal the 1st — Thu, 08 Nov 2018 23:01:57 GMT

Thank you for writing that up. It has probably created more questions from me tho. If I am reading that right the remote provider can send their 'client' to any veterinary practice if they are not able to provide a hands on service? This is one of the bits that concerns me.Remote provider decides that client needs to take their pet for a physical examination - so does that mean they would be making a formal referral and providing a full case history in advance of the visit? or will it be that client with a clapped out pet who has already spent what money they had on one or maybe more remote consults rocks up with no clinical history, no advance notice and we are expected to sort it out.?

I work in a small, single site, independent practice. Very often on Saturdays we get calls now where the client isnt actually registered with us but with a branch of one of the local groups but because we are closer and their branch is closed on Saturdays and they just can't be bothered to take their pet to the main practice 20 odd miles away they try and get in with us and some of them can get very narky when they can't get what they want. Do I really want more aggravation than I already have? Does anybody? This is also a classic route of inheriting another practices bad debtor where people just move from practice to practice leaving their debts behind them - safe in the knowledge the previous practice won't be able to discuss with the next one on the list they have just been stung for a 3 or 4 figure sum.

What about supercession? where the clients animal is already registered and under treatment. Will the remote prescriber be obliged to contact the original clinician?

On the flip side I wonder if remote prescribing may result in practices holding less stock in their dispensaries other than say injectables and a few emergency supplies and charging realistic prices for surgery and diagnostics rather than the couple of quid below the next nearest practice which seems to be the case now. Will it end up with the whole dispensary on just one shelf and written scripts for everything else? Can see that one being popular with the wholesalers.

will also be interesting to see how the insurance companies feel about this one - my guess is they will love it

Lots more questions but aware that this post is already a long one.

RE: Remote prescribing animal medicines by telemedicine

Arlo Guthrie — Thu, 08 Nov 2018 11:07:33 GMT

Here you go: https://www.vetnurse.co.uk/b/veterinary-nursing-news/archive/2018/11/07/the-remote-prescription-debate-that-could-redefine-what-it-means-to-be-a-vet.aspx

[quote user="Sal the 1st"]Just a thought but could a live video feed of meetings help those that aren't able to attend meetings keep up with what is happening?[/quote]

I wonder ... i mean it is quite simple to set up a webcam these days. The audio is perhaps the biggest challenge (was hard enough for me to hear everything at the back).

RE: Remote prescribing animal medicines by telemedicine

Sal the 1st — Wed, 07 Nov 2018 08:16:40 GMT

[quote user="Arlo Guthrie"]

It was the first time I'd attended a council meeting, and I must say, I was impressed about one thing: I think Council is often portrayed as rather remote, pushing things through, and what I saw was actually some really passionate debate going on.

[/quote]

Pleased to hear it, but I'm surprised (or maybe I'm not) something so important hasn't received more publicity or been subject to a profession wide consultation prior to it reaching debate by Council.

edit

Just a thought but could a live video feed of meetings help those that aren't able to attend meetings keep up with what is happening? Perhaps RCVS could look into setting it up? Just been talking about this with a vet friend over on facebook - with his permission I will share some of what he had to say, leaving out the swear words - was basically they are going to do to the vets what they have already done to the nurses where qualified nurses are 'less' qualified than a pet store employee to sell flea drops

RE: Remote prescribing animal medicines by telemedicine

Arlo Guthrie — Wed, 07 Nov 2018 07:57:03 GMT

I went to the council meeting, which I'm now writing up (a very long task as it involves paraphrasing much of what was said from an indistinct recording. Plus it is such an important subject, which will potentially have an impact on everyone in the profession, that I want to do it justice!).

My report should be up later today, maybe tomorrow ...

RE: Remote prescribing animal medicines by telemedicine

Sal the 1st — Tue, 06 Nov 2018 23:14:06 GMT

in the interests of transparency I would be interested to find out any relationship the vets carrying out this trial may have to any members of the RCVS Council. I would also like to know who voted for this - but realise there is probably more chance of finding out the winning lottery numbers before a rollover draw. I am really not getting this - I thought it was all about evidence based medicine these days and avoiding over prescribing, - so where exactly does this fit in? How can a vet effectively prescribe without the evidence of a physical hands on examination and how would they know that the animal they are prescribing for hasn't been previously prescribed elsewhere or even that the animal they are prescribing for is the animal that will be taking the medication?

Don't know about anybody else but I have definitely seen POM -V's dished out by breeders to owners of new puppies and kittens (because we all know that the average human has 'sucker' as part of their DNA and will gravitate towards the the 'runt' ) - this will just make access to POM-V's so much easier for people who shouldn't have them

RE: Remote prescribing animal medicines by telemedicine

Rachel Woodcock — Tue, 06 Nov 2018 10:23:22 GMT

One word......shocking!!!!!

RE: Remote prescribing animal medicines by telemedicine

molladog — Tue, 06 Nov 2018 09:10:58 GMT

'Cannot see any part of this idea that is good.

Amazing how the Code can be changed so easily for some things but not for others.'

Totally agree with Sal on all of this, especially the two lines above !!

RE: Remote prescribing animal medicines by telemedicine

Sal the 1st — Tue, 06 Nov 2018 09:03:03 GMT

I think its the beginning of the end, who is this helping exactly? Not the animal that is really ill where a vet is struggling to get any meaningful history from a client. ie a dog with GI upset were the owner 'forgets' that yes there might be items it could have chewed, or the dog that is getting on a bit, bit slow, bit lethargic - is the client going to be able to tell you its gums are dulux white, its abdo is a bit swollen.

What happens if as a result a vet then misses a diagnosis and an animal dies . If such a case were to come before the DC what would happen then?

Won't be long until all there is left are the corporates, online pharmacies and referrals - still I suppose it will solve the problem of a vet and nurse shortage because there just wont be the need for so many, but then again with fewer members the RCVS will need to look at finding another revenue stream.

Cannot see any part of this idea that is good.

Amazing how the Code can be changed so easily for some things but not for others.