What the UK’s new telemedicine rules mean for veterinarians in the US
A temporary relaxing of telemed rules in the UK is now set to become permanent, according to the RCVS. Here’s how that change could impact veterinarians on both sides of the pond.
When the Royal College of Veterinary Surgeons (RCVS) announced last Thursday that, after a years-long review of telemedicine rules, it would allow UK practitioners to do more virtually, without having a hands-on appointment first, it drew the attention of the veterinary community at home and around the globe.
The change is scheduled to be permanently applied beginning June 1, but before the new policy is implemented, RCVS officials will subject it to a review decision at their March council meeting.
“We’re following this with interest because we know that our colleagues in the UK are as passionate about this topic as we are,” says Jessica Vogelsang, DVM, chief medical officer for AAHA. “We’re really curious to see what outcomes they have at the end of the review process, and we’re anticipating that the trends we’re seeing in the UK and Canada will eventually make their way to the United States.”
While it’s safe to say that all veterinary organizations are following this development, they’re not all happy about it. In a press release, British Veterinary Association (BVA) President Malcolm Morley, BVSc, MRCVS, said that, while new technology presents exciting opportunities for practices, clients, and animals alike, “BVA has been very clear that we believe remote prescribing can only be safely delivered where a vet-client-patient relationship has been established. This is an internationally recognised concept, and we are disappointed that the RCVS has decided not to embrace it."
Understanding the argument
The controversy around telemedicine is nothing new, but the shape of the arguments changed during the pandemic, when restrictions were temporarily loosened in many areas. That included in Canada, where a June 2020 survey of over 500 veterinary professionals by the Ontario Veterinary Medical Association (OVMA) found that 81% of respondents to their survey utilized telemedicine during the pandemic and 60% planned to continue using it post-pandemic. OVMA also surveyed Ontario pet owners in June 2020, and again in April 2021, discovering that 75% of pet owners indicated that their issue was resolved with a telemedicine consultation with their veterinarian. And, even more telling, the 2021 survey showed that just over half of pet owners said they actually preferred a veterinarian who offered video or telemedicine appointments.
But while pet owners may be increasingly for telemedicine options, veterinarians are not necessarily following suit, according to a survey commissioned by the RCVS in 2021, which included responses from 5,544 veterinarians and veterinary nurses. By and large, this group said they believed a physical exam is essential in order for an animal to be considered under a veterinarian’s care (41% strongly agreed, 32% somewhat agreed; just 9% were neutral, 10% somewhat disagreed, and 7% strongly disagreed).
Gail C. Golab, PhD, DVM, MANZCVS, DACAW, chief veterinary officer for the AVMA, said comparing the US to the UK and Canada is not an "apples-to-apples" situation because "state and federal laws in the US are based on different needs, authorities, and public obligations . . . particularly when it comes to prescribing."
And she added: "Ontario's approach to the electronic VCPR includes a requirement for premise registration, which assists in addressing some quality concerns associated with direct-to-consumer telemedicine companies, but the concept of premise registration is not fully embraced in the US. Such registration is unlikely to happen here with any uniformity, and, accordingly, that firewall is largely absent."
While pet owners say they want telehealth services (which in this survey included teleadvice, teletriage, and telemedicine), Golab said: "We know from other research that the existence of a previous relationship has considerable impact on their confidence in the veteirnarian-client interaction and their willingness to pay for telemedicine varies depending on who is delivering it"—meaning they want these services from their own veterinarian rather than from a "nonconnected" direct-to-consumer company.
A matter of interpretation
The RCVS’s decision to relax telemedicine restrictions came down to a matter of interpretation of the UK’s Veterinary Medicines Regulations, which says that practitioners must carry out a clinical assessment of an animal under their care before prescribing medicines. The terms “clinical assessment” and “under that veterinary surgeon’s care” has now been interpreted to include both in-person and remote.
There are caveats, though. A physical exam is still required “in all but exceptional circumstances” when vets prescribe antimicrobials (such as antibiotics), and a 24/7 follow-up service involving a physical examination must be immediately available to that client if they need it (although this can be offered by the prescribing veterinarian or another practitioner).
AVMA President Lori M. Teller, DVM, DABVP (canine/feline), CVJ, clinical associate professor at Texas A&M University, was a reviewer of the 2021 AAHA/AVMA Telehealth Guidelines for Small-Animal Practice.
She said while she “strongly believes in the ability of telemedicine to expand and enhance the ability for owners to receive veterinary care for their pets” and has found telemedicine to be a “terrific adjunct” to patient care in her own experience, “every single patient has needed an in-person exam and would not have received appropriate care from telemedicine alone.”
And Teller warns that “laws and regulations regarding the practice of veterinary medicine are very different in the UK compared to the US.” For example, the UK has much stricter prescribing laws for antimicrobials and “rigorous monitoring of marketing, manufacturing, supply, and use of these medications” as well as more oversight of veterinarians in general by a national regulatory body that is also responsible for disciplinary action.
Expanding telehealth worldwide
Deb Leon, co-chair and founding board member of the Veterinary Virtual Care Association (VVCA) as well as founder and CEO of the pet telehealth company whiskerDocs, believes the UK's move is a step in the right direction. She’s encouraged by the change, saying that it’s a good indication of greater faith in the decisionmaking abilities of licensed veterinarians.
“Broadly speaking, it appears the RCVS has decided that the veterinarian, or ‘veterinary surgeon,’ who is ‘treating’ an animal has more discretion in determining whether virtual means are appropriate and what, if any, follow-up advice or care is needed,” she says.
“It is certainly meaningful that the RCVS has increased the level of trust and responsibility given to the veterinarian, allowing her or him to choose the most effective treatment modality, and reducing what can be a burdensome regulatory framework that limits treatments options unnecessarily.” Leon hopes to see the US follow suit within the next two years.
In the UK, Jessica May, BSc (Hons) BVetMed (Hons) MRCVS, chair of the VVCA-European Affiliate, has a similar wish. “It has always been the vision of the [VVCA] to expand globally and foster worldwide collaboration,” she says. “We now have a great opportunity to harness our collective understanding to organize and drive the conversation and provision of telehealth forward.”
As a final thought, Golab added: "How the VCPR is established isn't the same conversation as enthusiasm for the adoption of telemedicine (or, more broadly telehealth) overall. We have tremendous opportunity to improve understanding of all aspects of telehealth and to improve their adoption."
Kristen Seymour is a freelance writer based in Sarasota, Florida. She's a frequent contributor to many pet-focused publications including HealthyPet Magazine, USA Today's Pet Guide, Vetstreet.com, DailyPaws.com, Happy Paws, and more.
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