Pet-Specific Care for the Veterinary Team. Группа авторов
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owners should check with the insurance provider to determine telemedicine coverage.
Blair Donaldson is a 3‐year‐old neutered male Dalmatian, who has been previously diagnosed with atopic dermatitis. He has been well controlled for the past several months with a daily Janus kinase inhibitor, but started scratching significantly in the last few hours. Since Blair had previously experienced pyotraumatic dermatitis (a hot spot) from his scratching, Mrs Donaldson immediately telephoned ABC Veterinary Hospital to bring him in without delay.
Julie, the customer service representative who answered the phone, was very concerned about Blair and recalled how tragic Blair seemed after his hot spot. Julie would book Blair for an appointment the next day, which was the first availability, but asked if Mrs Donaldson might be interested in a telehealth consult that could be scheduled for that afternoon, when Julie would try to create some time between existing appointments.
When Dr Green and Mrs Donaldson connected on that telehealth call, it was very apparent that Mr. Donaldson was concerned and was afraid of what Blair might do to himself if the scratching could not be curtailed.
Dr Green suggested that the likely culprit was ragweed pollen in the environment, which was wreaking havoc with many pets in the practice as the pollen count was at an all‐time high for the season. He advised that Blair be given a cool‐water soak for at least 10 minutes, gently toweled dry, and then a mild antipruritic spray be used on affected areas. During the bathing, Mrs Donaldson was to do a thorough check for fleas and other parasites, and verify with her husband that Blair's parasite control product had been administered on schedule. It was advised that Blair remain indoors with windows closed and air conditioner on and it was recommended that an over‐the‐counter antihistamine be considered (suitable products and doses were provided). It was unlikely that the antihistamine would have a major impact on the pruritus, but it might help a bit and also have some sedating effects which might make Blair more sleepy and less likely to do damage to himself. The plan was to repeat the cool‐water soak and spray before bedtime, but if Blair was not significantly more comfortable by then to give another dose of his allergy medication just this once to keep him comfortable overnight, and they would address whatever issues remained at the appointment scheduled for the next day.
Mrs Donaldson was relieved that there was now a plan in place, and felt the telehealth consult provided her with peace of mind, and she was more than happy to pay for the service.
Most aspects of virtual care must be carried out under the auspices of a veterinary–client–patient relationship.
Ideally, guidelines should be created for telehealth consults so that the entire hospital team is aware of what they are, how they should be scheduled, payment terms, and standardized medical record entries.
Remote monitoring will be an increasingly important aspect of virtual care, allowing veterinary teams to track certain pet indices from a distance.
All indications are that clients are prepared to pay for virtual care options, if veterinary teams make them aware of the possibilities.
Charging for virtual care is more a lack of a “will to bill” rather than unwillingness of clients to pay for such services.
2.5.8 Cautions
Telehealth solutions are still evolving, and regulations have not caught up with many of the applications that are possible with today's technologies.
Without a valid VCPR, any advice provided should be considered general and not specific to any patient, and should not imply any intended diagnosis or treatment recommendation.
Veterinarians considering being telehealth providers should be prepared to present their particular credentials, provide any service disclaimers, and specify what services they are able to provide, and the limitations of such telehealth consultations. If clients have pet health insurance and are hoping to be reimbursed for virtual care, they should verify that telehealth services are covered by the policy.
Practices preparing to offer telehealth solutions should seek legal advice before providing such services, or affiliating with companies providing those services. It is also worth checking with the insurance provider regarding any liability issues that could be associated with telehealth solutions.
The majority of human physicians engage in different forms of telehealth. It should be anticipated that this same trend will eventually happen with veterinary medicine as well.
Recommended Reading
1 Ackerman, L. (2019). Why should veterinarians consider implementing virtual care? EC Veterinary Science 4 (4): 259–261.
2 Ackerman, L. (ed.) (2020). Telehealth. In: Five‐Minute Veterinary Practice Management Consult, 3e, 310–311. Wiley.
3 Ackerman, L. (2020). The new e‐commerce: E‐commerce is more than just selling products online. AAHA Trends 36 (11): 51–54.
4 American Animal Hospital Association, (2018) American Veterinary Medical Association. The real‐life rewards of virtual care – how to turn your hospital into a digitally connected practice with telehealth. www.aaha.org/globalassets/05‐pet‐health‐resources/virtual_care.pdf or https://www.aaha.org/practice‐resources/pet‐health‐resources/virtual‐care‐and‐telehealth/
5 American Veterinary Medical Association. Telehealth & telemedicine in veterinary practice. www.avma.org/telehealth
6 Duncan, S. (2018). Redefining the risks and rules for telehealth services. www.veterinarypracticenews.com/redefining‐risks‐rules‐telehealth‐services/print
7 Green, E. (2017). Veterinary telemedicine: are we leading? https://todaysveterinarybusiness.com/veterinary‐telemedicine‐leading
8 Katayama, M., Kubo, T., Mogi, A. et al. (2016). Heart rate variability predicts the emotional state in dogs. Behav. Processes 128: 108–112.
9 Miller, M.C. (2019). The Telehealth Trend. AAHA Trends 35 (4): 29–34.
10 Surman, S. and Fleeman, L. (2013). Continuous glucose monitoring in small animals. Vet. Clin. North Am. Small Anim. Pract. 43: 381–406.
2.6 Generational Considerations
2.6.1 Summary
Pet‐specific care is a concept that can revolutionize our approach to providing veterinary healthcare. However, in order to obtain client buy‐in, we must raise their awareness and understanding of this new approach. In veterinary medicine,