The company says it is calling for the change after analysing the records of its consultations held during the pandemic and finding that there was a low antibiotic prescribing rate, treatments were effective and no harm was caused.
During the seven months that Vet-AI collected data, from the 1st April to the 31st October 2020, its vets held 21,383 veterinary video consultations, an analysis of which is the subject of a paper published in the RCVS Knowledge journal, Veterinary Evidence1.
78.1% of the consultations were for dogs and 21.9% for cats.
Of the vet-led video consultations completed, 3,541 had medicines prescribed during the consultation.
Some consultations required more than one prescription, which meant a total of 4,282 POM-V medications were prescribed.
Of those, Vet-AI says 0.87% reported a mild adverse effect.
Antibiotics were prescribed in 5.9% of all consultations, 99.3% of which was first line.
Vet AI says follow-up on prescribing was available in 67.7% of cases and 89.4% of all known treatment outcomes were complete or had an expected response to treatment.
Skin problems were the most common body system/disease category seen and prescribed for.
The remaining 17,482 consultations, which did not require a prescription medicine, had resolutions assigned.
They included 959 referrals to an emergency in-person veterinarian visit; 4,852 recommendations to visit a vet in-person; 4,216 alternative products recommended, 6,421 follow-up consultations with the remote veterinary team, and 219 remote laboratory tests.
Samantha Webster MRCVS (pictured right), from Joii Pet Care, said: “Given the clear evidence outlined in this report, we believe the future of veterinary medicine should include remote consultations with remote prescribing where appropriate and regulated.
"We invite the RCVS and other veterinary governing bodies to consider that there is a place for prescribing remotely on an ongoing basis for certain cases under certain conditions, such as a secure video and audio link with clinical record keeping and pharmacovigilance practice.
"A blanket ban is not appropriate with the advance of modern technology."
“Bold steps have been taken in human health, incorporating modern technologies to support both GPs and patients, to great success.
"Our industry could use these learnings to help reduce the current strain and demands on vets across the country where mental health is already a key issue due to increased pressures, under resourcing, and compassion fatigue.
“We feel it’s important to take this approach to reach as many owners and provide professional advice and appropriate treatment on pet health so that those animals that do not necessarily currently receive veterinary care do so, and to bridge the gap wanted by clients.”
Reference
The company is making the claim based on a £20,000 study it conducted with three dermatology specialists from three different clinics, in different parts of the country.
Trevor Hardcastle, Vet-AI’s chief data scientist said: "We have undertaken a small-scale trial of remote diagnosis of dermatology conditions by veterinary dermatology specialists in canine patients, which has resulted in almost perfect agreement. No significant evidence was found that veterinary dermatology specialists are measurably compromised in their ability to accurately diagnose common dermatology conditions by being remote from the patient."
Strangely, given the strength of the claim, its importance and Vet AI's obvious vested interest in the result, there was no other information contained within the company's press release. No mention of who the specialists were, nothing about the study design, and nothing about the basis on which the claim is made.
However, presuming the company meant Specialists not specialists, it would be very unusual if they had agreed for an announcement of this importance to be made without the evidence being reasonably robust. So it's probably worth suspending judgement until the study is published in full.
Meantime, the company also says its own research into online diagnosis amongst pet owners has shown that more than 50% of people have avoided taking their pets to the vet for cost reasons, yet more than 65% have tried online self-diagnosis. Again, Vet AI doesn't reveal how many pet owners were asked, or how they were sampled.
Vet-AI co-founder Sarah Warren said: "Things like dermatological issues are beautifully aligned to remote consultation because they’re visual so we can gain a wealth of information from images and distribution maps and easily recommend treatments.
"This needs to happen in a regulated, ethical and correct way with a view to improving animal welfare.
"The RCVS has a chance to ensure that people have access to quality vet help online in an effective way. They can do this, or they can allow them to continue accessing poor-quality advice. As a profession, it’s vital we respond to the needs of pet owners."
First out of the stalls was Vet AI, a company founded in 2017 by Paul Hallett and Robert Dawson MRCVS, which announced last November that it had filed patents for artificial intelligence technology to deploy in giving online consultations through its newly-launched app: Joii.
More recently, a Swedish company called FirstVet has announced the UK launch of a consultation service it has offered in the Scandinavian countries for a few years now.
All three companies charge £20 for an online consultation with a veterinary surgeon.
All of these services are currently limited in what they can offer pet owners here in the UK, because veterinary surgeons are not allowed to prescribe medicines without having physically examined the patient. FirstVet says that in Sweden, similar rules apply, except that under current guidance, antiparasiticides and feline contraceptives can be prescribed remotely.
This means that for the moment at least, online consultations in the UK can only advise pet owners whether they do or do not need to see a veterinary surgeon in person, or recommend OTC treatments, such as flea control.
Personally, I'm not convinced that it's worth £20 for the privilege of asking a vet whether or not my pet needs to see a vet, although to be fair, Joii includes a free symptom checker to differentiate between those cases that need directing to see a vet in person, and those that would benefit from the online consultation. Also, if a case needs to be referred to another vet after a consultation, Joii refunds the consultation fee.
Nevertheless I think I'd just ring my normal practice and ask. But that's just me. Perhaps others will see a value in the immediacy of the online service, or that it entails less commitment.
FirstVet does, however, have another string to its bow. It has been busy forging relationships with insurers to fund the majority of its consultations. The insured owner gets a free consultation subsidised by the insurance company; if the animal requires treatment, the owner is referred to their normal vet, unless they don't have one, in which case the referral is to the nearest practice which can help.
That seems to make all sorts of sense for insured clients. It really adds value to the insurance policy, to be told you'll have access to free, immediate online veterinary consultations. Almost certainly it will mean pet owners seeking veterinary advice sooner than they might otherwise have done. For the insurer, that in turn might mean earlier diagnosis and therefore cheaper treatment. One assumes it also translates into cost-savings for the insurer by dealing with certain queries without needing a trip to the practice.
Still, the really big prize here for remote consultation companies will come if and when the regulations allow remote prescribing. Not necessarily because they'll make a mark up on the sale of prescription drugs, though of course they will, but because suddenly the proposition to the pet owner is that the consultation can, in many cases, offer more convenient and cheaper treatment than if they had to visit a practice in person.
The problem with that, however, is that the £20 remote consultation may carry a greater risk of misdiagnosis. It may mean that the preventative approach to veterinary medicine goes out of the window, at least until remote monitoring technology catches up. There is also a risk that these new limited service providers will take the bread and butter consultations from bricks and mortar practices, consultations that may have been to some degree subsidising care for other patients. These are all the sorts of things that were hotly debated at RCVS Council last November.
Nevertheless, Vet AI is unashamedly pushing for remote prescribing rules to be relaxed. Founder Robert Dawson MRCVS said: "I think that the ease and reduced cost of access to veterinary advice and medicines will have a positive impact on animal welfare. I also think that it will free up vets' time to see the cases they really need to see.
"But in truth, what I think is not the point. The whole debate at the moment is characterised by members of the profession saying what they think will happen as a result of remote prescribing. What we actually need is some evidence. I'd really like to see some movement from the College on this, for a limited number of treatments like parasiticides, before the end of the year."
As Robert says, the debate is characterised by a lack of evidence. But there is, of course, another way that online consultations could really add value to the client/vet relationship without any of these problems, and that is as an adjunct to the service offered by bricks and mortar practices.
Bricks and mortar practices can already prescribe medicines to animals under their care without physically seeing the animal on every occasion. Furthermore, there are a number of situations where a remote consultation could save both the practice and pet owner time and money. For example, post-operative follow-up consultations.
However, none of the existing providers I've spoken to plan to offer a 'white label' solution. So, if I owned a practice, I tell you what, I'd be looking into online consultation software right now. It is already possible, of course, to offer online consultations via things like Skype. But better still would be a system that allowed clients to schedule an online appointment with their normal vet, perhaps slotted in between their face-to-face consultations. As opposed to the existing online providers, you wouldn't need to refund money if a physical consultation was needed, just - perhaps - set it against the later consultation. You could also offer annual plans to include a certain number of online consultations. You could have online triage consultations carried out by veterinary nurses.
There are lots of possibilities. But if you're a bricks and mortar practice, one thing is for sure, the time to look into all this is now. You could do worse than to start here: https://www.vetsurgeon.org/news/b/veterinary-news/archive/2019/01/15/now-all-vet-practices-can-offer-remote-consultations.aspx