"Medication" check ups

Re: "Medication" check ups

Rob Loxley — Mon, 08 Mar 2010 19:52:38 GMT

[quote user="Andre Escudeiro-Vieites"]My post was more intended to discuss the "3 month rule" for those cases like the 8 year old with mild OA, helthy otherwise. This is,to discuss the balance of on the one hand to comply with the RCVS guidance, and on the other to avoid the impression in costumers that they have to pay for excesive number of consultation fees[/quote]

The answer is that there is no 'rule', it comes down to individual practice protocols (see all the various posts here). If you think q3mo for a stable dog on NSAIDs is too frequent then see them less often. Like others we have a general set of guidelines, modified up and down on an individual basis.

Re: "Medication" check ups

Laurence Webb — Sun, 07 Mar 2010 21:03:11 GMT

Clive - you can only prescribe enough treatment to cover treatment until you believe the next check should be due. If you (or practice protocol) believe that an animal must be checked in 6 months then precribing 250 days worth of medication would be breaking the law. If it's not under your care in 190 days then it definately isn't in 250 days!

Another way to view it would be that, if you'd prescribed 180 tablets to the dog and if in 6 months they asked for another 70 tablets would you write a new prescription?

As far as NSAID monitoring goes, it depends on the case, but stable animals where we have no significant concerns about any other health problems are examined at least every 6 months, but we would also do a urine sample for SG and dipstick every 3 months. Stable animals with mitral valve disease are examined every 3 months as would stable hyperthryoid cats. Hypothyroid dogs are examined every 6mths if they are stable.

Re: "Medication" check ups

Hanna Bennett — Sun, 07 Mar 2010 15:54:57 GMT

me too. Had a dog on Rocalcitrol which was on one tablet twice weekly, and the pharmacy wanted to supply in batches of 100 tablets - damn near a years worth! Thankfully owner took my point about not being happy to leave a potentially hypocalcaemic dog without any check ups for this length of time, and found a different supplier who would supply smaller doses, so everyone was happy.

Re: "Medication" check ups

Gillian Mostyn — Sun, 07 Mar 2010 14:43:13 GMT

Clive - same as you, I would have refused. And pointed out to the client that the online pharmacy can set whichever rules it wishes, including not taking the time to count out tablets to keep its own costs low - but that is her problem, not yours. Our concern is the welfare of her dog, not the pharmacy's profits.

Re: "Medication" check ups

Clive Ansell — Sun, 07 Mar 2010 11:13:44 GMT

A difficult area as a locum , every practice seems to be different, and some enforce it more than others. The maximum is usually 6 months if a patient is stable, except for flea and worm controls which are 12 months.

very ill, old or unstable cases are less according to the case.

I had a difficult one recently; the practice had a strict policy of a 6 month maximum, written in bold and underlined in their protocol manual even. A client requested a written script for 250 Soloxine tablets, 250 days worth. I expained in line with policy the maximum I could sign for would be 180 days or 6 months worth, but the online pharmacy will only supply unbroken 250 tablet bottles. The client had a history of not keeping check appointments and not turning up for routine monitoring blood tests, so I didn't feel happy allowing 8-9 months meds being given and trusting this client to return in 6 months. I therefore declined to sign the script resulting in a very unhappy client -what would others have done?.

Re: "Medication" check ups

Andre Escudeiro-Vieites — Sun, 07 Mar 2010 11:07:09 GMT

I obviously understand the need to check unstable ill patients on whatever frequency that is clinically appropriate (monthly, weekly, daily or continuously-hospitalised).I don´t think that is debatable.

My post was more intended to discuss the "3 month rule" for those cases like the 8 year old with mild OA, helthy otherwise. This is,to discuss the balance of on the one hand to comply with the RCVS guidance, and on the other to avoid the impression in costumers that they have to pay for excesive number of consultation fees (we all know that the press has decided to exploit the mine of "vets are welthy ruthless people who only try to get as much money from you as they can").I don´t know I if is paranoia, but I have the impression that more clients are questioning the need for routine check ups since all this media attacks started.

Thanks for the very usefull point of comparing the life spam of dogs with humans, and therefore the different relative importance of 3-6 months for a Doctor Vs Vet. I´ll definetly use it in consult.

Re: "Medication" check ups

Clive Ansell — Sun, 07 Mar 2010 10:53:00 GMT

Arlo - how do I remove - I initially posted in the wrong thread, have cut and paste to move, but cannot delete?

Re: "Medication" check ups

Utlendigur — Sun, 07 Mar 2010 09:21:04 GMT

Ditto on the case by case basis. Flea/worm POMs usually annual. Others between 3-6months (up to 12mnths in some cases like the large aggressive youngish dog on nsaids). Unstable diabetics etc monthly or less.

On thing I sometimes day to the complainers is that animals age faster than us - most clients have heard of the 7 dog years = 1 human year - so asking to see the animal every 3.5 years isn't OTT

Re: "Medication" check ups

Vikki Halliday LLB — Sat, 06 Mar 2010 22:24:49 GMT

Most of the time for stable chronic cases I would use the 3 month "rule", however OA treatments where there are no other problems and the animal comes for annual booster, I'd usually let that go to 6 months.

POM-V products which are by definition more preventative, such as wormers and combination flea treatments, usually annual check ups, and these are in animals under about 7 years old, usually free. (especially if they are annual vaccinators).

We do have the occasional client who complains that they can get whatever prescription medication they are on from their GP without seeing them for years, but most clients appreciate the need for checks.

Unstable e.g. diabetics, hyperT4 cats usually monthly, but it depends on the case. I guess this is one area where having a rather vague "under your care" statement in the GtPC can be a useful ally.

(see I can be nice about the RCVS!)

Re: "Medication" check ups

Andre Escudeiro-Vieites — Sat, 06 Mar 2010 20:10:01 GMT

Thanks Guilliam,

We follow in my practice the geneal "3 month rule", but I tend to apply judgement in certain cases like the one you put as an example (aggressive dog). Just wanted to know that it is within the guidelines as I get many clients saying, sometimes quite anoyed, that the required check ups (therefore consultation fees) have to be "more often than at the doctor's"

Re: "Medication" check ups

Gillian Mostyn — Sat, 06 Mar 2010 19:55:57 GMT

It is decided on a case by case basis. ' normal' for chronic condition, animal stable, is 3 monthly. But if there are exceptions eg very aggressive dog - if I can't get near it without sedation, a chat on the phone is sufficient - maybe check yearly. Others may be montly if the risk of problems is higher eg diabetic.

As to the concept of 'under my care' - I suppose it means that the animal's treatment is being correctly supervised so just make sure you can justify your reasons.