Telemedicine: Food for thought

RE: Telemedicine: Food for thought

Bob Russell — Tue, 08 Oct 2019 12:09:06 GMT

I am pleased to hear they have changed the wording. Not been on their site but it sounds as if they have responded suitably.

RE: Telemedicine: Food for thought

Arlo Guthrie — Fri, 04 Oct 2019 08:00:54 GMT

[quote user="Iain Richards"]As they say in Glasgow, "Aye, Right"[/quote]

You old cynic, you.

RE: Telemedicine: Food for thought

Iain Richards — Fri, 04 Oct 2019 07:54:12 GMT

[quote user="Arlo Guthrie"]I believe they just hadn't thought about it being misleading.[/quote]

As they say in Glasgow, "Aye, Right"

RE: Telemedicine: Food for thought

Arlo Guthrie — Thu, 03 Oct 2019 17:42:12 GMT

[quote user="Bob Russell"]IVC's 'Find a Vet' should be scrapped without delay and replaced perhaps by 'Find one of our Vets'![/quote]

...

Bob Russell

...

Ta Da

https://www.myfamilypet.co.uk/find-a-vet

It has been reworded to 'Search for a My Family Pet veterinary practice near you'

('My Family Pet' being the consumer brand that IVC is building).

And the 'About Us' page explains that 'My Family Pet' is brought to you by the Independent Vetcare Group.

And I also understand that following an online consultation, the company is also directing clients to their own vet finder AND the RCVS Find a Vet tool, which I think is more than they need to do!

Having brought this to their attention after it was raised in the forum, I believe they just hadn't thought about it being misleading. And as with so many organisations, it took a while for the cogs to turn, but they did in the end, and I think that deserves a bit of

RE: Telemedicine: Food for thought

Julian Earl — Wed, 02 Oct 2019 11:10:28 GMT

We should have learnt from the use of endo-parasiticidal-rugs in livestock. Flagrant and unwise- use has contributed to the widespread development of resistance. Hopefully if the profession can retain control then this should be less of a problem in the future. So making them easier to purchase without restriction and advice is potentially a problem. The epidemiology for parasites in dogs and cats is very different to flocks/herds on a restricted area of grazing but could resistance still be a huge problem even for our pets in future years?

We have had a salutary warning about resistance and I believe that we should heed this warning! Let us keep them under veterinary control!

RE: Telemedicine: Food for thought

Iain Richards — Wed, 02 Oct 2019 08:39:39 GMT

[quote user="Arlo Guthrie"]I went to the Council meeting, and my impression was not that the Council was pushing hard for remote prescribing, just that it was pushing hard to do SOMETHING![/quote]

I think you are right Arlo. Despite all the cries of vested interest (and they are legitimate) the college felt it needed to be seen to be acting to allow innovation and then adapt to regulate it. I strongly suspect it is a hangover from the Nick Stace era. The term telemedicine was used and used unwisely and at some point got conflated with remote prescribing. From this point however, there was a push for it, with the suggestion of a time-limited trial.

The college still have no plan for how to regulate telemedicine

RE: Telemedicine: Food for thought

Iain Richards — Wed, 02 Oct 2019 08:33:07 GMT

[quote user="Anthony Todd"]

What is the point of making [safe] drugs POMV when they can be legally bought from supermarkets?

What is the point, or the medical logic, of making some [all?] wormers POMV?

I can understand, and agree with, say, phenobarbitone, an extreme example, but cannot see why wormers etc should be restricted.

[/quote]

A new molecule has to go POM-V on first release, all sorts of pharmacovigilance stuff. After a set period, the company can apply to change category to "increase access". Most antiparasiticides act on receptors that are not found in mammals, so the safety issues are less than with actives that act on mammals.

RE: Telemedicine: Food for thought

Joyce Whitehead — Tue, 01 Oct 2019 20:34:36 GMT

And Anthony, when it says prescription at the checkout, it means they take the owner and pet details as they have an SQP available to “prescribe” it, not a vet prescription.

RE: Telemedicine: Food for thought

Thomas Johnson — Tue, 01 Oct 2019 17:55:13 GMT

[quote user="Anthony Todd"]

Drontal Plus Dog Tablets (8 pack) - Tesco

https://www.tesco.com › direct › drontal-plus-dog-tablets-8-pack

Drontal wormers have always been the first choice of wormer recommended by your vet. This is because of its wide spectrum of activity. The unique combination ...

Interesting! When I searched this yesterday re Drontal at various supermarkets, they offered a quote and some said "prescription at checkout....." now the TESCO site when Drontal is clicked gives an unconnected TESCO advertisement.....??

[/quote]

It looks like Tesco have had a big re-vamp of their website and no longer sell Drontal.

[quote user="Arlo Guthrie"]

[quote user="Thomas Johnson"]The worm and flea treatments that you can buy at the pharmacy counter in the supermarket, or online without a written prescription from a vet are not POM-V, they are NFA-VPS.[/quote]

I'm sure Tony knew that - I think he was making the point that to an owner a wormer is a wormer is a wormer. And I think he's right on that score.

[/quote]

I agree that to a client it can be hard to understand the difference, but Tony asked "What is the point of making [safe] drugs POMV when they can be legally bought from supermarkets?" to which the reply was that the ones you can buy at the supermarket aren't POM-V, which is why you can buy them at the supermarket.

RE: Telemedicine: Food for thought

Bob Russell — Tue, 01 Oct 2019 17:50:40 GMT

[quote user="Anthony Todd"]

[quote user="bob lehner"]Ah yes - the lovely Pooh sticks.... I get them very regularly too.[/quote]

Sorry Arlo, back again, but it saved my relative, [ie stools going "blackish"] and a friend, who is in for surgery so study your stool before it is too late! And it is so common!!

I think Henry V111 had someone who only did that, so it's not new!

[/quote]

The Groom of the Stool!!!

Quite an important post in those days. Who else could claim to have the Monarch's almost undivided attention?

Parasites etc would have been a significant risk. Henry VIII could have done with a tapeworm or ten!

RE: Telemedicine: Food for thought

Anthony Todd — Tue, 01 Oct 2019 17:05:43 GMT

Drontal Plus Dog Tablets (8 pack) - Tesco

https://www.tesco.com › direct › drontal-plus-dog-tablets-8-pack

Drontal wormers have always been the first choice of wormer recommended by your vet. This is because of its wide spectrum of activity. The unique combination ...

RE: Telemedicine: Food for thought

Arlo Guthrie — Tue, 01 Oct 2019 16:54:41 GMT

I'm sure Tony knew that - I think he was making the point that to an owner a wormer is a wormer is a wormer. And I think he's right on that score.

[quote user="Thomas Johnson"]Generally what seems to happen is that when parasite products for pets are introduced they are POM-V, but once they have been on the market for a while and have proven safe for mass use they are re-classified NFA-VPS, as has happened to Seresto recently.[/quote]

Is it really based on evidence of safety in mass use? I was always given to understand that it is more at the behest of the manufacturer. ie the maker would decide that they wanted the product to go OTC, and then safety would be a factor in the licensing decision. Not that once something has been on the market and in wide enough use for long enough, it automatically goes OTC.

RE: Telemedicine: Food for thought

Anthony Todd — Tue, 01 Oct 2019 16:53:44 GMT

[quote user="bob lehner"]Ah yes - the lovely Pooh sticks.... I get them very regularly too.[/quote]

Sorry Arlo, back again, but it saved my relative, [ie stools going "blackish"] and a friend, who is in for surgery so study your stool before it is too late! And it is so common!!

I think Henry V111 had someone who only did that, so it's not new!

RE: Telemedicine: Food for thought

Thomas Johnson — Tue, 01 Oct 2019 16:49:04 GMT

[quote user="Anthony Todd"]

What is the point of making [safe] drugs POMV when they can be legally bought from supermarkets?

What is the point, or the medical logic, of making some [all?] wormers POMV?

[/quote]

The worm and flea treatments that you can buy at the pharmacy counter in the supermarket, or online without a written prescription from a vet are not POM-V, they are NFA-VPS. Generally what seems to happen is that when parasite products for pets are introduced they are POM-V, but once they have been on the market for a while and have proven safe for mass use they are re-classified NFA-VPS, as has happened to Seresto recently.

RE: Telemedicine: Food for thought

bob lehner — Tue, 01 Oct 2019 16:34:08 GMT

[quote user="Bob Russell"]Instead of getting a birthday card from the NHS they sent me a bowel cancer detector card! [/quote]

Ah yes - the lovely Pooh sticks.... I get them very regularly too.

RE: Telemedicine: Food for thought

Gillian Mostyn — Tue, 01 Oct 2019 15:48:16 GMT

[quote user="Arlo Guthrie"]Not sure if I understand the distinction Gillian Mostyn, but yes, that is one of the main things the RCVS is considering as part of the review of the definition of 'under care', which of course defines who can prescribe what, when. [/quote]

Sorry, I meant has the RCVS indicated they want to change/relax the current guidelines, or just provide more clear guidance.

RE: Telemedicine: Food for thought

Arlo Guthrie — Tue, 01 Oct 2019 14:39:31 GMT

[quote user="Bob Russell"]IVC's 'Find a Vet' should be scrapped without delay and replaced perhaps by 'Find one of our Vets'![/quote]

Bob, I did have an undertaking from someone at IVC that they were going to change their website to remove the ambiguity. That was a while ago, but I have chased it up.

[quote user="Gillian Mostyn"]Is allowing remote prescription of POMs something that has been considered by RCVS? Or just been part of the discussion?[/quote]

Not sure if I understand the distinction Gillian Mostyn, but yes, that is one of the main things the RCVS is considering as part of the review of the definition of 'under care', which of course defines who can prescribe what, when.

[quote user="Iain Richards"]I thikn it is reasonable to say that, "the college" have pushed hard to allow remote prescribing[/quote]

Iain Richards I went to the Council meeting, and my impression was not that the Council was pushing hard for remote prescribing, just that it was pushing hard to do SOMETHING! i.e. take a leadership position on it (which seems fair enough to me). Personally, i think it is that which is the biggest driver here, as all the people I've spoken to with an apparently vested interest - bar one, as I remember - have sworn blind that they have not been lobbying for change.

[quote user="Anthony Todd"]What is the point of making [safe] drugs POMV when they can be legally bought from supermarkets?[/quote]

I used to be involved with the marketing of Program when pretty much all flea treatments were POM. The argument for safe medicines nevertheless being POM was simply that owners would not be as good at treating their animals themselves as if they had been directed by a veterinary surgeon.

I'm not so sure about that. I mean sure, if you have gone to the effort of seeing a VS and paying the premium, you probably are more likely to use the medication as directed.

But how many animals are untreated because the owner cannot be bothered (or can't find time) to visit the practice, or doesn't have or doesn't want to spend the money.

Is it half a dozen of one and six of the other?

Is there any research? The world doesn't seem to have imploded since Frontline went OTC.

But going back to your point, Anthony Todd I suppose you could say that if all the 'safe' parasiticides were made OTC, then the argument for allowing remote prescription without having seen the animal would be made much weaker.

But equally, it would remove something that drove owners into practice. So perhaps the better option is to relax remote prescribing of parasiticides by veterinary practices to people living in their area (whether or not registered as clients).

RE: Telemedicine: Food for thought

Bob Russell — Tue, 01 Oct 2019 13:31:47 GMT

I have been on epilepsy medication since my mid twenties. For a long time this was pretty much unsupervised until they took a blood sample which showed far too high doses!

For the last few years I have been seen at least yearly for review (even if seen the previous week for something else!).

Instead of getting a birthday card from the NHS they sent me a bowel cancer detector card! Think on balance I prefer a birthday card but I suppose that has little scope to save my life!!!

RE: Telemedicine: Food for thought

Gillian Mostyn — Tue, 01 Oct 2019 13:20:50 GMT

[quote user="bob lehner"]Seems that vets are more strict on this than their medical colleagues. I've been on some POM meds for hypertension for about 4 years - re-order monthly on-line from the pharmacy at my doctors' surgery. Never been asked to attend for any sort of check up....[/quote]

I've been on POM for migraines for 20 years with perhaps 2 requests for check ups!

However, as I've said, I think humans can take responsibility for their own health, but are not always able to be as knowledgeable or responsible with the health of their pets. I assume everyone has seen the crippled Labrador whose owner thinks it isn't in pain, just 'a bit stiff' or the hyperthyroid cat whose owner hasn't even noticed a 2kg weight loss!!!!

RE: Telemedicine: Food for thought

Bob Russell — Tue, 01 Oct 2019 12:14:02 GMT

I see patients as often as I consider it appropriate. I do not specify 3 months and doubt that there is any need to see a patient that is doing fine. Medication is prescribed over a suitable period and most are expected to to take a month at a time. We do ask about their wellbeing at every point of contact.

A hyperthyroid cat will be seen for review if there are any changes especially weight and appetite but then seen at least six monthly. This has worked well for many years but I admit to seeing one that had gone downhill without the owner picking it up. I do consider the owner has responsibilities for the care of their pets. I do not automatically blood test a cat that is on thyroid medication, eating well, no weight loss and drinking as normal. Why would I unless it is to cover my back?

My argument is that you cannot reliably diagnose a patient without seeing it. People are self diagnosing then going on-line to order medication for themselves. This is dangerous nonsense and the NHS seems to be abdicating some of its responsibilities to relieve the pressure on GP's.

Why would we, as a profession, drop our standards in a similar way? If the public find one to one consultations on-line of value then so be it but this should be limited to advice, not a diagnosis or treatment. Directing a client to a bricks and mortar practice should be open and honest if it is only to one of a corporate practices. IVC's 'Find a Vet' should be scrapped without delay and replaced perhaps by 'Find one of our Vets'!

RE: Telemedicine: Food for thought

bob lehner — Tue, 01 Oct 2019 11:37:30 GMT

[quote user="Gillian Mostyn"]Agreed - the RCVS and VMD allow personal discretion. However, just from personal experience I find most vet practices expect to see their patients on long term meds about every 3 months, but just yearly (usually at booster time) for parasite treatments. Maybe this is something that needs to be clarified - what does 'under our care' actually mean?[/quote]

Seems that vets are more strict on this than their medical colleagues. I've been on some POM meds for hypertension for about 4 years - re-order monthly on-line from the pharmacy at my doctors' surgery. Never been asked to attend for any sort of check up....

RE: Telemedicine: Food for thought

Michael Woodhouse — Tue, 01 Oct 2019 11:05:32 GMT

I've been involved in a number of discussions on this and the vast majority seem happy with 6 months for stable animals. We will only prescribe a maximum of 2 months supply (1 month for CDs) so we see them twice in that period of time and it gives a chance to ask how the dog is doing etc. I think that is very valuable contact and adds safeguards that a written prescription sent by post with 2X repeats does not.

Personally I do find it can be a challenge making an owner of a long term, stable dog on NSAIDs or thyroxine seem like they are getting value for money from a clinical exam, weigh and carry on as we have been for the last 3 years......... I'd hate that every 3 months.

To be clear I am talking about stable patients on long term meds, not sending the newly diagnosed diabetic off for 6 months.

RE: Telemedicine: Food for thought

Anthony Todd — Tue, 01 Oct 2019 09:37:25 GMT

[quote user="Gillian Mostyn"]What is it you are thinking is wrong about the current or possible future system?[/quote]

Last try:

What is the point of making [safe] drugs POMV when they can be legally bought from supermarkets?

What is the point, or the medical logic, of making some [all?] wormers POMV?

I can understand, and agree with, say, phenobarbitone, an extreme example, but cannot see why wormers etc should be restricted.

Propalin will be misused for sure, for example, but will wormers; ever and are they dangerous if so used??

The dose rates are on the pack!

If POMV was medically sensible then certainly but, currently, it is not, as far as I can see.

As I said, I think clients would love to buy their pet's drugs from their vet, but not if it costs them more for no apparent reason, and when they are available on their weekly shop.

RE: Telemedicine: Food for thought

Gillian Mostyn — Tue, 01 Oct 2019 09:11:04 GMT

[quote user="Thomas Johnson"]Absolutely, though I wouldn't agree that most vets set a 3 month time limit, I'm quite happy with 6 month checks for a lot of animals that are stable on long-term medications, and for parasite treatments every 12 months is fine.[/quote]

Agreed - the RCVS and VMD allow personal discretion. However, just from personal experience I find most vet practices expect to see their patients on long term meds about every 3 months, but just yearly (usually at booster time) for parasite treatments. Maybe this is something that needs to be clarified - what does 'under our care' actually mean?

RE: Telemedicine: Food for thought

Thomas Johnson — Tue, 01 Oct 2019 08:25:09 GMT

[quote user="Gillian Mostyn"]Currently vets are able to prescribe (including remotely) to an animal under our care. So clients whose animals are registered and familiar to the practice can indeed collect POMs or a written prescription as required without a consultation every time(including ectoparasiticides, NSAIDS, antibiotics etc). A remote consultation first, be it a phone call or web chat, may be appropriate in some cases, but the animal should already be known to the vet. Most vets set a 3 month time limit for this. I don't think anyone here thinks we should be prescribing POMs with no recent physical knowledge of the animal and owner. [/quote]

Absolutely, though I wouldn't agree that most vets set a 3 month time limit, I'm quite happy with 6 month checks for a lot of animals that are stable on long-term medications, and for parasite treatments every 12 months is fine.