Clinical audit of POM-V / POM prescriptions by remote consultation via a veterinary video telemedicine smartphone application

Published:

2022-06-08

Share
Open Access Logo

DOI

https://doi.org/10.18849/ve.v7i2.553

Abstract

There is an erratum to this paper published in Veterinary Evidence Vol 7, Issue 2 (2022): 10.18849/VE.V7I2.627

Objective: To assess outcomes of a limited period (7 months) of remote video consultation with prescribing of prescription-only (POM) or prescription-only-veterinary (POM-V) medications by Royal College of Veterinary Surgeons (RCVS) registered veterinary surgeons to UK clients via a veterinary telemedicine smartphone application.

Background: Objective evidence is needed to inform the veterinary profession on the impact that remote prescribing, without physical examination in person, has on animal health and welfare. During the COVID-19 pandemic, the RCVS allowed remote prescribing temporarily.

Methods: Clinical records from all veterinary video consultations from 1 April–31 October 2020 were reviewed. Details were assessed pertaining to: signalment, body system / disease categories managed, referrals into practice, medication classes prescribed and outcomes following POM-V / POM medications. Records of adverse events and antimicrobial prescribing were reviewed.

Results: 16.6% (3,541/21,383) of video consults had a POM-V / POM prescribed; with a (mild) adverse event rate of 0.8% (30/3541). Antibacterials were prescribed in 5.88% of all consultations (1,258/21,383), 99.3% (1249/1258) being first line. Follow-up on prescribing was available in 67.7% (2,399/3541) of cases. 89% (2135/2399) of all known treatment outcomes were complete or had an expected response to treatment. Dermatological disease was the most common body system / disease category seen and prescribed for.

Conclusion: Low prescribing rates (including antibacterials) were recorded, treatments were efficacious and no harm was done by prescribing remotely via a veterinary video consult app.

Application: Veterinary surgeons and governing bodies are invited to use the information provided in this clinical audit to inform decisions on the suitability of remote consultations and prescribing in veterinary medicine.

 

Open Access Peer Reviewed

References

BSAVA & SAMSoc. (2018). BSAVA / SAMSoc Guide to Responsible Use of Antibacterials: PROTECT ME. Available from: https://www.bsavalibrary.com/content/book/10.22233/9781910443644 [Accessed 1 Oct 2021].

Burke, B.L. & Hall, R.W. (2015). SECTION ON TELEHEALTH CARE. Telemedicine: Pediatric Applications. Pediatrics. 136(1). DOI: https://doi.org/10.1542/peds.2015-1517

Buckland, E.L., O'Neill, D., Summers, J., Mateus, A., Church, D., Redmond, L. & Brodbelt, D. (2016). Characterisation of antimicrobial usage in cats and dogs attending UK primary care companion animal veterinary practices. Veterinary Record. 179(19), 489. DOI: https://doi.org/10.1136/vr.103830

Cary, M. & Massecar, A. (2017). Veterinary Telehealth: What Is It, Where Are We, and What’s Next? Today’s Veterinary Practice. [online] Available from: https://todaysveterinarypractice.com/veterinary-telehealth-guide/ [Accessed 2 Jun 2021].

Cushing, M. (2017). NAVC Keynote Commentary for the Veterinary Community: A Regulatory Road Map for Telehealth & Pet Health Care. Today’s Veterinary Practice. [online] Available from: https://mydigitalpublication.com/publication/index.php?m=60565&i=597047&p=116&ver=html5 [Accessed 26 May 2022].

De Briyne, N., Gopal, R., Diesel, G., Iatridou, D. & O’Rourke, D. (2017). Veterinary pharmacovigilance in Europe: a survey of veterinary practitioners. Veterinary Record Open. 4(1). DOI: https://doi.org/10.1136/vetreco-2017-000224

Elkholly, D.A., O’Neill, D., Wright, A.K., Mwacalimba, K., Nolan, L.S., Pavlock, A., Pelligand, L., Church, D. & Brodbelt, D. (2019). Systemic glucocorticoid usage in dogs under primary veterinary care in the UK: prevalence and risk factors. Veterinary Record. 185(4), 108–108. DOI: https://doi.org/10.1136/vr.105220

Elkholly, D.A., Brodbelt, D.C., Church, D.B., Pelligand, L., Mwacalimba, K., Wright, A.K. & O’Neill, D.G. (2020). Side Effects to Systemic Glucocorticoid Therapy in Dogs Under Primary Veterinary Care in the UK. Frontiers in Veterinary Science. 7. DOI: https://doi.org/10.3389/fvets.2020.00515

EMA Categorisation of antibiotics for use in animals. [online] Available from: https://www.ema.europa.eu/en/documents/report/infographic-categorisation-antibiotics-use-animals-prudent-responsible-use_en.pdf [Accessed 1 Oct 2021].

Google BigQuery. (2022). [online] Available from: https://cloud.google.com/bigquery/docs/reference/standard-sql/introduction [Accessed 31 Mar 2022].

Joii Pet Care. (2021). Joii Pet Care Services. [online]. Available from: https://joiipetcare.com/pages/services [Accessed 2 Jun 2021].

Magalhães-Sant’Ana, M., Conceição Peleteiro, M. & Stilwell, G. (2020). Opinions of Portuguese Veterinarians on Telemedicine – A Policy Delphi Study. Frontiers in Veterinary Science. 7. DOI: https://doi.org/10.3389/fvets.2020.00549

McSwain, S.D., Bernard, J., Burke Jr., B.L., Cole, S.L., Dharmar, M., Hall-Barrow, J., Herendeen, N., Herendeen, P., Krupinski, E.A., Martin, A., McCafferty, D., Mulligan, D.A., North, S., Ruschman, J., Waller, M., Webster, K., Williams, S., Yamamoto, S. & Yeager, B. (2017). American Telemedicine Association Operating Procedures for Pediatric Telehealth. Telemedicine and e-Health: The Official Journal of the American Telemedicine Association. 23(9), 699–706. DOI: https://doi.org/10.1089/tmj.2017.0176

MySQL. (2022). [online]. Available from: https://dev.mysql.com/doc/ [Accessed 25 May 2022].

O'Neill, D., Hendricks, A., Summers, J. & Brodbelt, D. (2012). Primary care veterinary usage of systemic glucocorticoids in cats and dogs in three UK practices. Journal of Small Animal Practice. 53(4), 217–22. DOI: https://doi.org/10.1111/j.1748-5827.2011.01190.x

Radford, A.D., Noble, P.J., Coyne, K.P., Gaskell, R.M., Jones, P.H., Bryan, J.G.E., Setzkorn, C., Tierney, A. & Dawson, S. (2011). Antibacterial prescribing patterns in small animal veterinary practice identified via SAVSNET: the small animal veterinary surveillance network. Veterinary Record. 169(12), 310. DOI: https://doi.org/10.1136/vr.d5062

Ray, K.N., Shi, Z., Gidengil, C.A., Poon, S.J., Uscher-Pines, L. & Mehrotra, A. (2019). Antibiotic Prescribing During Pediatric Direct-to-Consumer Telemedicine Visits. Pediatrics, 143(5). DOI: https://doi.org/10.1542/peds.2018-2491

Robertson, T.A. (1999). Telemedicine – creating the virtual veterinary hospital. Compendium on Continuing Education for the Practicing Veterinarian. 21(2), 128–133. Available from: https://www.researchgate.net/publication/294327690_Telemedicine_-_Creating_the_Virtual_Veterinary_Hospital [Accessed 1 June 2021].

Robinson, N.J., Dean, R.S., Cobb, M. & Brennan, M.L. (2015). Investigating common clinical presentations in first opinion small animal consultations using direct observation. The Veterinary Record. 176(18), 463. DOI: https://doi.org/10.1136/vr.102751

Royal College of Veterinary Surgeons. (2020). Coronavirus: RCVS Council temporarily permits vets to remotely prescribe veterinary medicines. [online] Available from: https://www.rcvs.org.uk/news-and-views/news/coronavirus-rcvs-council-temporarily-permits-vets-to-remotely/ [Accessed 2 Jun 2021].

Royal College of Veterinary Surgeons. (2021). Code of Professional Conduct for Veterinary Surgeons. [online] Available from: https://www.rcvs.org.uk/setting-standards/advice-and-guidance/code-of-professional-conduct-for-veterinary-surgeons/ [Accessed 2 Jun 2021].

Shigekawa, E., Fix, M., Corbett, G., Roby, D.H. & Coffman, J. (2018). The Current State Of Telehealth Evidence: A Rapid Review. Health Affairs. 37(12), 1975–1982. DOI: https://doi.org/10.1377/hlthaff.2018.05132

Siew, L., Hsiao, A., McCarthy, P., Agarwal, A., Lee, E. & Chen, L. (2016). Reliability of Telemedicine in the Assessment of Seriously Ill Children. Pediatrics. 137(3). DOI: https://doi.org/10.1542/peds.2015-0712

Singleton, D.A., Sánchez-Vizcaíno, F., Dawson, S., Jones, P.H., Noble, P.J.M., Pinchbeck, G.L., Williams, N.J. & Radford, A.D. (2017). Patterns of antimicrobial agent prescription in a sentinel population of canine and feline veterinary practices in the United Kingdom. The Veterinary Journal. 224, 18–24. DOI: https://doi.org/10.1016/j.tvjl.2017.03.010

Singleton, D.A., Sánchez-Vizcaíno, F., Arsevska, E., Dawson, S., Jones, P.H., Noble, P.J.M., Pinchbeck, G.L., Williams, N.J., & Radford, A.D. (2018). New approaches to pharmacosurveillance for monitoring prescription frequency, diversity, and co-prescription in a large sentinel network of companion animal veterinary practices in the United Kingdom, 2014–2016. Preventive Veterinary Medicine. 159, 153–161. DOI: https://doi.org/10.1016/j.prevetmed.2018.09.004

Singleton, D.A., Noble, P.J.M., Sánchez-Vizcaíno, F., Dawson, S., Pinchbeck, G.L., Williams, N.J., Radford, A.D. & Jones, P.H. (2019). Pharmaceutical Prescription in Canine Acute Diarrhoea: A Longitudinal Electronic Health Record Analysis of First Opinion Veterinary Practices. Frontiers in Veterinary Science. DOI: https://doi.org/10.3389/fvets.2019.00218

Singleton, D.A., Rayner, A., Brant, B., Smyth, S., Noble, P.J.M., Radford, A.D., & Pinchbeck, G.L. (2021). A randomised controlled trial to reduce highest priority critically important antimicrobial prescription in companion animals. Nature Communications. 12(1593). DOI: https://doi.org/10.1038/s41467-021-21864-3

Summers, J.F., Hendricks, A. & Brodbelt, D.C. (2014). Prescribing practices of primary-care veterinary practitioners in dogs diagnosed with bacterial pyoderma. BMC Veterinary Research. 10(240). DOI: https://bmcvetres.biomedcentral.com/articles/10.1186/s12917-014-0240-5

Teller, L.M. & Moberley, H.K. (2020). Veterinary Telemedicine: A literature review. Veterinary Evidence. 5(4). DOI: https://doi.org/10.18849/ve.v5i4.349

University of Liverpool. (2021). Identification and reporting of adverse drug reactions. [online] Available from: https://www.liverpool.ac.uk/savsnet/current-research/adverse_drug_reactions/ [Accessed: 2 Jun 2021].

Venom Codes Website. [online] Available from: https://venomcoding.org/ [Accessed 5 May 2022].

Veterinary Medicines Directorate (VMD) Adverse event reporting website. [online] Available from: https://www.vmd.defra.gov.uk/adversereactionreporting/report-type [Accessed 25 May 2022].

Veterinary Pharmacovigilance Course. (2014). Management Forum, Personal Communication.

VMD. (2019). Veterinary Pharmacovigilance Clinical Signs Reported In Adverse Reaction Reports. [online] Available from: https://www.vmd.defra.gov.uk/PharmacovigilanceAdverseEventData/Dashboard [Accessed 2 Jun 2021].

VMD. (2020). Veterinary Pharmacovigilance in the UK Annual Review 2019 – a summary of veterinary adverse events. [online] Available from: https://www.gov.uk/government/publications/veterinary-medicines-pharmacovigilance-annual-review-2019-summary/veterinary-pharmacovigilance-in-the-uk-annual-review-2019-a-summary-of-veterinary-adverse-events [Accessed 2 Jun 2021].

YouGov. (2021). Survey Results. [online] Available from: https://yougov.co.uk/topics/overview/survey-results [Accessed 2 Jun 2021].

Themes by Openjournaltheme.com