1/24/23

Passage of AB 1399 in California Allows for Telemedicine Consults

A pivotal moment in the world of pet healthcare has come to pass - the legalization of veterinary telemedicine in California. As a pet owner, you're always looking for the best ways to care for your furry family members. With this new development, it's crucial to understand how it can impact your pet's health and your interactions with veterinary services. This article aims to provide you with a balanced view of veterinary telemedicine, highlighting its advantages and potential drawbacks. Let's embark on this journey to better understand how this innovative service can play a role in the health and well-being of our beloved pets.

Background: Understanding Veterinary-Client-Patient Relationship (VCPR) and AB 1399

Before we dive into the pros and cons, it's essential to grasp the concept of the Veterinary-Client-Patient Relationship (VCPR) and the significance of AB 1399 in the realm of veterinary telemedicine.

What is a Veterinary-Client-Patient Relationship (VCPR)?

At its core, a VCPR is a fundamental bond of trust and mutual responsibility between a veterinarian, a pet owner (the client), and the pet (the patient). This relationship is pivotal for any veterinary care, as it ensures that the veterinarian is adequately informed about the pet to make sound medical judgments. In a VCPR, the vet commits to knowing the pet well enough to diagnose and treat the animal effectively, while the pet owner agrees to follow the veterinarian's guidance and advice.

The Impact of AB 1399 in California

With the passage of AB 1399, California has become the sixth state in the U.S. to permit the establishment of a VCPR virtually. This legislative change is a significant stride in veterinary medicine, especially in today's tech-driven world. But what does this mean for you as a pet owner in California?

1. Virtual Establishment of VCPR: Now, a licensed veterinarian in California can establish a VCPR with your pet without the need for a physical, in-person meeting. This is a breakthrough, especially in situations where in-person visits are challenging.

2. Eligibility Criteria: It's important to note that this virtual VCPR can only be established by a veterinarian who is licensed in California, and it's applicable for pets that reside within the state. This ensures that the veterinary care adheres to the state's regulatory standards.

3. Medical History and Records: As a pet owner, you play a crucial role in this process. For a VCPR to be established virtually, you must provide a reliable medical history of your pet. If available, sharing your pet’s medical records is also vital. These documents are the cornerstone for the vet to understand your pet’s health background and current needs.

Why This Matters

Understanding the VCPR and the impact of AB 1399 is key to appreciating the full scope of veterinary telemedicine in California. It sets the stage for a new era in pet healthcare, where accessibility, convenience, and technology come together to offer innovative solutions for your pet's well-being.

Advantages of Veterinary Telemedicine

1. Convenience and Accessibility: One of the standout benefits of telemedicine is the convenience it offers. You can now consult with a veterinarian from the comfort of your home, which is especially beneficial for busy pet owners or those with mobility issues.

2. Reduced Stress for Pets and Owners: Many pets experience anxiety during clinic visits. Telemedicine allows them to receive care in their familiar environment, reducing stress for both pets and owners.

3. Quick Response Time and Efficient Follow-Up Care: In cases of minor health concerns, telemedicine can provide quick answers and peace of mind. For ongoing conditions, telemedicine provides a convenient way for vets to monitor progress and adjust treatments without the need for physical visits.

Disadvantages and Limitations of Veterinary Telemedicine

1. Limitations in Physical Examination: Telemedicine cannot replace the need for physical examinations in certain situations. Some conditions require hands-on assessment for accurate diagnosis and treatment. While telemedicine is effective for certain conditions, the lack of a physical exam could lead to misdiagnosis or oversight of serious health issues.

2. AMDUCA and Medication Restrictions: Under the Animal Medicinal Drug Use Clarification Act (AMDUCA), there are specific regulations around the prescription of controlled substances and extra-label drugs. These substances are strictly controlled to ensure they are used safely and effectively. In the context of telemedicine, some medications still cannot be prescribed without a prior in-person examination, as the law requires a thorough evaluation of the patient for such prescriptions. Historically veterinary medicine in the United States has relied on extra-label drug use to enable human medication use in veterinary patients. Therefore, veterinarians will have a a very limited repertoire of medications they can prescribe via telemedicine.

3. Limited Scope of Antibiotic Treatment: Another significant limitation is the 14-day limit on the prescription of antimicrobials for first-time diagnoses via telemedicine. This means if your pet is diagnosed and starts treatment remotely, any further antibiotics beyond the initial prescription will necessitate an in-person exam.

4. In-Person Requirement for Certain Services: Telemedicine cannot be used to issue Health Certificates for pets. This is due to the stringent requirements for these certificates that often require a thorough physical examination.

5. Technology Dependence: Effective telemedicine relies on stable internet connectivity and a basic understanding of technology, which might be a barrier for some pet owners.

1. Regulatory and Legal Boundaries: With its recent legalization, there are still evolving regulations and guidelines that govern veterinary telemedicine. This can lead to uncertainty about what services can be offered. Over time these boundaries will become more clear but expect there to be some major and minor hiccups along the way.

Making the Most of Veterinary Telemedicine

• Know When to Use It: Telemedicine is ideal for follow-up consultations, minor ailments, or behavioral advice. However, it's not suitable for emergencies or complex health issues.

• Prepare for the Consultation: Ensure you have a good internet connection and prepare any questions or concerns in advance. It's also helpful to have a way to take notes during the consultation.

• Follow-up: If your vet recommends an in-person visit following a telemedicine consultation, understand that this is to ensure the best care for your pet.

Veterinary Internal Medicine Specialist's View on Telemedicine

As we explore the realm of veterinary telemedicine, it's insightful to consider the perspective of a veterinary internal medicine specialist. Working in Colorado during the height of the pandemic (telemedicine was legalized at the time), we experienced the abrupt shift from in-person only exams to allowing telemedicine consults even for first time diagnosis of difficult or complex cases. A hybrid model followed whereby pets were allowed into the building for exam and diagnostics but whereby communication occurred via phone or video. There is much to be said about the convenience of having a telemedicine consultation, but the limitations for specialty medicine is even more pronounced.

Balancing Technology and Hands-On Care

1. The Value of Telemedicine in Chronic Care Management: For pets with chronic but stable conditions like diabetes or heart disease, telemedicine can be a boon. It allows for regular monitoring without the stress of frequent clinic visits. However, emphasis must be placed on the importance of initial in-person assessments to both establish accurate diagnoses and to ensure that a pet is receiving the personalized specialty care they deserve. If your pet is in the early stages of a complex disease, telemedicine may be inadequate for best practice medicine.

2. Diagnostic Limitations: While telemedicine offers convenience, it has severe limitations in diagnosing new or acute conditions. Internal medicine specialists often rely on detailed physical exams, lab tests, and imaging to make accurate diagnoses, most of which can’t be replicated remotely.

3. Medication Limitations: The limitations placed on prescribing medications to patients via telemedicine will be even more restrictive for specialty medicine, as a large majority of medications are used in an extra-label manner for specialists. For example, an antibiotic may be labeled by the drug company for simple infections of the skin or ears, but historically may be utilized for more severe infections of other organs like the liver or kidneys. Most newer research in veterinary medicine revolves around the use of human medications and extrapolating their use to animals. None of these newer medications can be used in patients that only have a telemedicine VRPC, and therefore an in-person exam will be required for many standard of care treatments nowadays.

4. Enhancing Client Education and Communication: One area where telemedicine shines is in client education and communication. It allows specialists to discuss care plans, dietary adjustments, and medication regimens in detail with pet owners, enhancing the overall care process. If you left your primary care veterinarian visit with complex questions they felt uncomfortable answering, a telemedicine consultation could be invaluable in helping bridge the gap in knowledge and set-up long term expectations moving forward.

A Complementary Tool, Not a Replacement

While telemedicine is an invaluable tool, especially in follow-up care and management of chronic conditions, it cannot replace the need for physical exams and in-clinic diagnostics in many cases. The use of telemedicine should be seen as a complement to specialty veterinary care, not a substitute.

Conclusion

As we navigate this new landscape of veterinary telemedicine, it's clear that it offers several benefits but also comes with certain limitations. For pet owners in California, this innovative approach can be a valuable tool in your pet care arsenal, providing convenience and quick access to veterinary advice. However, although telemedicine offers numerous benefits like convenience and reduced stress, it's important to be aware of its limitations, especially regarding prescription regulations and the scope of care it can provide. It's important to recognize its limits and use it judiciously, always keeping the best interest of your pet at heart. 

FAQs:

1. Is veterinary telemedicine suitable for all types of pet health issues?

   • No, it's best for minor issues, follow-up care, or behavioral advice. Emergencies and complex cases require in-person visits.

2. Will my pet insurance cover telemedicine consultations?

   • This depends on your insurance policy. Check with your provider for specific coverage details.

3. How do I prepare for a telemedicine appointment?

   • Have a stable internet connection, list your concerns or questions, and be ready to describe your pet's symptoms clearly.

4. Can I get any prescription through telemedicine for my pet?

   • Not all medications. Specifically, controlled substances, extra-label drugs, and extended antimicrobial treatments require an in-person exam.

5. How do I know if telemedicine is right for my pet?

• Consider the nature of your pet’s health issue. If it's a minor ailment or a follow-up, telemedicine might be suitable. In addition, a second-opinion may be a suitable use of telemedicine for some patients. However, for new, serious, or complex health concerns, an in-person visit is advisable.