Can telehealth offer a solution for access to veterinary care?

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Barriers to veterinary care affect millions of pets and their families. Studies have shown that 1 out of every 4 households experienced barriers to veterinary care,¹ and more than 50 million pets² do not see a veterinarian at least once annually. This issue is a complex societal problem with many contributing factors, including the cost of veterinary care, physical access to veterinary care, and the challenge of making a timely appointment. Finding methods for providing veterinary care to these neglected pets is crucial for advancing veterinary medicine. To solve this problem, the full range of barriers must be addressed.

Financial barriers

Studies have shown that 7 out of 10 pet owners³ consider their pets family members. However, many don’t realize the expense of a pet. The initial costs to purchase all the necessary supplies for a newly adopted pet can significantly lighten your wallet. Additionally, ongoing costs (eg, food, supplies, regular veterinary care, and emergency issues) add up quickly. The yearly cost of owning a dog is about $1,270 to $2,803, and a cat is $961 to $2,487, respectively.³

Impact on pet owners

A pet owners survey report¹ conducted by the University of Tennessee Center for Applied Research and Evaluation found that the most challenged groups include:

• Low-income households — 8 out of 10 respondents couldn’t get access to veterinary care for financial reasons.
• Middle class families — Families living paycheck to paycheck have a hard time acquiring funds to pay for veterinary care, especially for high expenses.
• Young pet owners — Younger respondents experienced a barrier to preventive care.
• Pet owners in the Northeast and West — People living in these areas were more likely to report difficulty receiving preventive care than those living in the Midwest and South.

How telehealth can ease financial barriers

Telehealth visits are typically less expensive than physical clinic visits, plus there are no travel expenses. If the cost is more manageable, pet owners are more willing to provide the recommended preventive care for their pet. In turn, more illnesses are avoided, or detected in the early stages, when these issues are easier and less expensive to treat and manage, ultimately saving the pet owner money to treat advanced diseases.

Money can also be saved in chronic disease management. In human healthcare, patients with chronic diseases account for 81% of all hospital admissions,⁴ and these cases tend to be the most expensive aspects of care. By using live video, mobile devices, and other smart digital tools, physicians, veterinarians, and specialists can manage a patient’s condition from a distance, reducing the need for in-person consultations. This technology allows veterinary professionals to triage new signs and determine if the pet needs additional care before their next scheduled physical examination.

Physical access barriers

Another problem for pet owners is physical access to veterinary care. Pet owners may live in a remote area, far away from a veterinary hospital, forcing them to drive long distances to receive pet care. This can be difficult, especially if their pet does not travel well. In addition, pet owners who do not own a car are at a significant disadvantage when accessing veterinary care. Plus in many areas, few veterinarians are available to provide care for all the pets in their boundaries.

Impact on pet owners

Specific examples of how pet owners are affected by these circumstances include:

• Dallas, Texas — Dallas has 1,176,291 pets,⁶ but only 129 veterinary hospitals and 1,530 veterinarians to service these pets. This means that each veterinarian in Dallas would need to be responsible for 769 pets for all the city’s pets to get the necessary care.
• Yazoo County, Mississippi — Yazoo County has 14,889 pets,⁶ only 1 veterinary hospital, and 0.2 veterinary employees per 1,000 pets.
• Sierra, California — Sierra has a pet population of 1,623,⁶ with 0 veterinary hospitals to service these pets. Pet owners must drive to neighboring counties, such as Yuba or Plumas, or Nevada in some cases, for veterinary care. These trips can take more than 1 hour to see a veterinarian, and for pets needing specialized veterinary care, travel time can be 3 hours or more to see a trained professional.⁶

How telehealth can improve physical access barriers

With telehealth, pet owners don't have to drive long distances or find transportation if they don’t have access to a vehicle. Along with pet owners being able to receive preventive care, these services increase access to specialized care. Pet owners can correspond with specialists from their home, to more easily get the care their pet needs while reducing the cost of care by eliminating travel expenses.

Telehealth can also reduce hospital readmissions. When veterinarians can remotely monitor their patient’s condition, they can help manage their treatment regimen, decreasing their chances of needing hospital readmittance, thereby also reducing the cost of care for the pet owner. When the University of Pittsburgh Medical Center (UPMC) Health Plan, which covers 3.4 million Pennsylvania patients, implemented a telehealth program, fewer congestive heart failure patients had to be placed in observation units. Participating members were 71% less likely to need admittance⁴ to an observation unit than nonmembers.

Timely appointment barriers

Many pet owners wait weeks to see a veterinarian, since these professionals are overloaded because of the staff shortages. A 2020 survey⁷ demonstrated that 15% of pets missed essential, routine treatments (eg, vaccines and parasite prevention) because making an appointment was so difficult. The veterinary field is highly demanding and stressful, causing many veterinarians to burn out. Furthermore, veterinary professionals are at higher risk for suicide⁸—female veterinarians are 3.5 times more likely than the public to die by suicide, while male veterinarians are 2.1 times more likely.

Veterinary burnout has caused many to leave the profession, and 44%⁸ of veterinarians report having considered another profession. The pandemic only exacerbated these issues, since pandemic protocols led to inefficiencies in seeing patients, such as requiring curbside appointments and deep cleanings between each visit. Additionally, many people stuck at home during the lockdown adopted a new pet, and people working from home more frequently noticed clinical signs, and wanted these issues addressed. These conditions led to a backlog of appointments for already overworked veterinarians, and a comparative analysis found a 9.4% increase in burnout levels between 2020 and 2021.

Impact on pet owners

There are simply not enough veterinarians to serve the growing pet population, causing long wait times for pets to get required care. Getting an appointment with a board-certified veterinarian is also extremely difficult. Examples include:

• California — California has 14,695,851 pets⁵ and only 3,387 veterinary hospitals.
• Arizona — Arizona has only 4 board-certified internal medicine diplomates in oncology,⁹ which means long wait times for cancer patients.
• Arkansas — Arkansas has only 2 board-certified diplomates in ophthalmology,¹⁰ which indicates that pets with serious eye issues must wait long periods to receive necessary care to potentially save their vision.

How telehealth can improve timely appointment barriers

Telehealth can help by triaging patients to determine which cases require medical attention. Some issues can likely be resolved without a veterinarian’s attention, and the remaining cases can be re-routed to other channels.

• Telemedicine — For patients with an existing veterinary-client-patient relationship,¹¹ a virtual visit with a veterinary professional can be scheduled.
• Emergency hospital — Urgent and life-threatening cases can be sent to the nearest emergency hospital.
• Specialists — Veterinarians can tele-consult with a board-certified diplomate, who can offer information on prognosis, potential clinical signs, and possible treatment options for patients requiring specialty care. Three-way conversations can be instigated, to ensure the owner’s questions are answered.

Educational barriers for pet owners

Many pet owners are uninformed about their pet’s health care needs. Pet care should be a team effort between the pet owner and the veterinarian, but the owner must be educated regarding what a wellness plan for their pet includes, and what signs indicate their pet is ill. It’s important they receive this information from a reliable source, rather than social media and Dr Google.

Impact on pet owners

When pet owners aren’t educated about their pet’s health care, their pet suffers the consequences. Information they should know includes¹²:

• Selecting a pet — When choosing a pet, pet owners should avoid impulsive decisions, which could result in adopting more pets than they can care for. They should also research the species and breed that will best suit their lifestyle for a successful outcome.
• Providing wellness care — Pet owners should be informed about why their pet needs regular wellness checkups, vaccinations, parasite control, and dental cleanings, to ensure they offer the best pet care.
• Providing enrichment — Pet owners should understand the importance of offering their pet enrichment, and the appropriate amount of physical and mental exercise.
• Recognizing problems — Pet owners should be able to recognize signs indicating their pet is sick or hurt, so they can provide them necessary care.

How telehealth can improve educational barriers

Veterinarians can help educate their clients¹³ by providing informational handouts, hanging educational posters in the practice, and offering a welcome pack that highlights important information. A blog on your website, and telehealth, are other great ways to provide information to your clients.

• Client evenings — You can offer client evenings, with the option to join by teleconference.
• Tele-advice — Providing constant access to a consultation using any format or platform that the pet owner prefers will ensure they receive the information they need promptly and improve prognostic outcomes. Studies¹⁴ have demonstrated that education delivered virtually is comparable, and in many cases more effective, than in-person delivery, when dealing with patients affected by a chronic disease. In fact, 68.75% of studies displayed improved outcomes when the patients were virtually educated compared with control conditions, and the remaining studies showed similar outcomes to the control conditions.

Education for veterinarians

Telehealth can also be used to educate healthcare professionals, including veterinarians. An example of this was demonstrated when healthcare providers in the Sichuan Province of China participated in a tele-education program¹⁵ for rapid response to COVID-19 on January 17, 2020, to learn about specimen collection methods, laboratory assays of nucleic acids, standardized diagnosis and treatment, prevention and control of hospital infections, personal protection, and medical waste disposal. Remote consultation networks, portals, and smartphone apps were used to access more than 800,000 person-times, which were devoted to training, and helped ensure prevention and control measures were implemented appropriately against epidemics.

Furthermore, learning from tele-education programs can provide veterinary professionals further mental stimulation to help prevent burnout and the feeling that they have reached a plateau in their career. Plus, veterinarians can use teleconsulting for advice from board-certified specialists on advanced case management strategies.

The future of telehealth

For a pet owner faced with a pet who is vomiting, limping, coughing, or has a lack of appetite, their biggest challenge is determining if their pet needs immediate care. The current model for veterinary clinics is to channel every incoming call to a physical appointment, to monetize the information exchange. The virtual care model triages each case prior to a physical visit, offering a telemedicine appointment with a veterinarian when appropriate. Other options, depending on the case, include the pet owner scheduling a physical appointment at their veterinary clinic, or being directed to seek immediate treatment at an emergency hospital.

A study¹⁶ performed in Dubai during the pandemic sampled 1,086 COVID-19-positive cases. The patients were initially assessed by trained professionals using telemedicine and following standardized guidelines, and the patients were sent to an isolation facility or admitted to a hospital. The second assessment phase was performed physically. The accuracy of the telemedicine assessment was compared with the physical assessment, and telemedicine was accurate in 1,080 of 1,086 screened patients. These results indicate that telehealth model has the potential to translate over well in veterinary medicine. However, most practices don’t have a standardized approach to streamline the process and make telehealth seamless for the staff, clients, and patients.

Wellness services and pet insurance are additional measures that, combined with telehealth, can provide better care for pets. Wellness services incentivize pet owners to provide wellness care for their pets to help prevent future health issues, and pet insurance is typically used in emergency cases, helping to defray the high cost of veterinary care. According to the North American Pet Health Insurance Association State of the Industry Report, close to 3.45 million pets were insured¹⁷ in North America at the end of 2020. This may seem like a large number, but when you consider that there are more than 63 million dog-owning households¹⁸ in the US, many more pets could be protected by insurance.

According to the 2019 to 2020 National Pet Owners Survey conducted by the American Pet Products Association (APPA), approximately 85 million US families own a pet. While virtual care will never replace in-person visits, wider adoption of these services can help provide better health care to more pets through accommodating the growing demand for veterinary services, distributing the caseload through tele-triage and teleconsulting, providing more flexibility and task variety to the veterinary teams, and improving the client experience.

References

1. Access to veterinary care: barriers, current practices, and public policy. Report from the Access to Veterinary Care Coalition. December 17, 2018. Accessed March 3, 2022. https://pphe.utk.edu/wp-content/uploads/2020/09/avcc-report.pdf
2. New, old challenges beg for radical change in veterinary profession. JAVMAnews. December 15, 2020. Accessed March 3, 2022. https://www.avma.org/javma-news/2020-12-15/new-old-challenges-beg-radical-change-veterinary-profession
3. Lifetime of care study. Synchrony. January 2022. Accessed March 3, 2022. http://petlifetimeofcare.com/#page=1
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5. The Veterinary Care Accessibility Score. The Veterinary Care Accessibility Project. Accessed March 3, 2022. https://www.accesstovetcare.org/vcas-map
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12. Responsible pet ownership. American Veterinary Medical Association. Accessed March 3, 2022. https://www.avma.org/resources-tools/pet-owners/responsible-pet-ownership
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14. Rush KL, Hatt L, Janke R, Burton L, Ferrier M, Tetrault M. The efficacy of telehealth delivered educational approaches for patients with chronic diseases: A systematic review. Patient Educ Couns. 2018;101(8):1310-1321. doi: 10.1016/j.pec.2018.02.006.
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16. Elhennawy A, Alsalem FA, Bahri S, Alarfaj N. Telemedicine versus physical examination in patients’ assessment during COVID-19 pandemic: the Dubai experience. Dubai Med J. 2021;4:175-180. doi: 10.1159/000514024.
17. Section #2: total pets insured. North American Pet Health Insurance Association. Accessed March 3, 2022. https://naphia.org/industry-data/section-2-total-pets-insured
18. Household penetration rates for pet-ownership in the United States from 1988 to 2020. Statista. Accessed March 3, 2022. https://www.statista.com/statistics/198086/us-household-penetration-rates-for-pet-owning-since-2007