The quantitative data were collected using a structured questionnaire based on studies on veterinary telemedicine (20, 21) and adapted to the specific target group. The questionnaire encompassed five distinct areas: (1) sociodemographics and digital infrastructure, (2) previous use and assessment of telemedicine, (3) COVID-19 pandemic-related changes, (4) willingness to pay and value, and (5) evaluation of veterinary telemedicine services. In addition to closed questions, free-text comments were also utilised, which were evaluated using a deductive coding scheme consistent with SWOT analysis. The survey was conducted from April 2023 to April 2024 via the online-survey platform LimeSurvey® and disseminated through social media channels. Furthermore, the questionnaire was distributed in paper form in four small animal practices to reach target groups with less technological literacy. The paper-based responses were also digitalised using LimeSurvey® for analysis. The data from both questionnaire formats were exported and further processed in Microsoft Excel®, where they were descriptively analysed and results were subjected to deductive content analysis (22, 23).

Furthermore, eight qualitative interviews were conducted with experts, including practicing veterinarians from both urban and rural areas, representatives of a veterinary chamber, the national Association of Practicing Veterinarians (bpt), as well as representatives of pet health insurance companies. To recruit experts for the semi-structured interviews, a purposive and convenience sampling strategy was employed. A list of potential experts was compiled through a combination of expert recommendations, and professional networks. Specifically, we identified 10 experts in the field of veterinary telemedicine who had a minimum of 5 years of experience and a proven track record of research or practice in veterinary telemedicine. These experts were contacted via email or phone, and a brief description of the study was provided to gauge their interest and availability for an interview. A total of eighth experts agreed to participate. The participants for the qualitative interviews were selected based on their professional relevance to the topic of veterinary telemedicine. The sampling focused on individuals who work directly with telemedical services, possess expertise in legal and regulatory frameworks, represent the interests of veterinarians, or are involved in communication processes between veterinarians and pet owners, particularly regarding reimbursement and insurance issues. The inclusion criteria were limited to willingness to participate, regional representation, and knowledge, interest, or practical experience in the field of telemedicine. Sampling was concluded after eight interviews, as no new thematic insights and information emerged, indicating that thematic saturation had been reached. This diverse group of experts was chosen to provide a comprehensive understanding of the research topic from multiple perspectives. The interviews were based on a semi-structured guideline structured along the SWOT dimensions (strengths, weaknesses, opportunities, and threats). The conversations were conducted online via Microsoft Teams®, and were subsequently recorded, transcribed, and analysed using deductive content analysis (22, 23).

For the analysis of the interviews and surveys, a deductive content analysis was conducted (22, 23). Categories were predefined based on the research questions and theoretical considerations, namely the categorisation of content to strengths (S), weaknesses (W), opportunities (O) and threats (T). The coding framework described the four main categories as follows:

Meaningful units of analysis (e.g., sentences, distinct ideas) relevant to the SWOT dimensions were systematically identified within the data and then assigned to these categories (24). The first author ensured that the coded units accurately reflected the operational definitions. Ambiguous content was discussed and resolved in consensus meetings among all authors. Finally, the content within the SWOT categories was analysed considering patterns and salient themes. Relationships and tensions between categories were subjected to strategic interpretation for practical application.

The integration of qualitative and quantitative datasets from online and paper surveys, as well as expert interviews, provides a differentiated basis for evaluating current usage patterns, key challenges and future development prospects (25) of telemedicine in small animal practice. A SWOT analysis was conducted to structure the findings and derive a practical action model. Within the SWOT framework, the qualitative interview findings and the quantitative survey results were systematically synthesised. By assigning both datasets to the same deductively defined categories, the SWOT model functioned as the analytical interface through which the triangulation of results was realised. This step enabled a consolidated interpretation of strengths, weaknesses, opportunities and threats, allowing converging and complementary insights from both methodological strands to be integrated. This approach facilitates a nuanced categorisation of identified factors into the four distinct categories of strengths, weaknesses, opportunities and threats (26). The SWOT analysis has been utilised not only in business and strategic corporate decision-making contexts, but also in scientific settings as a standalone diagnostic instrument. It thus offers a structured approach to visualise the strengths and weaknesses of the status quo, as well as external factors that can act as opportunities or threats (26). The merits of SWOT analysis for interdisciplinary research approaches are also highlighted, as it fosters strategic orientation and provides a catalyst for further development (27). The data utilised in this study were evaluated based on a coding scheme and assigned to the SWOT categories accordingly (Figure 1). Notwithstanding the recognised methodological limitations, including the subjective evaluation of individual factors and the constrained generalisability, the SWOT analysis functions as a constructive instrument for the documentation of salient subjects and the formulation of recommendations for action concerning the integration of digital care services in small animal practice (26).

A total of 426 questionnaires (online: n = 220, paper: n = 206) were completed during the survey. All of the 206 surveys filled out in paper format were completed in full and subsequently analysed. Of the 220 online surveys, 198 were fully completed and, subsequent to plausibility checks, were utilised for data collection. Incomplete forms or surveys lacking consent to the privacy policy were excluded from the subsequent analysis, so that 404 responses were included in the analysis.

Similar distribution of responses regarding age, gender, place of residence or distance from veterinarian were received in both formats, whereas more females participated in general and more frequently in the online format (Table 1).

The majority of survey participants (64.36%, n = 260) reported owning a dog, 46.04% (n = 186) indicated ownership of a cat, and 12.13% (n = 49) stated they had a small mammal. Thirteen respondents (3.22%) selected owning a bird, while 12.38% (n = 50) reported owning a reptile. Approximately one third of the respondents stated that they owned more than one pet (n = 132, 32.67%). Of these respondents 82.58% (n = 109) indicated that they owned two animals, 15.91% (n = 21) indicated that they owned three pets, and 1.52% (n = 2) indicated that they had four or more pets. A descriptive comparison of the paper and online versions of the survey indicated no notable differences in the distribution of pet species (Table 2).

The survey revealed that 61.63% of the participants were acquainted with the term “telemedicine,” while 136 individuals denied familiarity with it. In the paper survey, 58.74% of respondents confirmed their knowledge; in the online survey, this proportion was higher with 64.65%. The participants were also asked whether they had previously utilised digital media for the purpose of contacting their practice, with the exception of scheduling appointments. The survey revealed that 48.76% of respondents answered in the affirmative, indicating their familiarity with digital means of contact. Conversely, 45.54% of respondents indicated that they had not yet adopted such technologies. A further 5.69% of respondents did not provide an answer. A subsequent analysis of the subgroups indicated that only 30% of online respondents had utilised this option, while 66% of paper survey respondents said they had (Figure 2).

Digital communication channels were primarily utilised for the discussion of findings (84.26%, n = 166) and the clarification of ongoing treatment issues (85.79%, n = 169). The scope of application in other areas, such as the provision of feeding or husbandry advice (n = 50), was comparatively limited with 25%. Other areas of digital contact occured regarding questions on animal husbandry or handling, appointment or billing issues. The primary benefits of telemedicine were identified as the mitigation of stress for the animal, the convenience of conducting the procedure from a domestic setting, and the elimination of transportation requirements. The minimisation of stress was cited by 319 respondents. Only 13.61% of small animal owners selected changes in behaviour during the examination in practice rooms, and thus a possible absence of abnormal signs. A total of 227 subjects indicated that the convenience of performing the procedure in the home environment was a beneficial aspect of the study. Meanwhile, 208 participants expressed satisfaction with the elimination of transportation-related challenges. Furthermore, additional aspects such as accelerated performance, the future potential of digital solutions, and improved accessibility were highlighted in a few free-text responses (n = 23). With respect to potential disadvantages, the absence of a physical examination was identified as a significant point of criticism by 89.85% of respondents. The audiovisual modality of diagnostics was also met with critical scrutiny: three hundred individuals expressed apprehension regarding the inadequate dissemination of information and the concomitant possibility of misinterpretation. A total of 177 participants indicated that the absence of in-person consultation had the potential to result in communication difficulties. In contrast, only a small proportion of respondents (n = 41) perceived the relationship of trust between veterinarians and pet owners as being compromised by telemedicine. A total of 21 respondents expressed concerns regarding negative personal experiences with digital services, technical challenges, and access barriers for users with low digital affinity. These concerns were addressed in free-text contributions. The advantages and disadvantages from small animal owners’ perspectives are presented in Figure 3.

The impact of the COVID-19 pandemic on attitudes towards the utilisation of telemedicine was found to be negligible. The majority of respondents (n = 295) indicated that their stance on telemedicine remained unaltered in the wake of the pandemic. Among the participants who reported a change in their attitudes (n = 40), the comments generally reflected a more positive outlook. The experiences that individuals encountered during the pandemic resulted in a notable increase in receptivity to digital healthcare services. This increased receptivity was characterised by an emphasis on the benefits that these services offer, such as the potential for time savings and improved accessibility.

The preliminary assessment of willingness to pay (WTP) was designed to provide an initial descriptive overview rather than a validated economic measure. The items were piloted with a small group (n = 8) to ensure clarity and comprehensibility. WTP was collected through categorical response options, with defined boundaries (Figure 4). As the measure consisted of single categorical items, internal reliability indices are not applicable. Potential influences of social desirability were considered when interpreting the results; therefore, only descriptive analysis was conducted. The results showed a generally high willingness to pay for telemedicine services among respondents, particularly for audiovisual formats, such as video consultations, with 93.36% of participants being willing to pay. Remuneration expectations varied considerably depending on the communication format. Video consultations were rated highest in terms of both acceptance and WTP, with many respondents placing them in a medium price category. For telephone consultations, which 67.13% considered worthy of payment, a lower fee tended to be considered appropriate. WTP appeared more reserved for text-based formats such as email or messenger communication. Sixty-two participants perceived this as a paid service for which a lower fee was more commonly considered appropriate. For a messenger chat with veterinarians, 93 respondents stated that they would be willing to pay for this telemedicine service. Overall, the assessment of the value of telemedicine services depended on the type of consultation (Figure 4).

The survey results show a predominantly cautious attitude towards the implementation of a flat-rate model for audiovisual consultations. The data indicate that 55.59% of the participants expressed opposition to the proposed flat-rate solution, while 12.94% showed their support for this option. An additional 29.72% of respondents indicated that they could potentially envision a flat rate. The general classification of telemedicine services also presents a differentiated picture: while a majority of respondents (56.38%) recognised this as a fee-based service, 31.38% perceived it as being more of a free service. It is noteworthy that 12.23% of the respondents did not provide an answer. The inquiry concerning the awareness of the German veterinary fee schedule (GOT) disclosed that 59.04% of small animal proprietors are aware of this. Conversely, 35.12% of respondents expressed a negative stance, while 5.85% did not answer (Figure 5).

The final section of the client questionnaire was designed to explore attitudes towards telemedicine services and the acceptance of audiovisual consultations. It contained various evaluation statements. The majority of respondents indicated that the restrictions imposed by the pandemic had not led to an increase in their use of telemedicine consultations. A few respondents reported an increase or newfound interest in digital services due to the contact restrictions. There was a divergence of opinions regarding the potential of telemedicine to serve as a viable substitute for in-person consultations. The reception of digital consultations was varied, with some respondents considering them innovative or supportive additions to existing practices, while others did not regarded them as equivalent substitutes. Notably, some individuals explicitly rejected digital consultations, highlighting the diversity in attitudes towards this emerging form of communication in healthcare. The inclination towards a more pronounced utilisation of telemedicine services was met with a tempered response. While a proportion of respondents expressed interest, a predominant sentiment of scepticism or a sense of distance prevailed. Approximately one-third of the participants in the study expressed reservations regarding the use of telemedicine. Conversely, a more substantial group exhibited no discernible reservations or only exhibited nominal reservations, suggesting a range of experiences and levels of confidence in digital formats. However, only a small percentage of pet owners would consider changing their current veterinary practice to enhance access to telemedicine services. For the majority of respondents, this was not a salient factor for choosing the veterinarian. Approximately half of the participants expressed a desire for further information regarding telemedicine and its potential applications. Concurrently, a considerable proportion expressed satisfaction with the prevailing state of knowledge or perceived no necessity for further information. A 24-h veterinary consultation service, for example, via a call centre, was met with approval by many. The notion of designated contact personnel who are consistently accessible was regarded as reasonable by a substantial proportion of the participants, although a considerable number exhibited a degree of scepticism regarding this concept (Figures 6, 7).

As part of the study, semi-structured interviews were conducted with representatives from veterinary practices, veterinary associations, professional associations, and pet health insurance companies. The objective of the interviews was to contextualise practical experiences and expert assessments in relation to the results of the pet owner survey. In total, eight experts agreed to participate in the interview, which represents a response rate of 80% of invited experts. The duration of the interviews ranged from a minimum of 45 min to a maximum of 90 min (mean 67.5 min). Data saturation was achieved, on the one hand, by covering the targeted and convenient sampling strategy, and on the other hand, the interviewer noticed that no new topics or aspects cropped up, there being a repetition of responses regarding topics and ideas and a decrease in the amount of new information collected. The experts unanimously highlighted significant time savings and flexibility that telemedicine offers.

One veterinarian commented: “Digital consultations often serve as a first point of contact or a kind of ‘first aid’ for our patients.”

Digital consultations can also help to prioritise cases according to urgency and optimise practice workflows: “Telemedicine is particularly beneficial for people with limited mobility or for specialities where specialised knowledge needs to be disseminated quickly.”

Obstacles were identified, including technical issues such as unstable internet connections, inadequate equipment and limited digital literacy. As one expert explained: “The heterogenous infrastructure leads to very difficult usage options, and unclear legal regulations and billing modalities complicate practical implementation.”

In addition, the proliferation of incompatible software solutions was mentioned as a factor contributing to organisational challenges and competitive pressure. The experts also discussed the future potential of telemedicine: “I see opportunities mainly in relieving emergency services, improving networking between veterinarians, specialists, and pet insurance companies, and simplifying documentation and billing.”

Another interviewee added: “Low-threshold access could be particularly attractive to digitally savvy generations, and AI could help standardise diagnoses and minimize errors.”

On the other hand, other experts pointed out risks associated with the use of AI: “There is a risk of misdiagnoses by inexperienced veterinarians, and investment and training costs should not be underestimated. In addition, customer loyalty could suffer if telemedicine is not used appropriately.”

In practice, telemedicine has proven particularly useful for follow-up care, wound checks, feeding advice and behavioural abnormalities, as animals can be evaluated in their familiar environment. As one veterinarian emphasised: “As long as telemedicine is used as a supplement to in-person consultations, the trust relationship with our regular clients is not compromised.”

According to experts in the field, the pandemic served as a catalyst for acceptance, though it was not the sole cause of this development. Health insurance companies have already established comprehensive reimbursement policies for telemedicine services within partner networks. However, uncertainties persist in external contexts. The maintenance of uniform standards, targeted training, and improved integration into the fee schedule are considered essential for long-term success.

The evaluation of telemedicine by pet owners and experts reveals a nuanced perspective, underscoring both its potential benefits and the challenges it faces (Figure 8).

The SWOT analysis demonstrates that the successful establishment of telemedicine in small animal practice requires an integrated strategic approach. Strengthening user acceptance through increased trust in digital services and ensuring ease of use plays an overarching role. To this end, telemedical services must be communicated clearly, with their concrete benefits, such as time savings, flexibility, and reduced stress, being highlighted. At the same time, reducing uncertainties regarding diagnostic reliability, data protection, and potential additional costs is essential, as these factors strongly influence users’ willingness to adopt such services. From an organisational perspective, telemedicine requires greater professionalisation and standardisation of practice workflows. Consistent documentation processes, reliable software solutions and clear billing and legal frameworks provide orientation and reduce both internal and external barriers. Sustainable implementation additionally requires target-group-specific support measures that take different levels of digital competence into account. Training initiatives to strengthen internal acceptance as well as transparent communication with pet owners are essential prerequisites for generating positive user experiences. Investments in stable internet connections, appropriate hardware and continuous competence development represent key strategic elements. Overall, the findings suggest that telemedicine can be implemented successfully particularly when it is understood as a complementary, quality-enhancing service that improves veterinary care while simultaneously addressing the needs of its users.