Exploring the behavioural drivers of veterinary surgeon antibiotic prescribing: a qualitative study of companion animal veterinary surgeons in the UK

Abstract

BackgroundMulti-drug resistant bacteria are an increasing concern in both human and veterinary medicine. Inappropriate prescribing and use of antibiotics within veterinary medicine may be a contributory factor to antimicrobial resistance (AMR). The ‘One Health’ Initiative aims to work across species and environments to reduce AMR, however; little is currently known about the factors which influence antibiotic prescribing among veterinary surgeons in companion animal practice.This paper reports on qualitative data analysis of interviews with veterinary surgeons whose practice partially or wholly focuses on companion animals (N = 16). The objective of the research was to explore the drivers of companion animal veterinary surgeons’ antibiotic prescribing behaviours. The veterinary surgeons interviewed were all practising within the UK (England (n = 4), Scotland (n = 11), Northern Ireland (n = 1)). A behavioural thematic analysis of the data was undertaken, which identified barriers and facilitators to specific prescribing-related behaviours.ResultsFive components of prescribing behaviours were identified: 1) confirming clinical need for antibiotics; 2) responding to clients; 3) confirming diagnosis; 4) determining dose, duration and type of antibiotic; and 5) preventing infection around surgery (with attendant appropriate and inappropriate antibiotic prescribing behaviours). Barriers to appropriate prescribing identified include: business, diagnostic, fear, habitual practice and pharmaceutical factors. Facilitators include: AMR awareness, infection prevention, professional learning and regulation and government factors.ConclusionThis paper uses a behavioural lens to examine drivers which are an influence on veterinary surgeons’ prescribing behaviours. The paper contributes new understandings about factors which influence antibiotic prescribing behaviours among companion animal veterinary surgeons. This analysis provides evidence to inform future interventions, which are focused on changing prescribing behaviours, in order to address the pressing public health concern of AMR.

Effect of amoxicillin‐clavulanic acid on clinical scores, intestinal microbiome, and amoxicillin‐resistant Escherichia coli in dogs with uncomplicated acute diarrhea

“…This treatment approach is primarily based on the subjective impression of a more rapid clinical improvement with antibiotics. Furthermore, for several reasons there is a low threshold for using antibiotics in veterinary practice including diagnostic uncertainty, fear of clinical deterioration, time pressure, client expectations, and the general tradition to use antibiotics in dogs with diarrhea 42 . This study should serve as a basis documenting that routine antibiotic treatment is not advantageous for dogs with uncomplicated AD.…”

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“…All these factors are consistent with a referral population, which may be characterised by more complex illness and owners more willing to pursue further diagnostics. However, owner expectations for antimicrobial treatment after minimal diagnostic work-up has been reported as one of the barriers to prudent antimicrobial use in first opinion practice 39–42. Moreover, expertise of the staff, access to diagnostic tools and the existence and level of implementation of local policies for the use of antimicrobials may also vary between university hospitals and private practices.…”

Quantifying Antimicrobial Use in Dutch Companion Animals

“…Also differences in first opinion clinics vs. referral (i.e., secondary or tertiary) clinics, or clinics mainly treating emergency patients might account for observed differences between clinics. However and probably more important, AMU will be determined by prescribing policy and habits within companion animal clinics (e.g., the introduction and implementation of current guidelines regarding AMU) and veterinarian related prescribing habits, e.g., personal preferences in used dosages, frequency of dosing and course lengths as was shown in previous qualitative studies on AMU in companion animal clinics (32)(33)(34). The observation of clear and systematic differences between clinics in AMU highlights a potential for further optimization of AMU, eventually leading to smaller differences in AMU between clinics.…”