Investigating interactions between UK horse owners and prescribers of anthelmintics

Abstract

Helminths are common pathogens of equids and anthelmintic resistance is a major issue in cyathostomin species and Parascaris equorum. At the heart of mitigating the impact of increasing anthelmintic resistance levels, is the responsible dissemination and use of these medicines following best practice principles. There is a paucity of information on interactions between horse owners and anthelmintic prescribers and how this shapes control. Here, a study was undertaken to determine opinions and experiences of horse owners as they relate to anthelmintics purchase and implementation of best practice control. An online survey was distributed via email and social media to explore owners' experiences of purchasing anthelmintics from United Kingdom prescribers, these being veterinarians, suitably qualified persons (SQPs) and pharmacists. Owner responses (n=494) were analysed statistically to compare answers of respondents grouped according to: (i) from whom they bought anthelmintics (Veterinarians n=60; SQPs n=256; Pharmacists n=42; More than one channel n=136), and (ii) by which route (Face-to-face n=234; Telephone n=31; Online n=226) they purchased. Owners who purchased from veterinarians predominantly did so face-to-face (81.3%), whilst those that bought from SQPs purchased via face-to-face (48.8%) and online (46.0%) interactions. Those who purchased from pharmacists predominantly bought anthelmintics online (76.2%). Participants who bought from veterinarians were more likely to view certain factors (i.e. time to talk to the supplier, supplier knowledge) as more important than those who purchased from other prescribers. Those who purchased from veterinarians were more likely to be recommended faecal egg count (FEC) test analysis; however, there was high uptake of FEC testing across all groups. There was a low uptake of anthelmintic efficacy testing; regardless of the prescriber type from whom anthelmintics were purchased. Those who purchased from veterinarians were more likely to agree that anthelmintics should be sold as veterinary prescription-only medicines. Those who purchased online (regardless of which type of prescriber they bought from) were less likely to consider prescriber advice or knowledge when deciding which product to buy and indicated that sellers were less likely to raise use of anthelmintics for targeting parasites. Across all groups, many owners stated that they were aware of or used non-chemical control measures such as dung removal and diagnostic FEC testing to target treatments. In summary, there were some differences in the type of advice provided at the point of purchase and this was dependent upon whom anthelmintics were purchased from and by which route they were bought.

Equine de-worming: a consensus on current best practice

“…It is therefore necessary to consider in-depth the reasons why people are behaving in a certain way, in order to help them to change their behaviour. We know from surveys of horse owners that they are interested in de-worming (Stratford et al, 2014b), but these surveys also corroborate more general human behaviour studies in confirming that social norms are a more powerful influence than professional advice; horse owners are more likely to do what everyone else on the yard does than what the veterinary surgeon advises them to do (Stratford et al, 2014b;Easton et al, 2016;Rose Vineer et al, 2017). Anthelmintics are available from a variety of outlets and, contrary to guidelines, are often sold without investigation of which diagnostics have been performed and which product is most appropriate.…”

“…This makes it easy for owners to obtain the products they think they should be using or cost the least money, rather than the most appropriate product. Most owners indicate that they engage with targeted worming, yet when questioned on what they actually do, the responses indicate that most are still deworming at frequent intervals with the results of FEC failing to guide the need for treatment (Stratford et al, 2014b;Easton et al, 2016). A recent study set out to compare horse owners who reported that they used targeted worming strategies with those that did not, but it proved impossible to differentiate one group from the other by their actions (Hodgkinson et al, unpublished data).…”

Use of a saliva‐based diagnostic test to identify tapeworm infection in horses in the UK

“…Targeted selective treatment strategies aim to reduce use of anthelmintics by exploiting diagnostics (for example, faecal egg count [FEC] analysis) to identify animals that require treatment to reduce shedding of worm eggs in faeces. In the UK, this has become relatively commonplace in worm control programmes and is of value for detecting nematode eggs but not cestode eggs; the excretion of A. perfoliata eggs is intermittent and eggs are unevenly distributed in faeces resulting in low sensitivity of coprological analysis . To address this, a serum‐based test to diagnose tapeworm was developed and has been commercially available for over a decade .…”

Risk factor analysis of equine strongyle resistance to anthelmintics

“…This regulation was generally applied across the considered study sites and well correlated with the involvement of veterinarians into the drenching scheme design. Recent study in the UK suggests that practitioners may provide useful advice on drug use (Easton et al, 2016) and thus reinforce their role in sustainable parasite control. Such partnerships between veterinarians and horse owners should thus be encouraged in France as 40% of the considered sites designed their own drenching scheme.…”

“…These two findings need cautious interpretation and the latter association may be the consequence of identified problematic parasite control by managers who ultimately ask their veterinarians for advice. Recent study in the UK suggests that practitioners may provide useful advice on drug use (Easton et al, 2016) and thus reinforce their role in sustainable parasite control. However, a sub-optimal awareness of veterinarians in integrated management of strongyles in France cannot entirely be ruled-out (Sallé and Cabaret, 2015).…”