What makes an effective One Health clinical practitioner? Opinions of Australian One Health experts

Abstract

Despite agreement that One Health practices facilitate effective management of zoonoses, the pathways to a coordinated and collaborative approach by general medical practitioners (GPs) and veterinarians are hampered by limited understanding of how this can be practically incorporated in routine clinical settings. Data collected during a Delphi survey of Australian One Health ‘experts’ was used to explore opinions and insights into desired knowledge, attitudes and practices of effective One Health clinical practitioners. Five categories were identified as essential for GPs and veterinarians, namely: accurate baseline knowledge of specific zoonoses; a ‘big picture’ understanding of zoonoses; understanding of professional roles within the One Health paradigm; understanding one's own professional limitations; and collaboration and referral improve outcomes. An outline of the roles and responsibilities of GPs and veterinarians as effective One Health clinicians was determined based on the opinions of the expert panel. Educational interventions that foster interprofessional communication and collaboration will be necessary to successfully bring about the cultural change required to achieve effective One Health practice in Australia, and thus expedite improved human, animal and environmental health outcomes.

Towards One Health clinical management of zoonoses: A parallel survey of Australian general medical practitioners and veterinarians

“…Heightened concern about zoonoses amongst veterinarians is likely to be propelled by a number of factors, primarily their greater knowledge of zoonoses and their epidemiology (Chaddock, 2012;Hennenfent et al, 2018;Hoff et al, 1999;John et al, 2008;Smout et al, 2017;Steele et al, 2018Steele et al, , 2019Togami et al, 2018). Many veterinarians also have personal experience with zoonoses; nearly 45% of veterinarians in a previous Australian study reported contracting a zoonotic infection (Dowd et al, 2013).…”

“…These findings were comparable with other survey‐based studies in the United States (Grant & Olsen, 1999; Hennenfent et al., 2018; Hill et al., 2012; von Matthiessen et al., 2003). This is thought by many to be a consequence of differing priorities and demands of medical and veterinary school curricula (Hodgson et al., 2019; John et al., 2008; Kahn et al., 2008; Natterson‐Horowitz, 2015; Rabinowitz & Conti, 2013; Togami et al, 2018), with medical graduates receiving less training in zoonoses, epidemiology and One Health (Chaddock, 2012; Hoff et al., 1999; John et al., 2008; Smout et al., 2017; Steele et al., 2018, 2019; Togami et al, 2018). The strategic position occupied by veterinarians and GPs in recognizing and reporting sentinel disease events (Morse et al., 2012; Rabinowitz & Conti, 2013) makes it imperative that educational interventions are put in place to improve the confidence, competence and capacity of GPs in this area.…”

“…A cross‐sectional study using two parallel surveys directed at Australian GPs and veterinarians in clinical practice was conducted informed by research priorities established by the researchers in previous studies (Steele et al., 2018, 2019). Survey questions addressed participant experience, concern, confidence and practices regarding zoonotic diseases using binary response (yes/no), five‐point Likert‐scale and open‐ended questions to further explore clinician responses (See Appendix ).…”

“…• Addressing the significant differences between practitioner groups will require targeted changes in both medical and veterinary education as well as continuing practitioner education in the area of zoonoses. previous studies (Steele et al, 2018(Steele et al, , 2019. Survey questions addressed participant experience, concern, confidence and practices regarding zoonotic diseases using binary response (yes/no), fivepoint Likert-scale and open-ended questions to further explore clinician responses (See Appendix 1).…”

“…The current lack of effective One Health practice at the clinician level stems from varying knowledge of common endemic zoonoses and an understanding of the One Health paradigm amongst veterinarians and GPs (Eussen et al, 2017;Grant & Olsen, 1999;Hodgson et al, 2019;von Matthiessen et al, 2003;Rabinowitz & Conti, 2013). Previous research conducted by us and other researchers has suggested that the genesis of this problem lies in a number of factors, including the limited coverage of these subjects in clinical degree programs as well as continuing professional education (Hodgson et al, 2019;Kahn et al, 2008;Marcotty et al, 2013;Steele et al, 2018Steele et al, , 2019Togami et al, 2018). Further, the structure of medical and veterinary services and existence of professional silos results in clinicians tending to act individually rather than collaboratively and cooperatively (Rabinowitz & Conti, 2010;Speare et al, 2015).…”