title: Qualitative study of factors associated with antimicrobial usage in seven small animal veterinary practices in the UK.
abstract: Responsible use of antimicrobials by veterinarians is essential to contain antimicrobial resistance in pathogens relevant to public health. Inappropriate antimicrobial use has been previously described in practice. However, there is scarce information on factors influencing antimicrobial usage in dogs and cats. We investigated intrinsic and extrinsic factors influencing decision-making of antimicrobial usage in first opinion small animal practices in the UK through the application of qualitative research methods. Semi-structured interviews were conducted with 21 veterinarians from seven veterinary first opinion practices in the UK in 2010. Topics investigated included: a) criteria used for selection of antimicrobials, b) influences by colleagues, c) influences by clients, d) pet characteristics, e) sources of knowledge, f) awareness of guidelines and g) protocols implemented in practice that may affect antimicrobial usage by veterinarians. Hypothetical scenarios selected to assess appropriateness of antimicrobial usage were: a) vomiting in a Yorkshire Terrier due to dietary indiscretion, b) deep pyoderma in a Shar-Pei, c) Feline Lower Urinary Tract disease in an 7 year-old male neutered cat and d) neutering of a 6-months dog. Interviews were recorded and transcribed by the interviewer. Thematic analysis was used to analyse content of transcribed interviews. Data management and analysis was conducted with qualitative analysis software NVivo8 (QSR International Pty Ltd). Antimicrobial usage by participants was influenced by factors other than clinical evidence and scientific knowledge. Intrinsic factors included veterinarian's preference of substances and previous experience. Extrinsic factors influencing antimicrobial selection were; perceived efficacy, ease of administration of formulations, perceived compliance, willingness and ability to treat by pet owners, and animal characteristics. Cost of therapy was only perceived as an influential factor in low, mixed socioeconomic areas. Veterinarians had limited awareness of current recommendations for responsible use in small animal practice. Social norms, particularly verbally agreed protocols influenced veterinarians. Inappropriate antimicrobial usage was identified in the therapy of non-infectious diseases and prophylaxis of routine clean surgical procedures. Discussion of clinical cases with peers and effectiveness meetings in the workplace were useful to veterinarians to share scientific knowledge. Effectiveness meetings can be a common ground for veterinarians to discuss and agree protocols for clinical conditions and surgical procedures. Protocols should be evidence-based, follow current recommendations and take into account the resources available in the workplace. Targeted training of veterinarians in the workplace with peer support should be used to promote responsible antimicrobial usage.
authors.affiliation: Royal Veterinary College, Veterinary Clinical Sciences Department, Hawkshead Campus, Hawkshead Lane, North Mymms, Hatfield AL9 7TA, UK. Electronic address: amateus@rvc.ac.uk.
authors.forename: Ana L P
authors.initials: AL
authors.lastname: Mateus
authors.affiliation: Royal Veterinary College, Veterinary Clinical Sciences Department, Hawkshead Campus, Hawkshead Lane, North Mymms, Hatfield AL9 7TA, UK. Electronic address: dbrodbelt@rvc.ac.uk.
authors.forename: David C
authors.initials: DC
authors.lastname: Brodbelt
authors.affiliation: UCL School of Pharmacy, Department of Practice and Policy, Centre for Medication Safety and Service Quality, Tavistock (BMA) House, Tavistock Square, London WC1H 9JP, UK. Electronic address: n.barber@pharmacy.ac.uk.
authors.forename: Nick
authors.initials: N
authors.lastname: Barber
authors.affiliation: Royal Veterinary College, Veterinary Clinical Sciences Department, Hawkshead Campus, Hawkshead Lane, North Mymms, Hatfield AL9 7TA, UK. Electronic address: kstaerk@rvc.ac.uk.
authors.forename: Katharina D C
authors.initials: KD
authors.lastname: Stärk
mesh_terms: D000328:Adult; D000818:Animals; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000188:drug therapy / Q000662:veterinary*; D002371:Cat Diseases / Q000188:drug therapy*; D002415:Cats; D003657:Decision Making; D004283:Dog Diseases / Q000188:drug therapy*; D004285:Dogs; D024901:Drug Resistance, Multiple, Bacterial; D004363:Drug Utilization; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D006113:United Kingdom; D014730:Veterinary Medicine / Q000592:standards*
chemical_list: D000900:Anti-Bacterial Agents
keywords: Antibiotics; Antimicrobials; Decision-making; Qualitative; Small animals; Veterinary