Small and Large Animal Veterinarian Perceptions of Antimicrobial Use Metrics for Hospital-Based Stewardship in the United States

Abstract

Background: Robust measurement and tracking of antimicrobial use (AMU) is a fundamental component of stewardship interventions. Feeding back AMU metrics to individual clinicians is a common approach to changing prescribing behavior. Metrics must be meaningful and comprehensible to clinicians. Little is known about how veterinary clinicians working in the United States (US) hospital setting think about AMU metrics for antimicrobial stewardship. Objective: To identify hospital-based veterinary clinicians' attitudes toward audit and feedback of AMU metrics, their perceptions of different AMU metrics, and their response to receiving an individualized prescribing report. Methods: Semi-structured interviews were conducted with veterinarians working at two hospitals in the Eastern US. Interviews elicited perceptions of antimicrobial stewardship in veterinary medicine. Respondents were shown a personalized AMU Report characterizing their prescribing patterns relative to their peers and were asked to respond. Interviews were recorded, transcribed, and analyzed using the framework method with matrices. Results: Semi-structured interviews were conducted with 34 veterinary clinicians (22 small animal and 12 large animal). Respondents generally felt positive about the reports and were interested in seeing how their prescribing compared to that of their peers. Many respondents expressed doubt that the reports accurately captured the complexities of their prescribing decisions and found metrics associated with animal daily doses (ADDs) confusing. Only 13 (38.2%) respondents felt the reports would change how they used antimicrobials. When asked how the impact of the reports could be optimized, respondents recommended providing a more detailed explanation of how the AMU metrics were derived, education prior to report roll-out, guidance on how to interpret the metrics, and development of meaningful benchmarks for goal-setting. Conclusions: These findings provide important insight that can be used to design veterinary-specific AMU metrics as part of a stewardship intervention that are meaningful to clinicians and more likely to promote judicious prescribing.

Veterinary Practitioners’ Standpoints and Comprehension towards Antimicrobial Use—Are There Opportunities for Antimicrobial Stewardship Improvement?

“…In the current study, more than half of the respondents use domestic or foreign guidelines moderately when prescribing antibiotics in their daily work; however, almost all of them would also like to have more local guidelines available. Other studies conducted in the USA have had similar results [ 74 , 75 ].…”

Development and Pilot of an Interactive Online Course on Antimicrobial Stewardship in Companion Animals

“…Interactive meetings and discussions with other veterinarians and course organizers, as well as individual, clinic-based feedback, were highly appreciated. Participants from the former ASAP project reported that they were interested in seeing how their prescribing compared to other veterinarians (benchmarking), which is also underlined by other studies [42]. Having interactive discussions with other participants and course organizers might deepen insight and motivate participants to consider alternative attitudes.…”

Improving farm-level antimicrobial stewardship benchmarks by reporting antimicrobial use within the context of both the magnitude of disease pressure and the outcome of therapy

“…While there are some nuances across metrics which might relate to different stewardship program priorities, the differences are slight with the exception of measuring mass-based grams compared to a dose-based measure of treatment incidence ( 14 – 16 ). In a study looking at benchmarking both large and small animal clinicians in the United States it was found that “Prescribing frequency, durations of therapy, and ranking of antimicrobial classes appear to be the metrics most well-received by veterinary clinicians, while dose-based metrics associated with the ADD [animal daily dose] are less intuitive.” ( 17 ); even in a hospital setting with clinicians interpreting the benchmarks, dose-based metrics were perceived as “less intuitive.”…”