Qualitative study of factors associated with antimicrobial usage in seven small animal veterinary practices in the UK
Qualitative study of factors associated with antimicrobial usage in seven small animal veterinary practices in the UK
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DOI：
10.1016/j.prevetmed.2014.05.007
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发表时间：
2014-11-01
影响因子：
2.6
通讯作者：
Staerk, Katharina D. C.
中科院分区：
文献类型：
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作者：
Mateus, Ana L. P.;Brodbelt, David C.;Staerk, Katharina D. C.
兽医负责任地使用抗菌药物对于遏制与公共卫生相关的病原体的抗菌药物耐药性至关重要。先前在实践中描述了不适当的抗菌剂使用。然而，关于影响犬和猫抗菌药物使用的因素的信息很少。我们调查的内在和外在因素影响决策的第一意见的小动物的做法在英国通过应用定性研究methods.Semi-structured采访了21名兽医从7兽医第一意见的做法在英国在2010年进行。调查的主题包括：a）用于选择抗菌剂的标准，B）同事的影响，c）客户的影响，d）宠物特征，e）知识来源，f）对指南的认识和g）在实践中实施的可能影响兽医使用抗菌剂的方案。选择用于评估抗菌剂使用适当性的假设情景为：a）约克郡梗因饮食不当而呕吐，B）沙皮犬深度化脓，c）7岁雄性绝育猫的猫下尿路疾病和d）6个月犬的绝育。访谈由访谈者记录和转录。采用主位分析法分析转录访谈的内容。使用定性分析软件NVivo 8（QSR International Pty Ltd）进行数据管理和分析。参与者的抗菌药物使用受临床证据和科学知识以外的因素影响。内在因素包括兽医对药物的偏好和既往经验。影响抗菌剂选择的外在因素有：感知的有效性、制剂给药的便利性、感知的依从性、宠物主人治疗的意愿和能力以及动物特征。治疗费用仅被认为是低，混合社会经济领域的影响因素。兽医对目前在小动物实践中负责任使用的建议认识有限。社会规范，特别是口头商定的协议影响兽医。在非传染性疾病的治疗和常规清洁外科手术的预防中发现了不适当的抗菌药物使用。与同行讨论临床病例和工作场所的有效性会议有助于兽医分享科学知识。有效性会议可以成为兽医讨论和商定临床条件和外科手术方案的共同基础。协议应以证据为基础，遵循当前的建议，并考虑到工作场所的可用资源。应在同行支持下对工作场所的兽医进行有针对性的培训，以促进负责任的抗菌剂使用。(C)2014爱思唯尔有限公司版权所有。
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. (C) 2014 Elsevier B.V. All rights reserved.