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.
Highlights
Antimicrobial stewardship has been defined as “coordinated interventions designed to improve and measure the appropriate use of [antimicrobial] agents by promoting the selection of the optimal [antimicrobial] drug regimen including dosing, duration of therapy, and route of administration” [1]
antimicrobial use (AMU) is tracked at the farm level in many countries, and individual AMU data are regularly provided to producers and veterinarians for purposes of benchmarking in the context of regulatory programs or quality assurance schemes
The primary reason respondents gave for feeling negatively about the report was believing that their actual antimicrobial use performance was better than the report indicated (Table 2, Quote 1 [Q1])
Summary
Antimicrobial stewardship has been defined as “coordinated interventions designed to improve and measure the appropriate use of [antimicrobial] agents by promoting the selection of the optimal [antimicrobial] drug regimen including dosing, duration of therapy, and route of administration” [1]. A frequently used stewardship initiative is the provision of periodic feedback on a prescriber’s AMU, oftentimes situating their use relative to their peers’ In human medicine, this type of intervention has been shown to decrease AMU, improve clinical outcomes, and decrease costs in the outpatient clinical setting [3,4,5,6]. AMU is tracked at the farm level in many (mostly European) countries, and individual AMU data are regularly provided to producers and veterinarians for purposes of benchmarking in the context of regulatory programs or quality assurance schemes These types of initiatives are thought to be major contributors to the decline in AMU observed in many livestock sectors in these countries [7,8,9]. Little is known about how veterinary clinicians working in the United States (US) hospital setting think about AMU metrics for antimicrobial stewardship
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