Abstract
In this paper we consider the shifting role, practice and context of veterinary diagnosis in addressing concerns over what is, in the context of the growing threat of antimicrobial resistance, considered unnecessary or excessive antimicrobial medicine use in UK livestock farms. With increasing policy and regulatory interest in diagnostic practices and technologies, coupled with an expanding focus on the development and deployment of new rapid and point-of-care on-farm diagnostic testing, this paper investigates current diagnostic practices amongst veterinarians working on dairy, pig and poultry farms in Great Britain (England, Wales, and Scotland) and, more specifically, veterinarians' use and perceptions of new and emerging rapid and point-of-care diagnostic tests. Drawing on a series of 30 semi-structured interviews with farm animal veterinary professionals across the three sectors, this paper examines the manner in which such tests are both used and anticipated in clinical farm animal veterinary practice and the possible impact rapid test technologies might have on broader farm animal health management and disease control. Analysis of the transcribed interviews reveals a number of complexities around the use of rapid and point-of-care diagnostic tests. The relative rapidity and simplification of such tests, facilitating immediate treatment responses, is held in balance against both the accuracy and the more detailed and documented procedures of established laboratory testing routes. In situations of multifaceted on-farm etiologies, respondents maintained that rapid tests may offer restricted diagnostic capabilities, though in other situations they were found to offer ready confirmation of disease presence. A third complexity arising from the growth of rapid and point-of-care testing and revealed in this study relates to the shifting distribution of responsibilities in animal health care within contemporary food chains. The growing availability of rapid and point-of-care tests effectively diversifies the range of diagnostic actors with consequences for the flow of diagnostic and disease information. The veterinarians in this study identified areas where new rapid and point-of-care tests would be of particular value to them in their clinical practice particularly in addressing concerns over inappropriate antimicrobial use in animal treatment. However, despite the considerable policy advocacy on rapid and point-of-care tests as key tools in shifting diagnostic practice and reducing unnecessary antimicrobial use, veterinarians in this study, while recognizing the potential future role of such tools and technologies, nonetheless viewed diagnostic practice as a far more complex process for which rapid tests might constitute only a part.
Highlights
In 2015, the UK’s Review of Antimicrobial Resistance, originally commissioned in 2014 to investigate the emerging issue of antimicrobial resistance and propose workable solutions, released two reports
As we have shown above, rapid and point-of-care diagnostic tests are widely seen within various policy and scientific communities as part of the “solution” to excessive antimicrobial use in both human and animal health care: “a step change in the way that technology is incorporated into the decision-making process around antibiotic use” [1]
In their adoption by clinical veterinarians across different production sectors and across different animal health conditions, rapid and point-of-care diagnostic practices introduce or expose new and different levels of complexity, be they in the test parameters and on-farm sampling environment, the animals themselves or in the very divisions of labor that characterize the performance of diagnostic testing
Summary
In 2015, the UK’s Review of Antimicrobial Resistance, originally commissioned in 2014 to investigate the emerging issue of antimicrobial resistance and propose workable solutions, released two reports. Building on the earlier document, this second report highlighted the potential role that rapid and point-of-care diagnostic tools might play in reducing antimicrobial use in animal treatment. These two documents, followed by the Review’s final report [3]– known as the O’Neill report after the Review’s Chairman–have since become key statements in informing subsequent responses of Government [4], NGOs [5], and industry [6] to the need to reduce antimicrobial use in agriculture and to the potential role of rapid and point-of-care diagnostic tests (which we define, for both terms, following Abuelo and Alves-Nores [(7), p. The UK Government, under its current Five-Year Action Plan for Antimicrobial Resistance, thereby committed to: Explore, in collaboration with industry, options to develop rapid and reliable diagnostic tools to inform veterinarians’ prescribing decisions; and promote the uptake of these tools [4]
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