School of Veterinary Medicine and Science, University of Nottingham, Leicestershire, England.
PLoS One. 2019 Apr 9;14(4):e0213855. doi: 10.1371/journal.pone.0213855. eCollection 2019.
Resistance to antimicrobials is one of the biggest challenges worldwide for public health. A key strategy for tackling this is ensuring judicious use of antimicrobials in human and veterinary medicine. Whilst there are many studies in human medicine investigating prescribing behaviour of doctors, there is limited work to understand what factors influence veterinarian prescribing behaviour. Veterinarians often prescribe antimicrobials to sheep and beef farmers in contexts other than at a clinical consultation, and decision-making behind this has not been explored. The aim of this study was to measure, for the first time, the influence of factors from social theories on veterinarians' decision to prescribe antimicrobials to sheep and beef farmers without a clinical consultation, using a factorial survey approach. Respondents were presented with eight vignette scenarios, where a farmer asks for antimicrobials at the veterinary practice. Seven factors, identified from constructs of social theories, were included in the vignettes. Random intercept and random slope models were built to estimate the effects of the vignette factors and vet characteristics on the respondents' willingness to prescribe ratings. A total of 306 surveys were completed. The vignette factors: case type, farmer relationship, other veterinarians in practice, time pressure, habit, willingness to pay, and confidence in the farmer, were significant in the decision to prescribe. Confidence in the farmer was the most influential vignette variable, and was included as a random slope effect. Respondent variables with significant influence on the decision to prescribe were agreeableness personality score, region of veterinary practice, and presence of a small animal department. These influential factors could be considered to target interventions in beef and sheep farm animal veterinary practice for improved antimicrobial stewardship.
抗微生物药物耐药性是全球公共卫生面临的最大挑战之一。解决这一问题的关键策略是确保在人类和兽医医学中合理使用抗微生物药物。虽然在人类医学中有许多研究调查医生的处方行为，但对于影响兽医处方行为的因素了解有限。兽医经常在临床咨询之外向绵羊和肉牛农民开具抗微生物药物，而这种决策背后的因素尚未得到探索。本研究的目的是首次使用因素调查方法衡量社会理论因素对兽医在没有临床咨询的情况下向绵羊和肉牛农民开具抗微生物药物的决定的影响。受访者被呈现了八个情景案例，其中一位农民在兽医诊所要求开抗微生物药物。情景案例中包括了来自社会理论构建的七个因素。建立了随机截距和随机斜率模型，以估计情景因素和兽医特征对受访者开处方意愿评分的影响。共完成了 306 项调查。情景因素：病例类型、农民关系、实践中的其他兽医、时间压力、习惯、支付意愿和对农民的信心，对抗生素处方决策有重要影响。对农民的信心是最具影响力的情景变量，并被作为随机斜率效应包含在内。对处方决策有重大影响的受访者变量是宜人性人格得分、兽医实践区域和小动物部门的存在。这些有影响力的因素可以被考虑用于针对改善农场动物兽医学中的抗微生物药物管理进行干预。
