Department of Population Medicine, University of Guelph, Guelph, Ontario, Canada.
Department of Public and Ecosystem Health, Cornell University College of Veterinary Medicine, Ithaca, New York, United States of America.
PLoS One. 2023 Jul 27;18(7):e0289415. doi: 10.1371/journal.pone.0289415. eCollection 2023.
The aim of this study was to describe the factors that influence dairy cattle veterinarians´ antimicrobial prescribing, their attitudes toward reducing antimicrobial use (AMU) in the dairy industry, awareness of antimicrobial resistance (AMR), and perceived barriers to improving antimicrobial stewardship (AMS) on Canadian dairy farms. We used quantitative and qualitative research methods to consider the complexity of the antimicrobial prescription decision-making process. We designed and distributed an online survey, followed by four online focus groups with practicing veterinarians. We used frequency tables and unconditional associations to analyze quantitative data, and thematic analysis to analyze qualitative data. In total, 107 participants from four Canadian provinces responded to the survey, and 26 veterinarians participated in the focus groups. Results from both studies were triangulated to draw our key findings. We found that 1) Veterinarians must weigh numerous intra-personal and contextual considerations that could be conflicting in their decision-making process for prescribing antimicrobials. 2) Although less experienced veterinarians showed greater awareness of AMR and motivation to improve AMS than more experienced veterinarians, they also reported feeling more pressure to adapt their prescribing practices to farmers' wishes than more experienced veterinarians. 3) Some veterinarians experienced conflict between prescribing antimicrobials to maintain animal health, productivity, and welfare, and AMS, which could result in blaming others for inappropriate antimicrobial use and reducing the opportunity to critically review their own prescribing practices. 4) There were strategies and barriers in common between veterinarians and farmers such as collaborative reviews of disease treatment protocols and improving preventive medicine on dairy farms. 5) The main barriers to reducing AMU on dairy farms reported by veterinarians were concerns about animal welfare and AMU on dairy farms without consultation with the veterinarian. Our results can inform the development of AMS programs in the Canadian dairy industry.
本研究旨在描述影响奶牛兽医开具抗菌药物处方的因素、他们对减少奶牛养殖业中抗菌药物使用（AMU）的态度、对抗菌药物耐药性（AMR）的认识，以及在加拿大奶牛场改善抗菌药物管理（AMS）的感知障碍。我们使用定量和定性研究方法来考虑抗菌药物处方决策过程的复杂性。我们设计并分发了一份在线调查问卷，随后进行了四次在线焦点小组讨论，参与者为执业兽医。我们使用频率表和无条件关联来分析定量数据，并使用主题分析来分析定性数据。共有来自加拿大四个省的 107 名参与者对调查问卷做出了回应，26 名兽医参加了焦点小组讨论。对两项研究的结果进行了三角剖分，以得出我们的主要发现。我们发现：1）兽医在决定开具抗菌药物处方时，必须权衡许多个人和环境因素，这些因素在决策过程中可能存在冲突。2）尽管经验较少的兽医比经验丰富的兽医对抗菌药物耐药性的认识和改善 AMS 的动力更大，但他们也报告说，与经验丰富的兽医相比，他们感到更大的压力，需要根据农民的意愿调整他们的处方实践。3）一些兽医在维持动物健康、生产力和福利与 AMS 之间存在冲突，这可能导致他们将不适当的抗菌药物使用归咎于他人，并减少批判性审查自己的处方实践的机会。4）兽医和农民之间存在共同的策略和障碍，例如共同审查疾病治疗方案和改善奶牛场的预防医学。5）兽医报告的减少奶牛场 AMU 的主要障碍是对动物福利的担忧以及在未与兽医协商的情况下在奶牛场使用 AMU。我们的研究结果可以为加拿大奶牛养殖业的 AMS 计划的制定提供信息。
