Faculty of Veterinary Medicine, Department Biomolecular Health Sciences, Division of Infectious Diseases and Immunology, Utrecht University, Utrecht, The Netherlands.
Consumption and Healthy Lifestyles Group, Wageningen University and Research, Wageningen, The Netherlands.
PLoS One. 2024 Apr 18;19(4):e0299905. doi: 10.1371/journal.pone.0299905. eCollection 2024.
Streptococcus suis (S. suis) infections in weaned pigs are common and responsible for a high consumption of antimicrobials, and their presence is assumed to be multi-factorial. A specific evidence-based veterinary guideline to support the control of S. suis in weaned pigs was developed for veterinary practitioners in the Netherlands in 2014. Adherence to the S. suis clinical practice guideline helps veterinary practitioners to prevent and control the disease in a systematical approach and thereby improve antimicrobial stewardship and contribute to the prevention of antimicrobial resistance in animals and humans. The impact of such a clinical practice guideline on (animal) disease management depends not only on its content, but also largely on the extent to which practitioners adhere to the clinical guideline in practice. When the S. suis guideline was published, no specific activities were undertaken to support veterinarians' uptake and implementation, thereby contributing to suboptimal adherence in clinical practice. As the S. suis guideline was comprehensively written by veterinary experts following an evidence-based approach, our aim was not to judge the (scientific) quality of the guideline but to study the possibility to improve the currently low adherence of this guideline in veterinary practice. This paper describes the systematic development, using Implementation Mapping, of a theory-based intervention program to support swine veterinarians' adherence to the S. suis guideline. The knowledge, skills, beliefs about capabilities, and beliefs about consequences domains are addressed in the program, which includes seven evidence-based methods (modelling, tailoring, feedback, discussion, persuasive communication, active learning, and self-monitoring) for use in program activities such as a peer-learning meeting and an e-learning module. The intervention program has been developed for practicing swine veterinarians, lasts eight months, and is evaluated through a stepped-wedge design. The Implementation Mapping approach ensured that all relevant adopters and implementers were involved, and that outcomes, determinants (influencing factors), and objectives were systematically discussed.
猪断奶后感染猪链球菌（S. suis）很常见，这导致大量使用抗生素，而且这种感染被认为是多因素的。2014 年，荷兰为兽医从业者制定了一份针对断奶猪猪链球菌的具体循证兽医指南，以支持对其的控制。兽医从业者遵循猪链球菌临床实践指南，有助于系统地预防和控制疾病，从而改善抗菌药物管理，并有助于预防动物和人类的抗菌药物耐药性。这种临床实践指南对（动物）疾病管理的影响不仅取决于其内容，还在很大程度上取决于从业者在实践中对临床指南的遵守程度。当猪链球菌指南发布时，没有采取具体的活动来支持兽医的采纳和实施，从而导致临床实践中的遵守程度不理想。由于猪链球菌指南是由兽医专家根据循证方法全面编写的，我们的目的不是评判该指南的（科学）质量，而是研究提高兽医实践中该指南目前低遵守率的可能性。本文描述了使用实施映射系统地开发一个基于理论的干预计划，以支持猪兽医遵守猪链球菌指南。该计划针对知识、技能、能力信念和后果信念领域，包括七种基于证据的方法（建模、定制、反馈、讨论、有说服力的沟通、主动学习和自我监测），用于开展同行学习会议和电子学习模块等计划活动。该干预计划针对执业猪兽医，持续八个月，并通过逐步楔形设计进行评估。实施映射方法确保所有相关的采用者和执行者都参与其中，并系统地讨论了结果、决定因素（影响因素）和目标。
