Attitudes and perceptions of Dutch veterinarians on their role in the reduction of antimicrobial use in farm animals

https://doi.org/10.1016/j.prevetmed.2015.08.014Get rights and content

Highlights

  • Attitudes and perceptions of Dutch veterinarians on their role in the reduction of antimicrobial use in farm animals.

  • Farm animal veterinarians differ in attitudes on antimicrobial use based on animal species they are working with and years of experience.

  • Experienced veterinarians feel more confident to act independent from farmers’ wishes.

  • Experienced veterinarians rely more on the veterinary pharmacy.

  • Benchmarking, improved feed quality and improved housing believed to be effective in antimicrobial reduction.

Abstract

Little is known about attitudes of veterinarians towards antibiotic use and reduction opportunities, and their interaction with farmers herein. Therefore, a questionnaire was developed and sent out to Dutch farm animal veterinarians. The response rate was 40%. Categorical Principal Component Analysis (CATPCA) was conducted on statements measuring attitudes towards the use of antibiotics and reduction opportunities in farm animals, the veterinary pharmacy and the interaction of veterinarians with farmers in improving animal health. This resulted in 3 underlying dimensions. Additionally, possible explanatory variables (main farm animal species working with, years of experience in practice) were added to the CATPCA to identify differences between veterinarians. Veterinarians working with different animal species were comparable in their opinions towards the necessity to reduce veterinary antibiotic use and the current policy to halve veterinary antibiotic consumption. Veterinarians working with ruminants – “ruminant specialists” – and veterinarians working with several different animal species – “generalists” – reported to feel more uncertainty in acting independently from farmers' and significant others' (other advisors, colleagues) demands for antibiotics or opinions than veterinarians mainly working with intensively raised animals (pigs, poultry, veal calves) – “intensive specialists”. Years of experience in practice was negatively related to feelings of uncertainty in acting independently. At the other hand, years of experience was associated with being less concerned about the possible contribution of veterinary antibiotic use to antimicrobial resistance, considering it more important to keep the right to prescribe and sell antibiotics, and being less hesitant to apply antibiotics to prevent (further dissemination of) animal diseases. Intensive specialists expected most from improving feed quality and benchmarking of antibiotic prescribing and use in reducing veterinary antibiotic use; ruminant specialists and generalists preferred improving housing and climate conditions and benchmarking. The by veterinarians perceived main reasons for farmers not to comply to veterinary advices to improve animal health were related to financial and time restrictions, although intensive specialists stressed the importance of conflicting advices from other advisors as a cause for non-compliance. The results showed that younger veterinarians might require additional support to act independently from farmers’ and significant others’. Additionally, experienced veterinarians could be educated about possible risks related to veterinary overuse of antibiotics. Alternative approaches should be identified for veterinarians to preserve a decent income without pharmacy incomes. Especially in intensive farming, ways should be found to prevent contradictory advices as a barrier not to implement veterinary advices to improve animal health.

Introduction

The emerging antimicrobial resistance in bacteria is considered to be a major threat for public health. Farm animals are regarded as high antibiotic consumers with considerable levels of avoidable antibiotic use (U.S. Department of Health and Human Services. Centres for Disease Control and Prevention, 2013). Since antibiotic use drives resistance, there is an urgent need to reduce antibiotic use in animals to the absolute minimum that is required to safeguard animal health but still compatible with a sustainable animal production (Angulo et al., 2009, Prescott, 2008, Aarestrup et al., 2008, McEwen, 2006).

The Dutch government in 2010 imposed the livestock sectors to reduce veterinary antibiotic usage with 50% in 2013 and 70% in 2015 compared to 2009. After an initial rapid decrease in reduction of antibiotic use in farm animals (56% in 2013) there is a levelling in 2014 with 58% (MARAN, 2015). A 70% reduction will require additional fundamental changes in the behaviour of veterinarians and farmers towards the usage of antibiotics in farm animals (Speksnijder et al., 2015b). Tailored interventions directed to veterinarians to change antibiotic prescribing behaviour of veterinarians might be effective as they are key persons in reducing antibiotic use in farm animals (Prescott, 2008, Morley et al., 2005). However, only little is known about attitudes and other influences that might influence prescribing behaviour of veterinarians.

In human medicine, prescribing decisions of physicians are influenced by clinical reasoning as well as non-clinical factors which are related to personal characteristics (e.g., years in practice, extent of medical knowledge, attitudes, relationship with patients) (Akkerman et al., 2005). Knowledge of these prescribing determinants and categorization of health care providers into different target groups is extensively used for the purpose of sustainable implementation of tailored antibiotic stewardship programs and interventions (Hulscher et al., 2010a, Hulscher et al., 2010b, Kumar et al., 2003, Walker et al., 2001, Vander Stichele et al., 1996, Simpson et al., 2007).

Earlier qualitative research amongst Dutch farm animal veterinarians identified a broad variety of opinions regarding veterinary antibiotic use and ways to promote prudent use as well as determinants that influenced their prescribing behaviour (Speksnijder et al., 2015a). Further exploration of attitudes of farm animal veterinarians and their interaction with farmers in promoting animal health and subsequent categorization of farm animal veterinarians in different groups might support targeting interventions to promote prudent use of antibiotics more precisely. The purpose of this study was to explore differences in attitudes towards the use of antibiotics and reduction opportunities in farm animals and the interaction of veterinarians with farmers in improving animal health and reducing antibiotic use between categories of veterinarians.

Section snippets

Instrument

Based on our earlier qualitative research (Speksnijder et al., 2015a) a questionnaire was designed. Questions consisted of general descriptives, 5-point Likert scale statements (1 = completely disagree; 2 = disagree; 3 = neutral; 4 = agree; 5 = completely agree), ranking questions (ranking of items on importance) and open questions assessing attitudes, knowledge and self-reported behaviour of veterinarians regarding antibiotic use and reduction opportunities in farm animals, their interactions with

General descriptives

We received 437 questionnaires of which 377 were complete (response rate of 40% (34% complete) based on the estimated number of registered veterinarians working in farm animals). The respondents were on average 15.8 (range 1–41) years in practice and 90.2% of the respondents had received their veterinary training at Utrecht University, the Netherlands. Of the respondents, 62.9% were (co) owner of a practice while the others were working on payroll. Practice owners had on average 20.6 years of

Discussion

This study offers insights in different attitudes of different categories of farm animal veterinarians in the Netherlands towards antibiotic use and antimicrobial resistance in farm animals and their interaction with farmers herein.

Acknowledgement

This study was funded by ZonMW (Netherlands Organization for Health Research and Development), project no. 205100009.

All respondents are kindly acknowledged for their participation in this study.

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