Veterinary field expertise: using knowledge gained on the job

Exploring veterinarians' behaviour relating to antibiotic use stewardship on Irish dairy farms using the COM-B model of behaviour change

Employing a theoretical model of human behaviour (COMB), the current study explores the factors influencing veterinarians' engagement with antibiotic use stewardship on Irish dairy farms. One-to-one semi structured interviews were carried out by telephone with 12 veterinarians whose daily work focused on dairy cattle. A thematic analysis approach was undertaken. The identified themes and sub-themes were then mapped to the COM-B model. This study identified challenges faced by veterinarians when trying to prescribe responsibly which included lack of training to encourage farmer behaviour change, issues with laboratory testing, pressures from farmers to prescribe antimicrobials, concern for animal welfare and farmers going elsewhere for prescriptions. Having a good knowledge of AMR, peers as an advice source, potential financial benefits for farmers as a result of reduced antimicrobial costs and accepting a shared responsibility for AMR, facilitate veterinarians in their role as antimicrobial stewards. The barriers and facilitators identified as influencing veterinarians' capability, opportunity and motivation to responsibly prescribe antimicrobials formed the basis for a number of practical recommendations which should be considered by advisory and policy making teams. Recommendations include; continuous training for veterinarians on AMR and alternatives to overcome the barriers faced when trying to promote reduced AMU, veterinarian peer support groups to improve confidence in their knowledge and decision making to minimise the effect of client pressures/expectations, setting up collaborative farmer and veterinarian working groups to promote a transparent working relationship and the development of affordable and efficient diagnostic and susceptibility testing.

Danish cattle veterinarians' perspectives on antimicrobial use: Contextual and individual influencing factors

The global risk for antimicrobial resistance (AMR) can be reduced by reducing antimicrobial use (AMU). Veterinarians are one of the key actors in relation to AMU in livestock, and understanding the dynamics of veterinary treatment and prescription is central to achieving AMU reduction. Veterinary AMU decisions are influenced by a complex pattern of both individual and contextual factors. In this study, we conducted semi-structured interviews with 16 Danish cattle veterinarians to investigate their perspectives on AMU and current practices in a national context with low use and extensive legal control. We found that personal experiences and emotions, rather than scientific evidence, guided some veterinarians when making AMU choices. Furthermore, less-experienced veterinarians felt pressure to prescribe according to colleagues' and farmers' preferences for certain antimicrobials. We found that changes in Danish legislation seemed to have introduced hesitancy and a lack of motivation within the veterinary profession, and that AMR was perceived as an abstract threat not applicable to the veterinarians' daily professional decision making. We concluded that the lack of field-generated research of local relevance nourished a culture in which AMU choices are built on personal experience rather than scientific evidence, which also diminished newly educated veterinarians' self-confidence in relation to their AMU choices. Future research should focus on developing locally relevant research on optimal AMU choices and AMR, and the implications of extensive legal control of AMU in livestock farming should be further investigated to find a balance on the path to reducing AMU.

Exploring farmers' understanding of and responses to endemic animal health and welfare issues in the UK

BACKGROUND

This paper uses two endemic health conditions to explore farmer understandings of and responses to livestock health and welfare issues.

METHODS

The findings are based on a survey of 42 livestock farmers in the north of England, exploring how they manage lameness in sheep and cattle and bovine viral diarrhoea in cattle. We identify similarities and differences in their approaches.

RESULTS

Two themes emerge. (1) The importance of difference between animal types (i.e., beef cattle, dairy cattle and sheep), which highlights the 'complex' and 'multifactorial' nature of animal health and welfare. It is necessary to unpack this to understand the interplay of animal, resource and management issues in farmer responses. (2) Previous research has identified 'lack of knowledge' as a key welfare issue. Our findings reveal farmers are in fact seeking, acquiring and sharing knowledge on practices related to the management of animal health however individual circumstance and context influence how this translates in practice.

CONCLUSION

Our research highlights the importance of integrating different perspectives and knowledges as a way of understanding and responding to animal health and welfare concerns. Facilitating knowledge exchange both within and between different groups and sectors is vital in achieving this.

Confidence of veterinary surgeons in the United Kingdom in treating and diagnosing exotic pet species

BACKGROUND

With exotic pet species commonplace in the UK, owners are increasingly seeking veterinary advice regarding the health and welfare of their small mammals and reptiles. This study aimed to assess the confidence of veterinarians in the UK in treating and diagnosing rabbits, guinea pigs, small mammals and reptiles.

METHODS

A 41-question survey was promoted via social media, including on interest groups focused specifically at veterinary professionals. A total of 131 practising veterinarians in the UK completed the questionnaire.

RESULTS

Frequency of presentation of exotic pets to a practice had a significant effect (P<0.01) on the confidence of veterinarians in treating them. Veterinarians who were presented with exotics more frequently had increased self-reported knowledge of their health and disease and were more confident in treating, diagnosing and anaesthetising them. Knowledge of and confidence in diagnosing and treating exotic pets were significantly less than for dogs and cats (P<0.001). There was a significant effect of length of time qualified on confidence in treating exotic pet species (P<0.01).

CONCLUSIONS

Increased provision and engagement with continuing professional development may increase veterinary confidence in diagnosing, treating and anaesthetising exotic pet species that are less commonly encountered in practice.

Veterinary peer study groups as a method of continuous education-A new approach to identify and address factors associated with antimicrobial prescribing

Within the dairy industry, most antimicrobials are used for dry-cow therapy or mastitis treatment. To reduce antimicrobial usage in dairy cows, increasing awareness and behaviour change is necessary. As veterinarians are known to be influenced by their peers, peer study groups as a continuous education might contribute to this. Therefore, the objective of this study was to analyse written records of veterinary peer study group meetings to identify factors associated with antimicrobial prescribing decisions, and to analyse veterinarians' attitude towards the benefits of this continuous education method. Twenty-three participating Swiss cattle practitioners were divided into three groups. Each group met every two to five months, together with a facilitator and an expert on the topic to be discussed. Written records from every meeting were taken and analysed qualitatively to identify factors influencing veterinarians' decisions on antimicrobial prescribing and mastitis therapy. In addition, focus group discussions were conducted after the last meeting, to assess the veterinarians' learning achievements gained during the peer study group meetings. Extrinsic factors such as external pressure, competition, farmer, individual animal, farm and diagnostics as well as intrinsic factors such as own experience/attitude, knowledge and change of mindset during career could be shown to influence veterinarians' decisions on antimicrobial prescribing. In the focus group discussions, the veterinarians stated that they gained new knowledge, received new stimuli, exchanged with their peers and felt supported in their relationship to their farmers. Since the identified factors are partly interrelated, it is not sufficient to change a single factor to achieve a change in the antimicrobial prescription behaviour of veterinarians. Veterinary peer study groups could contribute to the intention to change, because veterinarians experienced multiple benefits from this method of continuous education. In order to quantify this, the prescription data of the veterinarians are analysed in a next step.

Motivating factors and perceived barriers to participating in continuing professional development: a national survey of veterinary surgeons

Although continuing professional development (CPD) is regarded as mandatory by the Royal College of Veterinary Surgeons, it is not yet a statutory requirement. To understand what motivates veterinary surgeons to engage in CPD and perceived barriers to participation, a national survey was administered to a sample of the profession. The study sought to report overall opinion and to compare the views of different groups in terms of decade of graduation, gender, employment status, area of employment and position in the workplace. The results of the study are encouraging in that recent graduates would like to engage in more CPD, compared with their predecessors, and are the most intrinsically and extrinsically motivated. However, significant barriers to participation exist, including personal barriers, a lack of workplace support and a lack of CPD activities at a suitable time, location or level. Part-time workers reported higher barriers than full-time workers. Although the majority (90 per cent) of respondents receive all or part of their CPD funding from employers, a significant proportion (41 per cent) are required to fund at least part of their CPD. First-opinion practitioners reported significantly less access to a professional library, which has implications for lifelong learning and the practice of evidence-based veterinary medicine.

How does reviewing the evidence change veterinary surgeons' beliefs regarding the treatment of ovine footrot? A quantitative and qualitative study

Footrot is a widespread, infectious cause of lameness in sheep, with major economic and welfare costs. The aims of this research were: (i) to quantify how veterinary surgeons' beliefs regarding the efficacy of two treatments for footrot changed following a review of the evidence (ii) to obtain a consensus opinion following group discussions (iii) to capture complementary qualitative data to place their beliefs within a broader clinical context. Grounded in a Bayesian statistical framework, probabilistic elicitation (roulette method) was used to quantify the beliefs of eleven veterinary surgeons during two one-day workshops. There was considerable heterogeneity in veterinary surgeons' beliefs before they listened to a review of the evidence. After hearing the evidence, seven participants quantifiably changed their beliefs. In particular, two participants who initially believed that foot trimming with topical oxytetracycline was the better treatment, changed to entirely favour systemic and topical oxytetracycline instead. The results suggest that a substantial amount of the variation in beliefs related to differences in veterinary surgeons' knowledge of the evidence. Although considerable differences in opinion still remained after the evidence review, with several participants having non-overlapping 95% credible intervals, both groups did achieve a consensus opinion. Two key findings from the qualitative data were: (i) veterinary surgeons believed that farmers are unlikely to actively seek advice on lameness, suggesting a proactive veterinary approach is required (ii) more attention could be given to improving the way in which veterinary advice is delivered to farmers. In summary this study has: (i) demonstrated a practical method for probabilistically quantifying how veterinary surgeons' beliefs change (ii) revealed that the evidence that currently exists is capable of changing veterinary opinion (iii) suggested that improved transfer of research knowledge into veterinary practice is needed (iv) identified some potential obstacles to the implementation of veterinary advice by farmers.

Determinants of biosecurity behaviour of British cattle and sheep farmers-a behavioural economics analysis

The paper analyses the impact of a priori determinants of biosecurity behaviour of farmers in Great Britain. We use a dataset collected through a stratified telephone survey of 900 cattle and sheep farmers in Great Britain (400 in England and a further 250 in Wales and Scotland respectively) which took place between 25 March 2010 and 18 June 2010. The survey was stratified by farm type, farm size and region. To test the influence of a priori determinants on biosecurity behaviour we used a behavioural economics method, structural equation modelling (SEM) with observed and latent variables. SEM is a statistical technique for testing and estimating causal relationships amongst variables, some of which may be latent using a combination of statistical data and qualitative causal assumptions. Thirteen latent variables were identified and extracted, expressing the behaviour and the underlying determining factors. The variables were: experience, economic factors, organic certification of farm, membership in a cattle/sheep health scheme, perceived usefulness of biosecurity information sources, knowledge about biosecurity measures, perceived importance of specific biosecurity strategies, perceived effect (on farm business in the past five years) of welfare/health regulation, perceived effect of severe outbreaks of animal diseases, attitudes towards livestock biosecurity, attitudes towards animal welfare, influence on decision to apply biosecurity measures and biosecurity behaviour. The SEM model applied on the Great Britain sample has an adequate fit according to the measures of absolute, incremental and parsimonious fit. The results suggest that farmers' perceived importance of specific biosecurity strategies, organic certification of farm, knowledge about biosecurity measures, attitudes towards animal welfare, perceived usefulness of biosecurity information sources, perceived effect on business during the past five years of severe outbreaks of animal diseases, membership in a cattle/sheep health scheme, attitudes towards livestock biosecurity, influence on decision to apply biosecurity measures, experience and economic factors are significantly influencing behaviour (overall explaining 64% of the variance in behaviour). Three other models were run for the individual regions (England, Scotland and Wales). A smaller number of variables were included in each model to account for the smaller sample sizes. Results show lower but still high levels of variance explained for the individual models (about 40% for each country). The individual models' results are consistent with those of the total sample model. The results might suggest that ways to achieve behavioural change could include ensuring increased access of farmers to biosecurity information and advice sources.