Opportunities and challenges to improving antibiotic prescribing practices through a One Health approach: results of a comparative survey of doctors, dentists and veterinarians in Australia

Annie Zhuo; Maurizio Labbate; Jacqueline M Norris; Gwendolyn L Gilbert; Michael P Ward; Beata V Bajorek; Chris Degeling; Samantha J Rowbotham; Angus Dawson; Ky-Anh Nguyen; Grant A Hill-Cawthorne; Tania C Sorrell; Merran Govendir; Alison M Kesson; Jonathan R Iredell; Dale Dominey-Howes

doi:10.1136/bmjopen-2017-020439

Opportunities and challenges to improving antibiotic prescribing practices through a One Health approach: results of a comparative survey of doctors, dentists and veterinarians in Australia

BMJ Open. 2018 Mar 30;8(3):e020439. doi: 10.1136/bmjopen-2017-020439.

Authors

Annie Zhuo¹, Maurizio Labbate^#^{2

3}, Jacqueline M Norris^{4

5}, Gwendolyn L Gilbert⁵, Michael P Ward^{4

5}, Beata V Bajorek⁶, Chris Degeling⁷, Samantha J Rowbotham^{8

9}, Angus Dawson¹⁰, Ky-Anh Nguyen^{11

12}, Grant A Hill-Cawthorne^{5

13}, Tania C Sorrell^{5

14}, Merran Govendir⁴, Alison M Kesson^{5

15

16}, Jonathan R Iredell^{5

14

17}, Dale Dominey-Howes^#^{1

5}

Affiliations

¹ School of Geosciences, The University of Sydney, Sydney, NSW, Australia.
² School of Life Sciences, University of Technology Sydney, Sydney, New South Wales, Australia.
³ The ithree Institute, University of Technology Sydney, Sydney, New South Wales, Australia.
⁴ Sydney School of Veterinary Science, University of Sydney, Sydney, New South Wales, Australia.
⁵ Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Sydney, New South Wales, Australia.
⁶ Graduate School of Health, University of Technology Sydney, Sydney, New South Wales, Australia.
⁷ Faculty of Social Science, University of Wollongong, Wollongong, NSW, Australia.
⁸ Menzies Centre for Health Policy, Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia.
⁹ The Australian Prevention Partnership Centre, The Sax Institute, Sydney, New South Wales, Australia.
¹⁰ Sydney Health Ethics, University of Sydney, Sydney, New South Wales, Australia.
¹¹ Faculty of Dentistry, University of Sydney, Sydney, New South Wales, Australia.
¹² Institute of Dental Research, Westmead Centre for Oral Health, Sydney, New South Wales, Australia.
¹³ Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia.
¹⁴ Westmead Institute for Medical Research, Sydney, New South Wales, Australia.
¹⁵ Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.
¹⁶ Infectious Disease and Microbiology, The Children's Hospital at Westmead, Sydney, NSW, Australia.
¹⁷ Westmead Hospital, Sydney, New South Wales, Australia.

^# Contributed equally.

Abstract

Objectives: To explore and compare the knowledge, attitudes and experiences of doctors, dentists and veterinarians (as prescribers) in relation to antibiotic use and antibiotic resistance (AbR), and to consider the implications of these for policy-making that support a One Health approach.

Design: A cross-sectional survey conducted online.

Setting: Doctors, dentists and veterinarians practising in primary, secondary or tertiary care in Australia.

Participants: 547 doctors, 380 dentists and 403 veterinarians completed the survey.

Main outcome measures: Prescribers' knowledge, attitudes and perceptions of AbR, the extent to which a range of factors are perceived as barriers to appropriate prescribing practices, and perceived helpfulness of potential strategies to improve antibiotic prescribing in practice.

Results: There was substantial agreement across prescriber groups that action on AbR is required by multiple sectors and stakeholders. However, prescribers externalised responsibility to some extent by seeing the roles of others as more important than their own in relation to AbR. There were common and context-specific barriers to optimal prescribing across the prescriber groups. Prescriber groups generally perceived restrictive policies as unhelpful to supporting appropriate prescribing in their practice.

Conclusions: The results have implications for implementing a One Health approach that involves doctors, dentists and veterinarians as key players to tackling the crisis of AbR. The findings are that (1) prescribers understand and are likely receptive to a One Health policy approach to AbR, (2) policy development should be sensitive to barriers that are specific to individual prescriber groups and (3) the development and introduction of interventions that might be perceived as reducing prescriber autonomy will need to be carefully designed and implemented.

Keywords: antibiotic resistance; health policy; microbiology.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Anti-Bacterial Agents* / therapeutic use
Australia
Cross-Sectional Studies
Dentists*
Female
Humans
Male
Middle Aged
One Health*
Physicians*
Practice Patterns, Physicians'*
Surveys and Questionnaires
Veterinarians*

Substances

Anti-Bacterial Agents