. 2024 Feb 16;14(4):626.

doi: 10.3390/ani14040626.

An Evaluation of the Impact of an OPEN Stewardship Generated Feedback Intervention on Antibiotic Prescribing among Primary Care Veterinarians in Canada and Israel

Kamal R Acharya¹, Adar Cohen², Gabrielle Brankston¹, Jean-Paul R Soucy³, Anette Hulth⁴, Sonja Löfmark⁴, John S Brownstein^{5

6}, Nadav Davidovich⁷, Moriah E Ellen^{8

9

10}, David N Fisman³, Jacob Moran-Gilad⁷, Amir Steinman², Derek R MacFadden¹¹, Amy L Greer¹

Affiliations

¹ Department of Population Medicine, University of Guelph, Guelph, ON N1G 2W1, Canada.
² Koret School of Veterinary Medicine, The Robert H. Smith Faculty of Agriculture, Food and Environment, The Hebrew University of Jerusalem, Rehovot 7610001, Israel.
³ Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada.
⁴ Public Health Agency of Sweden, 171 82 Stockholm, Sweden.
⁵ Computational Epidemiology Lab, Boston Children's Hospital, Boston, MA 02115, USA.
⁶ Harvard Medical School, Harvard University, Boston, MA 02115, USA.
⁷ School of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva 84105, Israel.
⁸ Department of Health Policy and Management, Guilford Glazer Faculty of Business and Management, Ben-Gurion University of the Negev, Beer Sheva 84105, Israel.
⁹ Department of Health Policy and Management, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva 84105, Israel.
¹⁰ Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON M5T 3M6, Canada.
¹¹ Ottawa Hospital Research Institute, Ottawa, ON K1Y 4E9, Canada.

PMID: 38396594
PMCID: PMC10885889
DOI: 10.3390/ani14040626

An Evaluation of the Impact of an OPEN Stewardship Generated Feedback Intervention on Antibiotic Prescribing among Primary Care Veterinarians in Canada and Israel

Kamal R Acharya et al. Animals (Basel). 2024.

. 2024 Feb 16;14(4):626.

doi: 10.3390/ani14040626.

Authors

Affiliations

¹ Department of Population Medicine, University of Guelph, Guelph, ON N1G 2W1, Canada.
² Koret School of Veterinary Medicine, The Robert H. Smith Faculty of Agriculture, Food and Environment, The Hebrew University of Jerusalem, Rehovot 7610001, Israel.
³ Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada.
⁴ Public Health Agency of Sweden, 171 82 Stockholm, Sweden.
⁵ Computational Epidemiology Lab, Boston Children's Hospital, Boston, MA 02115, USA.
⁶ Harvard Medical School, Harvard University, Boston, MA 02115, USA.
⁷ School of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva 84105, Israel.
⁸ Department of Health Policy and Management, Guilford Glazer Faculty of Business and Management, Ben-Gurion University of the Negev, Beer Sheva 84105, Israel.
⁹ Department of Health Policy and Management, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva 84105, Israel.
¹⁰ Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON M5T 3M6, Canada.
¹¹ Ottawa Hospital Research Institute, Ottawa, ON K1Y 4E9, Canada.

PMID: 38396594
PMCID: PMC10885889
DOI: 10.3390/ani14040626

Abstract

An interrupted time-series study design was implemented to evaluate the impact of antibiotic stewardship interventions on antibiotic prescribing among veterinarians. A total of 41 veterinarians were enrolled in Canada and Israel and their prescribing data between 2019 and 2021 were obtained. As an intervention, veterinarians periodically received three feedback reports comprising feedback on the participants' antibiotic prescribing and prescribing guidelines. A change in the level and trend of antibiotic prescribing after the administration of the intervention was compared using a multi-level generalized linear mixed-effect negative-binomial model. After the receipt of the first (incidence rate ratios [IRR] = 0.88; 95% confidence interval (CI): 0.79, 0.98), and second (IRR = 0.85; 95% CI: 0.75, 0.97) feedback reports, there was a reduced prescribing rate of total antibiotic when other parameters were held constant. This decline was more pronounced among Israeli veterinarians compared to Canadian veterinarians. When other parameters were held constant, the prescribing of critical antibiotics by Canadian veterinarians decreased by a factor of 0.39 compared to that of Israeli veterinarians. Evidently, antibiotic stewardship interventions can improve antibiotic prescribing in a veterinary setting. The strategy to sustain the effect of feedback reports and the determinants of differences between the two cohorts should be further explored.

Keywords: antibiotic prescribing; antibiotic stewardship; interrupted time series analysis; veterinarian.

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Conflict of interest statement

The authors declare no conflicts of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results.

Figures

**Figure 1**
Monthly mean number of antibiotics prescribed per 100 visits by the participating veterinarians in Canada, Israel and both study sites. Solid line represents total antimicrobials prescribing, dashed line represents critical antimicrobials prescribing, and dotted line represent narrow-spectrum antimicrobials prescribing. Dashed and dotted vertical reference lines represent the months in which interventions were administered for the first time to the study participants in Canada and Israel.

**Figure 2**
Number of total antibiotic prescriptions per month per 100 visits by the participating veterinarians before (red dots) and after (blue dots) the first feedback report. The solid black line represents the monthly mean number of total antimicrobials prescribed.

**Figure 3**
Number of total antibiotic prescriptions per month per 100 visits by the participating veterinarians before (red dots) and after (blue dots) the second feedback report. The solid black line represents the monthly mean number of total antimicrobials prescribed.

**Figure 4**
Number of total antibiotic prescriptions per month per 100 visits by the participating veterinarians before (red dots) and after (blue dots) the third feedback report. The solid black line represents the monthly mean number of total antimicrobials prescribed.

**Figure 5**
Number of critical antibiotic prescriptions per month per 100 visits by the participating veterinarians before (red dots) and after (blue dots) the first feedback report. The solid black line represents the monthly mean number of critical antimicrobials prescribed.

**Figure 6**
Number of critical antibiotic prescriptions per month per 100 visits by the participating veterinarians before (red dots) and after (blue dots) the second feedback report. The solid black line represents the monthly mean number of critical antimicrobials prescribed.

**Figure 7**
Number of critical antibiotic prescriptions per month per 100 visits by the participating veterinarians before (red sots) and after (blue dots) the third feedback report. The solid black line represents the monthly mean number of critical antimicrobials prescribed.

**Figure 8**
Mean monthly percentage of narrow-spectrum antibiotics (solid line) and broad-spectrum antibiotics (dashed line) prescribed by the participating veterinarians before and after the third feedback report on August 2021 (grey vertical dashed line). The horizontal grey dashed line represents 50% of antimicrobial prescribing. The dotted line represents the total antimicrobial prescriptions per 100 visits during the time period.

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An Evaluation of the Impact of an OPEN Stewardship Generated Feedback Intervention on Antibiotic Prescribing among Primary Care Veterinarians in Canada and Israel

Affiliations

An Evaluation of the Impact of an OPEN Stewardship Generated Feedback Intervention on Antibiotic Prescribing among Primary Care Veterinarians in Canada and Israel

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

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