Do clients really want antibiotics, or do we just think they do?
Veterinarians often feel the pressure of owner expectation to prescribe medications. This, coupled with diagnostic uncertainty about what is actually wrong with those animals that ‘aren’t quite right’ can result in inappropriate prescriptions of antimicrobials.
There is no doubt that the pressure is felt by vets, but the question is; is the pressure real or perceived? An Australian study of veterinary clients explored the opinions of pet owners and their expectations and preferences about consultations and antimicrobials, along with their level of understanding about the risks of antimicrobial use. The results might surprise you!
Importantly, in this survey of 558 dog and cat owners, veterinarians were viewed as trusted experts. Participants saw value in veterinary consultations, even if they didn’t receive medications. The main priority of owners was noted to be resolution of their pet’s problem using the most effective treatment, this over-riding any desire for a cheap and convenient solution. Most (83%) were happy about treatment decisions, whether or not antibiotics were prescribed. Approximately 25% of participants were surprised/annoyed when they didn’t receive antibiotics for their pet, with 15% of these specifically requesting them. About a quarter reported they would be annoyed if their animal wasn’t cured after the first visit.
Most owners understood that antibiotics should not be used for all infections, and particularly are not indicated for viral infections. A minority understood that bacteria can transfer from animal to human and vice versa, and there was little comprehension that giving antibiotics to their pets can have adverse effects on them and other animals in the household.
A larger body of research exists in human medicine focusing on the interface between medical practitioners and patients and antimicrobial use. Interestingly (and unsurprisingly), studies show that GPs also feel pressure to prescribe from patients, in many cases for reasons similar to those reported by veterinarians. Research looking at patient understanding of AMR is highly likely to be representative of that of veterinary clients, providing additional insights to assist our discussions with clients about antimicrobial use.
In a qualitative study of Australian patients exploring their understanding of AMR, the majority of participants had poor understanding of the development of AMR. Most thought that they/their body became resistant to the antibiotic. Antimicrobial resistance was seen by many as a hypothetical possibility. Patients didn’t think it was likely to affect them personally, seeing it more likely to be a future problem. There was an accompanying perception that ‘science will find an answer’.
There was poor understanding of the likelihood of spread of resistant strains between family members. Some respondents were shocked to find that this was a possibility. This is similar to findings of the veterinary study where there was poor understanding of the potential for transfer of bacteria between animals and people. It seems highly likely that pet owners would additionally be unaware of the possibility of spread of resistant bacterial strains between pets and human household members (and vice versa).
Antibiotics were perceived as beneficial as participants thought they will make you better more quickly and reduce the severity of infections. However, some were reluctant to take antibiotics for minor infections, preferring to reduce overuse and only take them in the presence of severe infections. Participants had varying perceptions of possible harm from antimicrobials, some referring to gastrointestinal side-effects and thrush, others being unaware of any possibility of harm. Some were concerned about the possibility of AMR; however, this was accompanied by a poor understanding of what AMR actually is. In a similar finding to the veterinary study, trust in the clinician increased satisfaction with the decision to or to not prescribe antimicrobials.
So, how does this help us speak to clients about antimicrobial use?
Both the veterinary and human health study concluded clear communication of the benefits and harms of antimicrobial use was necessary. Messaging focused on the health of the pet, including the direct risks of antibiotics, within the context of the personal experience and opinion of the veterinarian were preferred by veterinary clients. Owners with higher levels of education also appreciated evidence-based information. In contrast to human patients, veterinary clients in this study appeared less convinced by a discussion of the public health impacts of antimicrobial use on the broader community.
While some clients had clear expectations of receiving antimicrobials, this study shows we shouldn’t think they are in the majority. Therefore, an explanation of the recommended treatment, why or why not antibiotics are indicated, and an expressed desire to recheck the animal if it is not improving will be the preferred option for many clients. While this can take time in a busy schedule, raising awareness and understanding of the mechanisms leading to AMR and the potential for transfer of resistant organisms from animals to humans may assist in changing client expectations.
The AMR Vet Collective has a number of simple client-facing resources that can be used to help raise awareness.