Shared Decision-Making in Veterinary Clinics: A Cross-Sectional Study Examining Effects on Appropriate Antibiotic Prescribing and Value-Driven Factors Influencing It

TL;DR

This study explores how shared decision-making with pet owners affects appropriate antibiotic use in veterinary clinics, finding that it can reduce unnecessary prescriptions.

Contribution

The study is the first to examine shared decision-making's impact on antibiotic prescribing in veterinary care, using a value-driven framework.

Findings

Engaging pet owners in shared decision-making was linked to more appropriate antibiotic prescribing for periodontal disease in pets.

Veterinarians with higher alignment of AMR-related values were more likely to engage in shared decision-making.

Antibiotics were most often inappropriately prescribed for ear infections and periodontal disease in cats and dogs.

Abstract

Background: Shared decision-making (SDM) can improve appropriate antibiotic prescribing in human primary care clinics, but little is known about it in the veterinary setting. This study examines the association between SDM and antibiotic prescribing for cats and dogs in veterinary clinics, then determines the key factors influencing SDM through a value-driven approach. Methods: This cross-sectional study surveyed 41 veterinarians practicing in Singapore veterinary clinics. Appropriate antibiotic prescribing was defined as concordance with local antibiotic guidelines for companion animals, while an adapted SDM-Q-9-Doc scale measured SDM on antibiotic prescribing with pet owners. Questions were developed to measure constructs of the VALUE model and factor analysis was conducted to identify latent factors. Multivariable logistic and linear regressions were performed to assess the association between SDM and antibiotic prescribing, and determinants of SDM, respectively. Results: Antibiotics were most inappropriately prescribed for cats/dogs with ear infections (cocci observed) (63%), and periodontal disease (59%). Engaging owners in SDM (AOR 1.31; 95% CI 1.05, 1.62; p = 0.014) was positively associated with appropriate antibiotic prescribing for cats/dogs with periodontal disease. After adjusting for age, gender, clinic role and practice type, veterinarians with a higher overall VALUE score (β = 0.14; 95% CI 0.02, 0.26; p = 0.021) were more likely to engage in SDM with owners on antibiotic prescribing. Conclusions: SDM with pet owners improves appropriate antibiotic prescribing for cats and dogs, though effects vary by clinical scenario. Aligning AMR-related values between veterinary clinics and veterinarians to enable effective communication with pet owners can promote SDM and subsequently drive appropriate antibiotic prescribing for pet cats and dogs.

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