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Production animal practice – case study

Jenny Bellini, Eleanor Price and Andrea Turner discuss the whole team approach to changing antibiotic prescribing, through 2 interview questions.
So our campaign to change our prescribing started probably in 2015. I joined as a vet in 2014, having graduated from the University of Bristol and was taught by the guys behind the AMR force, so Kristen Reyher and David Barrett, David Tisdall. When I joined the practice, prescribing was, I guess, in line with prescribing across the rest of the country at the time, so high priority CIAs were used routinely on farms. And that kind of went against what we’d been taught at uni. So we had a discussion with the whole team and decided that we wanted to try and do something more responsible and change our prescribing. I was also a Bristol graduate of 2015.
So I joined Friars Moor a year after Jenny, by which point the antimicrobial campaign was well underway at Friars Moor. So I kind of joined a team who was already thinking about it. It was the early stages, but I think I’d also been educated by the same team of people at Bristol and sort of joined feeling quite strongly about it, that we wanted to do something. But I was lucky to join a group of people who were already partway through the process, which probably, for me as an individual, made it slightly easier, but hopefully also helped the team because I had some sort of recent impetus from my education. Well, my name’s Andrea Turner.
I’m a clinician here at the Langford Farm Animal Practice, which is associated with the University of Bristol. I completed a residency here, four years, working towards the European College Bovine Health Management diploma. As part of that, I did some research and wrote a paper that was following the changes in the antimicrobial use within the practice, moving towards more responsible use and following the health and welfare implications that had on our dairy farms. And so that was following some changes that had already been happening within the practice that were set up starting in 2009, 2010 by my colleague David Tisdall. And so from then on, there was a lot of education and changes within the practice prescribing policies.
And so that led me to change my own, or just follow the practice prescribing policies when I was working here as a resident.
So I guess our main challenge initially was, are we going to get the whole team on board? And that was quickly realised that we did, and everyone in the practice was really behind what we wanted to do. You know, right through to the older vets, to the support team. And then we were concerned about how the farmers would feel, how they would feel about the advice changing and us changing things that worked well on their farm at the minute. I think that was a big worry for us all at the practice. I think it can be frustrating for farmers because we try and practice evidence-based medicine, and evidence and research changes.
And I think that can be hard for farmers to sort of grasp. They get the hang of one idea, and then we slightly change the angle that we’re coming from. And I think that can be frustrating for them, although I think they understand quickly. I think it can be frustrating that advice changes frequently, and some of the new advice was contrary to some of the old advice. And I think it was very well taken on board by the farmers, but I don’t think it was easy. Another barrier, I think, that we face as a practice, particulary from directors was finances.
So were we going to make up the loss of income if we started changing the antibiotics we sell or reducing the antibiotics we sell? But we’ve got some data that proves that, in fact, we didn’t need to worry about that, and it is a forward-thinking idea, I think, to leave what was in the past behind and think of new ways to make our income as veterinary surgeons. I think there was also an element of social pressure. I think from the vet’s perspective, social pressure was a positive one. We were moving in the right direction.
And I think there was a lot of positive social pressure from the veterinary world, but for the farmers, because we were quite an early adopting practice, I think those farmers who have friends elsewhere, et cetera– I think there was sometimes a question of, well, why us? My friends still undertake the practises they were historically undertaking. But we’re very lucky that they ran with it. And I think they’re very proud, now, that they were early adopters. Initially, I think there were some barriers just with understanding of what was trying to be achieved, both from the farmer and client perspective, and also from people working within the practice, both vets and administration staff.
So in order to tackle that, it was a big push on education and explaining why certain antibiotics were critically important for human health and why we were trying to change our prescribing practice, and educating farmers just into how to use antibiotics responsibly themselves, because we obviously don’t always prescribe directly on farm to certain animals if we’re dispensing from the practice. So educating farmers to know why we were doing what we were doing, and also empower them to make changes themselves on the farm with their own prescribing was really important to our practice.
And with regards to empowering people and making changes within the practice, again, education and lots of communication within the practice and the practice team as a whole, so not just having vets on board with the idea of changing how we’re prescribing, but also having the farm admin team on board with what we’re doing and why we’re doing it. Because ultimately, they’re really client-facing, so when people come in to pick up certain drugs or asking for certain antibiotics, they’re often the front face of the practice, having to explain why we’re not prescribing certain drugs anymore. And so having them on board, having them confident to explain what we were doing was actually really important to the practice.
As well as that, some of the things that might lead vets to prescribe certain drugs on farm might be the idea of defensive prescribing and trying to cover your back, as it were, for certain situations. And some vets might be more inclined to do that than others. And some farmers might be more inclined to do that than others.
And so actually going onto farms, and looking at what they were using, and setting farms up with protocols, for treatment protocols for certain situations, certain diseases, that meant that the onus was taken off the farmer or off the individual vet as to how they were going to prescribe in a certain situation and back onto the practice team decisions as to, this is going to be the first-line treatment for, for example, calf pneumonia, second-line treatment. And under these circumstances, these certain classes of drugs will be prescribed. So that was very helpful, I think, to both farmers and vets. And then, of course, ongoing, we also have challenges with different vets coming into the practice.
So we’ve had staff turnover, obviously, over the last few years. And so certain vets turn up with their own way of prescribing, and so just ongoing training, open communication, and where necessary, certain vets having one-on-one communication with other vets that have been in the practice for longer to give them confidence and just outline how we prescribe in a more responsible way, how that we might hope or expect certain vets coming into the practice to change their prescribing practice. And that’s now helped by the fact that over time, the farmers, the clients have reduced their expectation for certain high priority critically important antimicrobials to be prescribed to them.
So all in all, a multipronged approach with farmers, admin staff, and vets is basically the bottom line.

In the video above, Jenny Bellini and Eleanor Price from Friars Moor Livestock Vets and Andrea Turner, from Langford Farm Animal Practice, describe the whole team approach to changing antibiotic prescribing.

They were asked:

  1. What led you to change your prescribing practice?

  2. What barriers did you come across when trying to change prescribing?

Watch the video to see their answers and then use the comments section below to share your thoughts on these two questions.

Which of the challenges mentioned in this and the previous step have you experienced in your practice and how have they changed since you began practicing?

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Antimicrobial Stewardship in Veterinary Practice

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