A Framework for Assessing Antimicrobial Stewardship Implementation in Small Animal Clinics

Thesis Abstract

The inappropriate and excessive use of antimicrobials in small animal clinics has contributed significantly to the global rise of antimicrobial resistance, necessitating the development of robust assessment frameworks to monitor and enhance antimicrobial stewardship (AMS) practices. This study aims to develop and validate a comprehensive framework for assessing the implementation of antimicrobial stewardship in small animal clinical settings, with specific objectives to identify key indicators of AMS, examine factors influencing stewardship practices, and propose a practical assessment model adaptable across diverse clinic contexts. Employing a mixed-methods research design, the study integrates qualitative exploratory phases with quantitative validation. The qualitative component involves semi-structured interviews and focus group discussions with 30 veterinary practitioners, clinic managers, and microbiologists across ten small animal clinics, guided by the Structuration Theory to explore perceptions, attitudes, and organizational factors influencing AMS implementation. The quantitative phase samples 200 veterinary clinics selected through stratified random sampling from a national veterinary association registry, utilizing a structured survey instrument developed based on the initial qualitative findings. The survey's psychometric properties are established through validity testing (content and construct validity) and reliability analysis (Cronbach’s alpha). Data collection utilizes online questionnaires complemented by field observations, while qualitative data are analyzed via thematic content analysis using NVivo, and quantitative data undergo descriptive statistics, exploratory and confirmatory factor analysis, and multiple regression analysis employing SPSS to identify significant predictors of effective AMS. The anticipated key findings reveal a complex interplay of organizational, knowledge-based, and behavioral factors that influence AMS implementation levels, with the derived framework emphasizing key indicators such as antimicrobial prescribing patterns, diagnostic testing rates, practitioner knowledge, client communication, and clinic policy adherence. The framework integrates these indicators into a multidimensional assessment model supported by a scoring system that allows clinics to benchmark their AMS practices and identify areas for targeted intervention. Validation results are expected to demonstrate the framework’s reliability, internal consistency, and predictive capacity concerning antimicrobial prescription quality and resistance management outcomes. This research makes a substantial contribution to veterinary medicine by providing a validated, adaptable assessment framework that fills a critical gap in the measurement and enhancement of AMS in small animal practices. It advances theoretical understanding through the application of Structuration Theory to organizational behaviors within veterinary clinics, offering a novel perspective on how structured practices and individual behaviors interplay to shape antimicrobial use. Practically, the framework serves as a decision-support tool for veterinary clinics, policymakers, and professional bodies aiming to standardize and improve AMS strategies globally. It also sets the foundation for longitudinal and intervention-based studies to evaluate the impact of targeted stewardship programs. The study concludes that implementing a structured, evidence-based assessment framework significantly enhances the capacity of small animal clinics to monitor, evaluate, and optimize antimicrobial use. The recommendations emphasize integrating the framework into routine clinic audits, developing targeted training modules based on identified gaps, and fostering collaborative efforts among veterinarians, microbiologists, and clients. Future research should explore longitudinal validation across different geographic and practice settings, as well as the integration of technological innovations such as electronic health records to further refine antimicrobial stewardship assessment and promotion strategies. Overall, this study underscores the vital role of systematic evaluation frameworks in combating antimicrobial resistance within small animal veterinary practice.