A Framework for Assessing Antimicrobial Stewardship in Small Animal Practice

Thesis Abstract

The escalating prevalence of antimicrobial resistance (AMR) in veterinary medicine, particularly in small animal practice, underscores the urgent need for effective antimicrobial stewardship (AMS) frameworks to optimize antimicrobial use and mitigate the development of resistant pathogens. This study aims to develop and empirically evaluate a comprehensive framework for assessing antimicrobial stewardship practices in small animal veterinary clinics. The specific objectives are to identify key components influencing antimicrobial prescribing behaviors, to design a practical assessment model incorporating clinical, behavioral, and organizational factors, and to validate this framework across diverse practice settings. Employing a mixed-methods research design, the study integrates qualitative stakeholder interviews with quantitative surveys and observational data collection. The qualitative phase involves in-depth semi-structured interviews with 20 veterinary practitioners, practice managers, and pet owner representatives to explore perceptions, challenges, and facilitators of antimicrobial stewardship. The quantitative phase encompasses a cross-sectional survey administered to 150 veterinarians across a stratified random sample of small animal clinics within the region, complemented by direct observational audits of antimicrobial prescribing patterns. Data collection instruments include a structured questionnaire developed based on insights from the qualitative phase, standardized prescribing audits, and background demographic data. The validity and reliability of survey instruments are established through expert review, pilot testing, and Cronbach's alpha analysis, with values exceeding 0.75 indicating acceptable internal consistency. Data analysis employs thematic analysis for qualitative insights, following Braun and Clarke’s methodology, to identify core themes influencing antimicrobial use. Quantitative data are analyzed using descriptive statistics, chi-square tests for association, and multiple regression analysis to determine predictors of appropriate antimicrobial prescribing. Structural equation modeling (SEM) is utilized to validate the proposed framework’s conceptual pathways, assessing the relationships among contextual variables, practitioner knowledge, attitudes, and prescribing practices. The expected findings include identification of specific organizational, behavioral, and knowledge-based factors influencing antimicrobial use, which will inform the development of a practical assessment tool. The framework is anticipated to delineate key domains such as practitioner knowledge, client expectations, diagnostic resources, and organizational policies, thus providing a multidimensional understanding of stewardship practices in small animal clinics. It is also hypothesized that higher levels of practitioner education, availability of diagnostic support, and organizational commitment are positively associated with appropriate antimicrobial prescribing, whereas perceived client pressure and time constraints predict suboptimal use. This research significantly contributes to the veterinary antimicrobial stewardship literature by offering a validated, context-specific assessment framework adaptable for routine practice evaluation and targeted intervention design. It will assist veterinary practitioners, professional organizations, and policymakers in identifying gaps and tailoring strategies to improve antimicrobial stewardship, ultimately combating AMR at the clinical level. The study concludes that a structured, evidence-based framework is feasible for routine assessment of AMS in small animal practice, which can be integrated into veterinary quality assurance programs. Recommendations include implementing targeted educational initiatives, enhancing diagnostic capacities, and fostering organizational policies supportive of judicious antimicrobial use. It is suggested that future research explore longitudinal evaluation of stewardship interventions utilizing the framework to measure impact on prescribing behaviors and resistance trends over time.