Development of a Framework for Veterinary Antimicrobial Stewardship in Small Animal Practice

Thesis Abstract

In the face of rising antimicrobial resistance and escalating veterinary antimicrobial use, small animal practices increasingly struggle with balancing effective patient care and stewardship obligations, underscoring the need for a structured framework that supports evidence-based antimicrobial decision-making. The study aims to develop and validate a comprehensive framework for Veterinary Antimicrobial Stewardship (VAS) tailored to small animal practice, integrating clinical decision support, diagnostic stewardship, and practice-level governance. Specific objectives are to (i) identify determinants of antimicrobial prescribing behaviors among veterinarians in companion animal clinics, (ii) synthesize best practices from human and veterinary stewardship models into a conceptually coherent framework, (iii) develop measurable process and outcome indicators for VAS implementation, (iv) pilot test the framework in ten small animal clinics, and (v) assess its feasibility, acceptability, and potential impact on prescribing patterns. The research adopts a mixed-methods design grounded in the Theory of Planned Behavior and the COM-B model (Capability, Opportunity, Motivation—Behavior) to elucidate behavioral drivers and contextual factors influencing antimicrobial use. The population comprises veterinarians, veterinary nurses, practice managers, and antimicrobial stewardship leaders in medium- to high-volume companion animal clinics across the region. A purposive sample of 120 veterinarians and 60 support staff will be recruited for surveys, complemented by 40 in-depth semi-structured interviews and 20 focus groups with clinicians and staff to illuminate Barriers and Facilitators to stewardship. Data collection instruments include a structured questionnaire based on the Theoretical Domains Framework for behavioral assessment, a practice audit checklist to capture prescribing patterns and diagnostic testing, and an interview guide to explore perceived barriers, facilitators, and governance structures. Instrument validity will be established through content validity by an expert panel and pilot testing with 15 practitioners, while reliability will be assessed via test-retest for the survey and intercoder agreement for qualitative transcripts. Quantitative data will be analyzed using multivariate regression to identify predictors of narrow-spectrum prescribing and adherence to guidelines, interrupted time-series analysis to evaluate changes during the pilot, and cluster analysis to group clinics by stewardship maturity. Qualitative data will be analyzed using thematic analysis with NVivo, followed by framework synthesis to integrate findings with the proposed framework components. The anticipated outcome is a validated VAS framework comprising five interrelated modules clinical decision support, diagnostic and microbiological stewardship, formulary governance and access, education and behavioral incentives, and monitoring and reporting. Each module will include process and outcome indicators, implementation steps, required resources, and governance roles. The study expects to demonstrate that clinics adopting the framework exhibit a statistically significant reduction in broad-spectrum antimicrobial use (measured as Defined Daily Doses per 100 patient encounters) and an increase in guideline-concordant prescribing within six months of implementation, with qualitative data revealing improved confidence in decision-making and perceived patient care quality. The contribution to knowledge includes (i) a transferable, theory-informed VAS framework tailored to small animal practice, (ii) a validated set of indicators and diagnostic stewardship tools adaptable to diverse clinical settings, and (iii) empirical evidence on behavioral determinants of antimicrobial prescribing in veterinary contexts, filling gaps in cross-disciplinary stewardship literature. The study will inform policy and continuing education for veterinary professionals and provide a practical roadmap for scalable stewardship integration in private and referral practices. The main conclusion posits that a structured, theory-driven framework incorporating behavioral insights, diagnostic support, and governance mechanisms can meaningfully improve antimicrobial stewardship in small animal practice, with measurable reductions in inappropriate use and enhanced treatment outcomes. Recommendations include broader multi-site validation, integration of rapid diagnostics, incentives aligned with stewardship goals, and inclusion of client communication strategies to sustain responsible antimicrobial use.