‘Ideal’ versus ‘real-world’: Application of vignettes to investigate antibiotic prescribing decisions by farm vets.

Antimicrobial resistance (AMR) represents a major threat to public and animal health, and inappropriate antimicrobial prescribing by doctors and vets is an important contributing factor to increasing rates of AMR. This study used vignettes, which are an under-utilised method in veterinary medicine research, to examine differences between farm vets’ ‘ideal’ antibiotic prescribing and their ‘real-world’ experiences of antibiotic prescribing. Vets attending the British Cattle Veterinary Association annual congress (n = 16) were presented with seven clinical scenarios relating to ailments in cattle and were asked to consider how likely they would be to prescribe antibiotics in each scenario, once in an ‘ideal, text-book’ situation, and once in a ‘real-world’ situation. Across all seven scenarios, participants reported being more likely to prescribe antibiotics in the ‘real-world’ situation compared to the ‘ideal, text-book’ situation. These results, based on the vignettes, support the hypothesis that farm vets’ everyday patterns of antibiotic prescribing are different from their ideals for antibiotic prescribing. It is recommended that further research is required to better understand how non-clinical factors influence vets’ prescribing decisions, in order to develop effective antimicrobial stewardship interventions that can help support vets to more frequently prescribe in line with stewardship ideals.