Antimicrobial prescription behavior among veterinary practitioners in the Netherlands: a cultural theory on attitudes and trade-off decisionmaking

Abstract

Background: To curb the increasing threat of antimicrobial resistance, antimicrobial use in farm animals should be minimized. Veterinary antimicrobial prescription behaviour is influenced by trade-off decision making. Trade-offs are value decisions, which derive from a hierarchy of attitudes. In this study we explore and theorize on changes and differences in professional values and attitudes, affecting trade-off decision making, using a cultural anthropological methodology Materials/methods: The theory has been formed by deduction from findings of recent qualitative and quantitative research concerning antimicrobial prescription behaviour of farm animal veterinarians in the Netherlands and literature review. Results: For the veterinary profession, four fundamental attitudes have been identified as constituting work values, job satisfaction and as underpinning trade-off decision making. These are: 1. ‘intrinsic to the work’ attitude 2. ‘intellectually challenging’ attitude 3. ‘accountable to society’ attitude 4. ‘economic efficiency’ attitude All four can be present, although seldom equally strong, in the individual veterinarian, While making a trade-off decision, one of the four attitudes dominates the other three. In case of an antimicrobial prescription decision, especially the third and fourth attitude can cause a dilemma. This may result in veterinarians deciding differently in comparable prescribing situations, depending on the dominant attitude. Submersion in a context (sector subset) in which economic efficiency values prevail, is likely to induce a bias in trading off towards the economic efficiency attitude. Conclusion: The scope of antimicrobial reduction policy interventions should broaden from farm level to sector and market level, because economic efficiency values may counteract further antimicrobial reduction.