PENNSYLVANIA VETERINARIAN PERSPECTIVES OF ANTIBIOTIC USE AND ANTIBIOTIC ...

155 Pages·2014·1.45 MB·English

by  Caitlin Foley

The Pennsylvania State University
The Graduate School
College of Agricultural Sciences
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PENNSYLVANIA VETERINARIAN PERSPECTIVES OF ANTIBIOTIC USE AND
ANTIBIOTIC RESISTANCE
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A Dissertation in
Agricultural and Extension Education
by
Caitlin Ann Foley
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Submitted in Partial Fulfillment
of the Requirements
for the Degree of

Doctor of Philosophy

May 2014
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The dissertation of Caitlin Ann Foley was reviewed and approved* by the following:

Rama B. Radhakrishna
Professor of Agricultural and Extension Education
Dissertation Advisor
Chair of Committee

Edgar P. Yoder
Professor of Agricultural and Extension Education

John C. Ewing
Associate Professor of Agricultural and Extension Education

Bhushan M. Jayarao
Professor of Veterinary and Biomedical Sciences
Director of Animal Diagnostic Lab

Connie D. Baggett
Associate Professor of Agricultural and Extension Education
Graduate Program Chair

* Signatures are on file in the Graduate School
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ABSTRACT

Antibiotic drugs have been used to combat pathogenic bacteria for over fifty years and
have proven to be one of the most valuable tools in preserving human and animal health. With an
increase in the use and availability of antibiotics, antibiotic resistance has become a public health
concern and has received much attention from government agencies, public interest groups, and
the media. There is disagreement within the medical, veterinary, and regulatory communities
regarding the veterinary use of antibiotics and associated risks to public health, and it is therefore
important to investigate the many facets of antibiotic use and encourage the development of
educational programs and resources for all stakeholders.
This study focused on the use of a conceptual framework and survey instruments to
explore the beliefs, knowledge and practices of veterinarians and to assess the current status of
available educational resources pertaining to antibiotic use and antibiotic resistance. The primary
purpose of this study was to investigate a wide variety of Pennsylvania veterinarians in order to
identify relationships and differences between their perspectives, and facilitate the development
of educational programs and strategies to benefit the field of veterinary medicine, animal
industry stakeholders, and the public.
A non-experimental, descriptive-correlational research design was used to develop this
study that focused on the population of all veterinarians licensed to practice medicine in
Pennsylvania. Survey instruments were designed to capture the perspectives of two different
groups of veterinarians: Group 1 – food/large animal vets, and Group 2 – all other vets. The
surveys contained three sections to obtain demographic information, veterinarian perspectives of
antibiotic use and antibiotic resistance across five perspectives dimensions (Antibiotic
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Resistance, Antibiotic Use, Veterinary Clientele, the General Public, and Veterinarian Practices),
and perspectives of available educational resources. Veterinarians attending the PVMA Keystone
conference completed a total of 66 usable paper surveys, and veterinarians contacted via email
listservs completed 284 usable internet-based surveys.
Findings indicated that the two groups of veterinarians possessed varied perceptions
across the five perspectives dimensions, and that significant differences in perspectives existed
(p < .05). Data also indicated that the two groups of veterinarians recommended different types
of antibiotic drugs for disease treatment and prevention. Significant relationships existed
between the select demographic variables (gender and years post-graduation from veterinary
school) and the five perspectives dimensions. Findings also indicated the need for educational
materials and resources regarding antibiotic resistance for veterinarians, veterinary staff,
veterinary clientele, and the general public; and concluded that veterinarians may be the best
resource for educating their staff and clientele. Several modes for disseminating educational
information to stakeholders were also identified, with veterinarian preferences shown for
journals, veterinary specific websites, and continuing education (CE) events.
Further research is necessary to determine the status of veterinary knowledge, beliefs and
practices of antibiotic use and antibiotic resistance in Pennsylvania, and this study provides a
basis for further inquiry. It is the hope that the descriptive findings of this study will provide
valuable insight for veterinary practitioners, and stimulate thought and discussion among the
veterinary profession and key stakeholders.
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TABLE OF CONTENTS
Page
LIST OF FIGURES ......................................................................................................... vii
LIST OF TABLES ........................................................................................................... viii
ACKNOWLEDGEMENTS ............................................................................................. x

CHAPTER
1 INTRODUCTION ……………………………………………………… 1

Statement of Problem …………………………………………………... 4
Rationale ………………………………………………………………... 4
Purpose and Objectives …………………………………………………. 6
Operational Definitions …………………………………………………. 7
Assumptions and Limitations …………………………………………… 9
Organization of Dissertation …………………………………………….. 10
Variables and Conceptual Framework …………………………………... 11
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2 REVIEW OF LITERATURE …………………………………………... 13
Purpose and Objectives …………………………………………………. 13
Antibiotic Overuse and Antibiotic Resistance ………………………….. 14
Antibiotic Uses and Practices in Veterinary Medicine and
Livestock Production …………………………………………………… 16
Food Safety and Public Health …………………………………………. 20
Survey Research Involving Stakeholder Perspectives ………………….. 21
Current Resources, Educational Programs, and Strategies ……………... 25
Summary of Literature Review ………………………………………….. 28

3 RESEARCH METHODOLOGY ……………………………………… 30
Purpose and Objectives …………………………………………………. 30
Research Design ………………………………………………………… 31
Population and Sample ………………………………………………….. 31
Instrumentation ………………………………………………………….. 32
Data Collection ………………………………………………………….. 39
Data Analysis ……………………………………………………………. 40
Intercorrelations Between the Five Perspectives Dimensions …………... 43
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TABLE OF CONTENTS (Continued)
Page
4 FINDINGS ……………………………………………………………… 45
Purpose and Objectives …………………………………………………. 45
Demographic Profile of Pennsylvania Veterinarian Respondents ……… 46
Objective 1: Determine the Perspectives of Pennsylvania
Veterinarians Regarding Antibiotic Use and Antibiotic
Resistance ………………………………………………………. 50
Objective 2: Determine the Differences in Perspectives that Exist
Between Two Groups of Pennsylvania Veterinarians
Regarding the Various Aspects of Antibiotic Use and
Antibiotic Resistance ……………………………………………. 55
Objective 3: Determine the Relationships that exist between the
sample demographic variables and veterinarian perspectives
of antibiotic use and antibiotic resistance ……………………….. 74
Objective 4: Determine the Perceptions of Pennsylvania Veterinarians
Regarding the Available Educational Resource Materials
Pertaining to Antibiotic Resistance ……………………………… 80

5 SUMMARY, DISCUSSION, IMPLICATIONS AND
RECOMMENDATIONS ………………………………………………… 83
Purpose and Objectives …………………………………………………... 83
Summary of Procedures ………………………………………………….. 84
Summary of Findings …………………………………………………….. 85
Conclusions ………………………………………………………………. 99
Implications ………………………………………………………………. 100
Recommendations for Future Research …………………………………... 103

REFERENCES …………………………………………………………………………… 105

APPENDICES
A INTERCORRELATIONS ……………………………………………….. 110
B CORRESPONDENCE …………………………………………………… 112
C SURVEY INSTRUMENTS ……………………………………………… 118

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LIST OF FIGURES
Figure Page
1.1 Conceptual Framework for research involving Pennsylvania
veterinarian perspectives of antibiotic use and antibiotic resistance……… 12
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LIST OF TABLES
Table Page
3.1 Reliability values for Pilot and Final Studies ……………………………... 37
3.2 Variables, Scales of Measurement, and Data Analysis by Research
Questions …………………………………………………………………. 42
4.1 Demographic Profile of Respondents …………………………………….. 47
4.2 Veterinarian’s Perception Scores on Five Perspectives Dimensions ……... 52
4.3 Veterinarian Perspectives Dimension 1: Beliefs and Knowledge
of Antibiotic Resistance …………………………………………………… 57
4.4 Veterinarian Perspectives Dimension 2: Beliefs and Knowledge of
Antibiotic Use ……………………………………………………………… 59
4.5 Veterinarian Perspectives Dimension 3: Beliefs and Knowledge
of Veterinary Clientele ……………………………………………………... 61
4.6 Veterinarian Perspectives Dimension 4: Beliefs and Knowledge
of the Public ………………………………………………………………… 63
4.7 Veterinarian Perspectives Dimension 5: Veterinary Practices
pertaining to Antibiotic Use and Antibiotic Resistance ……………………. 66
4.8 Independent t-test Results on Veterinarian’s Perception Scores
on the Five Perspectives Dimensions by Primary Practice Focus ………….. 68
4.9 Veterinarian Antibiotic Recommendations for Disease Treatment ………… 72
4.10 Veterinarian Antibiotic Recommendations for Disease Prevention ………… 73
4.11 Relationships Between Veterinarian’s Perception Scores on the
Five Perspectives Dimensions and Gender ………………………………….. 75
4.12 Relationships Between Veterinarian’s Perception scores on the Five
Perspectives Dimensions and Years Post-Graduation from
Veterinary School ……………………………………………………………. 76
4.13 Relationships Between Veterinarian’s Perception Scores on the Five
Perspectives Dimensions and Location of Veterinary School Attended …….. 78
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LIST OF TABLES (Continued)
Table Page
4.14 Relationships Between Veterinarian’s Perception scores on the Five
Perspectives Dimensions and Pennsylvania Region of Practice …………… 79
4.15 Veterinary Preferences for Educational Resources regarding Antibiotic
Use and Antibiotic Resistance ……………………………………………… 82
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ACKNOWLEDGEMENTS

I would like to sincerely thank Dr. Rama Radhakrishna for being an exemplary advisor,
mentor, and teacher. His guidance and support allowed me to thrive as a graduate student and
paved the way for my professional endeavors. I would also like to extend my gratitude to three
committee members: Dr. Ed Yoder, Dr. John Ewing, and Dr. Bhushan Jayarao. Dr. Yoder
provided necessary insight into the research design, implementation, and analyses data, as well
as invaluable experience and guidance. The wealth of knowledge regarding educational practices
shared by Dr. Ewing allowed me to develop and hone my interests and ideas both academically
and professionally. Dr. Jayarao provided excellent scientific insight to the study and encouraged
the integration of my interests in animal science, survey research, and epidemiology.
Special thanks to Dr. Dave Wolfgang and Dr. Ernest Hovingh who volunteered their time
and expertise in assisting with the development of the survey instruments and reaching the target
population for the study. As Extension veterinarians and researchers, they provided valuable
insight into their profession and enabled me to collect data in a timely fashion. I would also like
to thank various members of the veterinary profession who assisted with the dissemination and
completion of the pilot and final surveys, and provided time, money, and services pertaining to
the study. I am also very grateful for the support received from the Pennsylvania Veterinary
Medical Association, the American Association of Bovine Practitioners, and Pennsylvania State
and Regional veterinarians.
I would like to thank my fellow graduate students for their support, comic relief, and
endless Creamery breaks. Finally I want to thank my veterinarian/significant other, Dr. Matt
Mink, for moving north of the Mason-Dixon line and being the best support system and friend
that I could ever hope for.