Survey of antimicrobial prescribing practices across western Canadian beef cow-calf veterinarians

Abstract

Objective

This study was to determine if the prescribing practices of western Canadian beef cow-calf veterinarians changed after Canada revised federal regulations in 2018 to require veterinary prescriptions for all medically important veterinary antimicrobials.

Animals

Beef cattle, cow-calf.

Procedure

An electronic survey was used to capture onboarding of new clients and to record herd health information, dispensing of antimicrobials after hours, reported client concerns with the regulation changes, and basic veterinary practitioner demographics such as province of licensure and number of years in practice. Seventy-two western Canadian veterinarians completed the survey in the winter of 2024.

Results

After 2018, the frequency of onboarding of new clients increased, as did herd health data capture. Most participants (80%) reported spending more time supporting client needs for antimicrobial prescriptions after 2018, with 63% reporting more beef cow-calf clients needing this service and 39% reporting the acquisition of new beef cow-calf clients. Billing for onboarding as professional time increased after 2018 but the relative frequencies of methods for dispensing antimicrobials after hours did not change. Changes in prescribing veterinary antimicrobials after 2018 included a decrease in sulfonamides and increases in tetracyclines and phenicols. Reported changes in client antimicrobial use included decreases in penicillin and sulfonamides and increases in phenicols and macrolides.

Conclusion and clinical relevance

Although veterinarians reported challenges in meeting client needs and complying with the regulatory change, their comments were largely neutral to positive regarding the effect of the changes. Suggestions from veterinarians included the development of tools to support prescribing and to track client antimicrobial inventory, client antimicrobial use, and disease incidence.

INTRODUCTION

Canada introduced new regulations in 2018 that require a veterinary prescription for all veterinary antimicrobials licensed as medically important (1). This regulatory change was aimed at aligning with international best practices, promoting responsible use of medically important antimicrobials in animals, and protecting human and animal health and food safety (1). The regulation requires veterinary prescriptions for antimicrobials such as penicillins, tetracyclines, and sulfonamides, which were previously available without prescription. In Canada, a veterinary prescription is conditional on a current Veterinary- Client-Patient-Relationship (VCPR) (2). The VCPR exists when several elements are in place. First, the veterinarian has assumed responsibility for making clinical assessments and recommendations regarding the health of the animals and the need for medical treatment. Second, the veterinarian has sufficient knowledge of the animals on which to base the assessment, diagnosis, and treatment of the medical condition of the animal(s). Third, the client has agreed to follow the veterinarian’s recommendations and prescription. Finally, the veterinarian is available or has arranged for follow-up evaluation, especially in the event of adverse reactions or failure of the treatment regimen (3). Intrinsic to the development and maintenance of a VCPR is its documentation, which requires clinic staff time and capacity for data storage and timely retrieval.

In the Canadian beef cow-calf sector, antimicrobials are used in pre-weaned calves for the treatment of diseases such as calf diarrhea and respiratory disease, and in cows for disease such as lameness associated with infection, though the proportion of individuals treated within a herd tends to be relatively low (4). Across the beef cow-calf sector, antimicrobials are typically administered by the producer-owner, following instructions from the herd veterinarian, in compliance with the guidelines for prudent use of antimicrobials drafted by the Canadian Veterinary Medical Association (CVMA) (2). All antimicrobials used for these common conditions became prescription-only medications in 2018.

Potential changes in producer attitudes since 2018 have been investigated; however, the effect of changes on veterinary prescribing practices has not (5). The objective of this survey was to determine veterinary prescribing practices since the regulatory change in 2018. Changes of interest included documentation of initiation and maintenance of the VCPR underpinning veterinary antimicrobial prescription, dispensing practices, and classes of antimicrobials prescribed and used in beef cow-calf herds in western Canada.

MATERIALS AND METHODS

This project was approved by the University of Saskatchewan’s (Saskatoon, Saskatchewan) Animal Research Ethics Board (animal use protocol #2014003) and the University of Saskatchewan’s Behavioural Research Ethics Board (Beh-REB#309).

Survey design

Preliminary individual interviews were conducted with a purposively selected group of beef cattle veterinarians practicing from a range of clinic sizes, and beef cow-calf producers from a range of geographic locations. The objective was to identify veterinary standard operating procedures in documenting VCPRs and producer experiences in obtaining antimicrobials, especially after hours, when a broader range of dispensing practices could be expected. Based on the findings of these initial interviews, a survey for Canadian beef veterinarians was drafted. The survey captured changes in the standard operating procedures used by the veterinarians, time required, cost-recovery strategies, producer concerns regarding dispensing shared with their veterinarians, and changes in classes of antimicrobials prescribed by veterinarians or used by beef cow-calf producers. The survey was designed and administered using SurveyMonkey online survey platform (San Mateo, California, USA) under the University of Saskatchewan enterprise license. The survey was previewed and tested by industry professionals and veterinarians.

Survey content

The survey consisted of 3 sections. The 1st section captured veterinary clinic procedures around “onboarding” clients (information recorded at the first contact of a new client with the veterinary practice): whether this was a defined procedure; if so, which clinic personnel completed it; estimates regarding time required per client; methods, if any, of cost recovery for staff time; and frequency of updates. The 2nd section similarly captured veterinary clinic procedures around recording herd health information, such as vaccination and treatment protocols, if present, and ongoing animal health concerns. The 3rd section captured clinic procedures regarding prescribing and dispensing antimicrobials. Questions included which classes of antimicrobials were most frequently prescribed to beef cow-calf clients and which classes were most frequently used by clients, before and after 2018. The survey also queried methods for dispensing antimicrobials, time required per client in supporting VCPRs, number of clients seeking VCPRs, and number of beef cow-calf clients in general, all before and after the 2018 regulatory change.

Each survey section contained closed binary (yes/no) or multiple-choice questions followed by free-text areas where respondents could make additional comments. The finalized survey was loaded to an electronic survey platform (6). An invitation for practicing Canadian beef veterinarians to complete the survey was extended at the annual meeting of the Western Canadian Association of Bovine Practitioners (WCABP) in January of 2024, as well as on the websites of the Canadian Cow-Calf Health and Productivity Enhancement Network (C3H/PEN) and the Western Canadian Animal Health Network (WeCAHN). An honorarium was extended to all survey participants.

Survey analysis

The survey closed on February 29, 2024 and responses were downloaded and summarized using Stata 18 statistical software (7). As the purpose of the survey was to elicit the views and experiences of veterinary practitioners, an initial question designated as an inclusion criterion for participation asked whether the participant was a licensed veterinarian serving the cow-calf industry. Participants responding that they were not veterinary practitioners were excluded from further analysis.

Because the outcomes of interest were changes in prescribing practices after the 2018 regulatory changes, analysis of the questions capturing procedures used before and after 2018 was restricted to survey participants who were in practice before that date. Differences in participant responses to individual categorical variables were analyzed with McNemar’s exact test for paired data (8). Questions eliciting numerical responses were analyzed as continuous variables. Differences in participant responses to continuous variables before and after the regulatory changes were analyzed using the Wilcoxon signed-rank test to assess significance (9).

The text comments were qualitatively analyzed using NVivo software (10) by the Canadian Hub for Applied and Social Research (11). Open-ended survey responses to each question were imported into NVivo 14 software for thematic and content coding. Once imported, data were read while an initial list of several categories comprehensive of any significant concepts was then amalgamated into fewer, broader categories. Theme names and definitions were finalized, and relevant quotes were extracted for inclusion in this report.

RESULTS

Descriptive summary of participants

Of 84 participants, 73 were practicing veterinarians serving the cow-calf industry at the time of survey completion. Only the responses of practicing veterinarians are described further. One respondent from Ontario was also excluded from further analysis to limit responses to those practicing in western Canada. Veterinarians were licensed in Alberta (43/72, 60%), followed by Saskatchewan (24/72, 33%), Manitoba (9/72, 13%), and British Columbia (8/72, 11%). Some veterinarians (12/72, 17%) were licensed in multiple provinces. Most respondents (52/72, 72%) were practice owners, and almost 1/2 had been in practice for > 20 y (35/72, 49%) (Table 1).

TABLE 1.

Descriptive summary of survey participants.

Survey question	Number of affirmative responses/total number of responses (% of responses)
Is the participant a licensed veterinarian serving the cow-calf industry?
Yes	72
No	11
Province in which participant is licenseda
BC	8/72 (11%)
AB	43/72 (60%)
SK	24/72 (33%)
MB	9/72 (13%)
Employment status
Practice owner	52/72 (72%)
Associate	19/72 (26%)
Other	1/72 (1%)
Years of practice
< 5 y	5/72 (7%)
5 to 10 y	9/72 (13%)
11 to 20 y	23/72 (32%)
> 20 y	35/72 (49%)

AB — Alberta; BC — British Columbia; MB — Manitoba; SK — Saskatchewan.

^aSome respondents were licensed in multiple provinces (12/72; 17%).

Onboarding practices

Most participants (47/68, 69%) reported onboarding of new clients before the regulatory change, but this became nearly universal (66/68, 97%) after 2018 (Table 2). Onboarding was largely done by veterinarians, followed by an equal split between veterinarians and veterinary technologists, with a small proportion of practices using only veterinary technologists for this purpose. The relative frequencies of staff member types conducting onboarding did not change for veterinarians (P = 0.99) or veterinary technologists (P = 0.99) after the new regulations, nor did the median time per client spent onboarding (P = 0.17) change after the new regulations.

TABLE 2.

Descriptive summary of client data collection practices.

Data collection procedure	Time period: Until 2018	Time period: After 2018	P-valuea
Routinely gather basic herd information (“onboarding information”) from new clients?
No	21/68 (31%)	2/68 (3%)
Yes	47/68 (69%)	66/68 (97%)	< 0.0001
Person spending the most time on this onboarding process
Veterinarians	36/47 (77%)	36/47 (77%)	0.99
Veterinary technologists	3/47 (6%)	3/47 (6%)	0.99
Time spent is equivalent for both groups	8/47 (17%)	6/47 (12%)	0.89
Other	0	1/47 (2%)
Time per client spent on onboarding	Median (min, max)	Median (min, max)
Number of respondents	47	47
Median time required (h)	0.50 (0.16, 2.0)	0.75 (0.16, 3.0)	0.17
Minimum time required (h)	0.25 (0.017, 1.0)	0.42 (0.03, 1.0)	0.29
Maximum time required (h)	1.0 (0.25, 6.0)	1.50 (0.25, 5.0)	0.54
How practice recovers cost of onboarding
Billed as professional time	14/46 (30%)	25/46 (54%)	0.003
Incorporated in other fees	10/47 (21%)	7/47 (15%)	0.18
No cost recovery was done	24/47 (51%)	14/47 (30%)	0.006
Other	2/32 (6%)	5/32 (33%)	0.69
Frequency onboarding information was updated
Annually	16/47 (34%)	30/47 (64%)	0.002
More often than annually	3/47 (6%)	3/47 (6%)	0.99
Less often than annually	19/47 (40%)	7/47 (15%)	0.002
Varied across clients	9/47 (19%)	7/47 (15%)	0.75
Routinely gather herd-specific disease information and guidelines (“herd health information”) for disease recognition and treatment from clients?
No	34/67 (51%)	19/67 (28%)
Yes	33/67 (49%)	48/67 (72%)	0.002
Person in practice spending most time capturing herd health information
Veterinarians	28/31 (90%)	24/31 (77%)	0.22
Veterinary technologists	1/31 (3%)	2/31 (6%)	0.99
Time spent is equivalent for both groups	0	4/31 (13%)	0.13
Other	2/31 (6%)	1/31 (4%)	0.99
Time per client spent collecting herd health information Median (min, max) Median (min, max)
Number of respondents	32	32
Median time required (h)	0.71 (0.16, 2.0)	0.50 (0.16, 6.0)	0.68
Minimum time required (h)	0.40 (0, 1.0)	0.25 (0, 2.0)	0.88
Maximum time required (h)	1.60 (0.25, 3.0)	1.50 (0.30, 6.0)	0.72
How practices recover cost of collecting herd health information
Professional time	6/31 (19%)	13/31 (42%)	0.04
Client fee	10/31 (32%)	10/31 (32%)	0.99
Not received	11/31(35%)	16/31 (52%)	0.27
Other	3/31 (10%)	5/31 (16%)	0.69
Frequency herd health information was updated
Annually	13/32 (40%)	13/32 (40%)	0.99
More often than annually	1/32 (3%)	3/32 (9%)	0.50
Less often than annually	12/32 (38%)	7/32 (22%)	0.13
Varied across clients	6/32 (19%)	5/32 (%)	0.99

^aStatistical significance of changes in onboarding and herd health data capture practices before and after regulatory changes was assessed using McNemar’s exact test on matched pairs of participant responses for categorical variables, and Wilcoxon signed-rank test for continuous variables. Only responses from veterinarians practicing both before and after 2018 and answering the question for both before and after were eligible for the paired analyses.

Bold font indicates statistically significant associations or differences.

The approach to cost recovery for time spent onboarding did change after 2018, with the proportion of participants reporting professional billing for this service increasing from 30 to 54% (P = 0.003). This difference was supported in the qualitative analysis of comments (Table S1, available online from: Supplementary Materials). Comments regarding the post-2018 period noted that professional billing was sometimes used to recover associated costs. They also noted that cost-recovery methods were case-specific. The frequency of updating this information changed, with annual updating increasing from 34 to 64% (P = 0.002) and updating less often than annually decreasing from 40 to 15% (P = 0.002) (Table 2).

Herd health information

Herd health information was recorded by almost 1/2 of survey participants (33/67, 49%) before the regulatory change and increased to 72% (P = 0.002) after. As with onboarding, veterinarians were most likely to complete this task. The proportion of herd health data capture carried out by veterinarians did not change after 2018 (P = 0.22) (Table 2), nor did the median time spent capturing herd health information (P = 0.68). The proportion of participants reporting professional billing for this service was 19% before 2018 and 42% after (P = 0.04). The proportion reporting updating this information less often than annually decreased. This change was nonsignificant (P = 0.13); however, the trend was supported by free-text comments (Table S1, available online from: Supplementary Materials).

Antimicrobial dispensing and prescribing before and after the regulatory change

The most frequently reported method of dispensing antimicrobials after hours occurred at the clinic when a client phoned ahead, and the frequency of this practice did not change after 2018 (P = 0.24) (Table 3). Other scenarios involved bringing an animal into the clinic, veterinary examination of an animal on-farm, or waiting until the clinic opened. The relative frequencies of each of these methods also did not change after 2018 (P = 0.38, 0.99, and 0.99, respectively). This was supported by the free-text comments in responses to this question (Table S1, available online from: Supplementary Materials).

TABLE 3.

Descriptive summary of antimicrobial (AM) prescribing and dispensing practices.

Clinic procedure	Time period: Until 2018	Time period: After 2018	P-valuea
How do clients obtain AM after hours?
Brought an affected animal to the clinic	2/67 (3%)	5/67 (7%)	0.38
Veterinarian examined affected animal on-farm	5/67 (7%)	4/67 (6%)	0.99
Clients able to obtain at clinic by phoning ahead	33/67 (49%)	27/67 (40%)	0.24
Client waits until clinic open again	5/67 (7%)	4/67 (6%)	0.99
Other	22/67 (33%)	27/67 (40%)	0.20
Since 2018, has the average time spent in supporting clients’ AM prescriptions increased?
No		11/64 (17%)
Yes		51/64 (80%)
Don’t know		2/64 (3%)
Since 2018, has the number of beef cow-calf clients requiring AM prescriptions increased?
No		19/64 (30%)
Yes		40/64 (63%)
Don’t know		5/64 (8%)
Since 2018, has the number of beef cow-calf clients increased?
No		29/64 (45%)
Yes		25/64 (39%)
Don’t know		10/64 (16%)
Since 2018, have the classes of AMs most frequently prescribed to beef cow-calf clients changed?
No		34/64 (53%)
Yes		21/64 (33%)
Don’t know		7/64 (11%)
Other		2/64 (3%)
Since 2018, have beef cow-calf clients indicated that the classes of AMs most frequently used have changed?
No		37/64 (58%)
Yes		18/64 (28%)
Don’t know		7/64 (11%)
Other		2/64 (3%)
Top 3 classes of antimicrobials PRESCRIBED most frequently?
Penicillin	24/64 (38%)	20/64 (31%)	0.42
Tetracycline	56/64 (88%)	61/64 (95%)	0.03
Sulfonamides	23/64 (36%)	12/64 (19%)	0.008
Phenicols	44/64 (69%)	51/64 (80%)	0.04
Macrolides	40/64 (63%)	47/64 (73%)	0.17
Other
Cephalosporin	1/64 (2%)	2/64 (3%)	0.99
Top 3 classes of antimicrobials USED by clients most frequently?
Penicillin	47/64 (73%)	19/64 (30%)	< 0.0001
Tetracycline	60/64 (94%)	60/64 (94%)	0.99
Sulfonamides	27/64 (42%)	12/64 (19%)	0.003
Phenicols	37/64 (58%)	50/64 (78%)	0.003
Macrolides	19/64 (30%)	49/64 (77%)	< 0.0001
Other
Cephalosporin	1/64 (2%)	2/64 (3%)	0.99
Clients’ reported concerns with changes:
Decreased access
No		41/65 (63%)
Yes		24/65 (37%)
Reduced choice
No		54/65 (83%)
Yes		11/65 (17%)
Decreased convenience
No		18/65 (28%)
Yes		47/65 (72%)
Increased price
No		47/65 (72%)
Yes		18/65 (28%)

^aStatistical significance of changes in antimicrobial prescribing or use before and after regulatory changes was assessed using McNemar’s exact test on matched pairs of participant responses for categorical variables. Only responses from veterinarians practicing both before and after 2018 and answering the question for both before and after were eligible for the paired analyses.

Bold font indicates statistically significant associations or differences.

Since 2018, most survey participants (51/64, 80%) reported spending more time supporting client antimicrobial prescriptions and seeing more beef cow-calf clients requiring antimicrobial prescriptions, with 39% also reporting seeing more beef cow-calf clients.

The majority (34/64, 53%) of veterinarians also reported that the classes of antimicrobials most frequently prescribed to clients did not change after 2018. The most frequently prescribed classes of antimicrobials were tetracyclines, phenicols, and macrolides, with increases in the prescription of tetracyclines (P = 0.03) and phenicols (P = 0.04) and no change for macrolides (P = 0.17). In contrast, sulfonamides were prescribed less frequently after 2018 (P = 0.008).

The antimicrobial classes reported as most frequently used by clients were tetracyclines, penicillin, and phenicols before 2018; and tetracyclines, phenicols, or macrolides after. The reported frequency of penicillin use decreased (P < 0.0001) after 2018, as did sulfonamide use (P = 0.003). In contrast, the reported frequencies of phenicol (P = 0.003) and macrolide (P < 0.0001) use increased after 2018.

The most frequently reported client concern regarding access to antimicrobials was decreased convenience (47/65, 72%), followed by decreased access (24/65, 37%), increased price (18/65, 28%), and reduced choice (11/65, 17%) (Table 3). In free-text responses, additional concerns reported by veterinarians included challenges for staff dealing with clients unfamiliar or unhappy with the new regulations, the challenge involved in establishing a VCPR with small client herds, and the loss of income resulting from some unhappy clients no longer using their practice (Table S1, available online from: Supplementary Materials).

Qualitative summary of additional comments

The final free-text field of the survey invited participants to offer additional comments. Most (43/72, 60%) did, with some sharing paragraphs-long comments on their experiences. Using NVivo qualitative analysis, these comments were grouped into 3 key areas: reactions to the regulation changes, their impact, and suggestions for additional veterinary supports (Table S1, available online from: Supplementary Materials).

Reported reactions among clients ranged from frustration to acceptance, with veterinarians stressing that most of the negative reactions originated from infrequent clients. Veterinary reaction was summarized as “feeling the changes were necessary and important.”

Among clients, the impact was reported to be greatest on infrequent clients. A positive observation was that communication with clients was improved, as regulation compliance required regular contact. The veterinary impact was positive in terms of improving control over antimicrobial use (AMU), but negative impacts included client loss and increased time burden for compliance.

Several veterinarians suggested that tools were needed to support veterinarians in the prescribing of antimicrobials. Tools included infrastructure to assist with the changes (Table S1, available online from: Supplementary Materials), such as antimicrobial record-keeping systems, templates, ways to track clients’ antimicrobial inventories, and ways to easily transfer prescriptions between practices. Additional tools included practice-management software that could monitor refills, an easy-to-use app for beef cattle antibiotic-prescribing guidelines for various diseases, and a unified platform that could document herd profile (number of animals by class and weight) and record client-documented disease incidence annually.

DISCUSSION

Before 2018, producers could, if they wished, diagnose their animals’ medical problems and treat them using over-the-counter, nonprescription antimicrobials. Since 2018, with all antimicrobials requiring a veterinary prescription, all livestock producers must have a VCPR to obtain these products. This fundamental change to the regulatory landscape could have had several predicted consequences: increased numbers of beef producers seeking veterinary assistance, increased veterinary time being required to meet this demand, and potential resentment from producers not using veterinary services for this purpose before 2018. The results of this veterinary survey confirmed that all these trends were observed, broadly painting the picture of more beef cow-calf clients obtaining antimicrobials after 2018 using the veterinary prescribing procedures established before 2018.

Onboarding procedures recording basic herd demographics were common before the regulatory change and became almost universal after, primarily conducted by veterinarians, with professional billing more often used to recover the associated costs. This could reflect the increased numbers of beef clients reported by some practices and their increased needs for professional support, specifically to maintain valid VCPRs. Veterinarians were the practice staff type most frequently reported as involved in onboarding.

Similarly, recording of herd health data increased after the regulatory changes, again largely completed by veterinarians. The relatively high proportion of practices reporting veterinarians as the group most frequently providing this service was somewhat unexpected, given the relative shortage of veterinary practitioners in Canada that is forecast to worsen over the next decade (12). This role could potentially be filled by veterinary technologists, including for documenting VCPRs, in some provinces (3). However, follow-up e-interviews with purposively selected practitioners suggested several reasons for veterinarians to continue this work in some practices, including a lack of technologist time, veterinarian preference, and the need for veterinarians, specifically, to address questions arising from these client interviews.

The biggest client concern reported by participants was loss of convenience in obtaining antimicrobials; that this was more important than loss of access or price concerns likely reflected the loss of other retail outlets as purchasing options. The relative frequencies of common methods to dispense antimicrobials after hours did not significantly differ after the regulatory changes, again supporting the broad picture of more beef cow-calf clients obtaining antimicrobials after 2018 using the veterinary prescribing procedures established before 2018.

Participants described significant increases in prescribing of tetracyclines and phenicols and decreases in sulfonamides, with corresponding shifts in client use, including increases in macrolides and phenicols and decreases in sulfonamides and penicillin. Successive AMU surveys of western Canadian cow-calf producers conducted in 2002, 2014, and 2020 showed oral sulfonamides, followed by injectable sulfonamide-trimethoprim combinations, as the most common antimicrobials used to treat diarrhea in pre-weaned calves (4,13,14). Although the percentage of herds using oral sulfonamides for the treatment of diarrhea in pre-weaned calves was essentially the same in both the 2002 and 2014 surveys (13,14), it declined from 52% in the 2014 survey to 41% in the 2020 survey (4). In line with guidelines for the prudent use of antimicrobials in cases where diarrhea is mild to moderate with no signs of septicemia (15,16), fewer veterinarians reported prescribing sulfonamides or any antimicrobial to treat calfhood diarrhea.

Concurrent with the regulatory changes has been a transition from focusing on treating individual diarrheic calves with antimicrobials to recommending administration of scour vaccines to pregnant cows and heifers to prevent or control calfhood diarrhea. A recent western Canadian survey of veterinary practitioners showed the vast majority recommending this practice (17). In addition, 4 different surveys administered to western Canadian producers over an 18-year period demonstrated increased scour vaccine use. In a 2002 survey, 31 and 35% of producers vaccinated their pregnant cows and heifers, respectively, at least once against calfhood diarrhea (13). The practice of administering scour vaccines to pregnant females by surveyed producers increased from 42% in 2010 (18) to 52 and 54% in 2016 (19) and 55 and 59% in 2020 (20) in pregnant cows and heifers, respectively.

Data from successive AMU surveys showed that the use of macrolides by western Canadian cow-calf producers increased significantly, from 44% in 2014 to 61% in 2020 (4). That trend matches a result from this study that indicated a significant increase in reported client use of phenicols and macrolides after 2018. A number of factors are potentially linked to this increase. First, this study showed that a significant increase in phenicol prescriptions occurred post-2018. Second, many phenicols and macrolides marketed in Canada are indicated for the treatment of bovine respiratory disease (including nursing calves), foot rot, and pink eye (21) — all of which are commonly treated diseases on cow-calf operations (4,14). Third, 8 new generic tulathromycins and 2 new generic florfenicols have entered the Canadian market since June 2017 (21,22), leading to a reduction in client price for these commonly used antimicrobials. Finally, the recent introduction of shock-resistant plastic bottles for some generic tulathromycin products and for generic florfenicols has been appealing to beef cattle operators.

Although numerically, macrolide prescriptions from veterinarians also appeared to trend upward, any increase in reported veterinary prescriptions observed in this study was not significant — unlike the reports of producer use. A caveat to the findings from the section of the survey querying producer use is that beef cow-calf producers tend to most frequently administer the antimicrobials to their animals themselves, so veterinarian reports are based on their impressions or discussions about client compliance.

The study population of veterinarians responding to the survey could have differed from the target population of all western Canadian veterinarians serving beef cow-calf clients in several aspects, known and unknown. Those agreeing to voluntarily participate in a survey are recognized to potentially differ in aggregate from all subjects in a target population. If they do, this can introduce selection bias (23). The net direction of this potential bias within the context of this survey was difficult to predict. Many individual text responses were not entirely positive or negative regarding the regulatory changes but were nuanced, presenting both pros and cons. Survey participants received a cash honorarium. Although such honoraria have been reported to increase study participation, research reporting the potential effects of such honoraria on selection or reporting bias is lacking (24).

Most study participants (52/72, 72%) were practice owners, and this group may have had different views regarding changes in antimicrobial prescription than the overall group of western Canadian beef practitioners. As business owners, their concerns include consideration of the effects of unpleasant or abusive interactions with potential clients, and the potential effects of client loss. The current survey was not intended to investigate these specific sub-questions, and thus the direction of bias associated with practice ownership in our dataset is unknown.

Since 2018, veterinary antimicrobial stewardship in Canada has been promoted in multiple ways, including through CVMA initiatives such as SAVI: The Stewardship of Antimicrobials by Veterinarians Initiative and its supporting Firstline phone app for veterinarians (2) and continuing education resources for veterinarians on antimicrobial stewardship. These activities may have broadly created a culture more supportive of stewardship, which then could have influenced participants’ survey responses. In the absence of published research reporting on the effects of these activities, the direction of bias is unclear. Hypothetically, participants could have been motivated to report optimal stewardship procedures even prior to, or alternatively, in response to, recent stewardship promotion initiatives.

Given the before-and-after nature of the study question, survey participants were asked to report on prescribing practices before and after the regulatory changes in 2018. Participants might have more accurately recalled more recent events, with potential for differential or non-differential misclassification of responses to vary based on personal characteristics of the participant, significance of the behavior probed, and social desirability of the behavior (25).

Of 72 survey participants, 43 shared additional, free-text comments for ≥ 1 question, the longest of which was 277 words. Given this volume of additional data, qualitative methods were used to summarize the messages the veterinarians took time to share. Analysis using NVivo yielded both themes and grouped specific comments. This was extremely helpful in adding insight to the quantitative results, highlighting how specific practice contexts led to varying experiences with the regulatory changes. For example, some participants from smaller practices indicated they were unable to offer the same pricing for antimicrobials as larger practices and, consequently, several participants described a shift in client numbers from smaller practices to larger ones.

Other factors affecting the practice experience after 2018 included the proportion of small-size operations served (as they posed more challenges in establishing and maintaining a VCPR), number of beef producers within the practice area not previously using a veterinarian, and staffing complement of the practice. The range of comments both positive and negative, sometimes from an individual participant, in the final comments section reflected the complexity of the topic. A major takeaway of this study was the picture it provided of the efforts made by practicing veterinarians to meet client needs while complying with the new regulatory environment.

Several participants suggested that additional tools could be created to support beef cow-calf veterinarians in antimicrobial prescribing. One comment suggested the need for an app presenting guidelines for antimicrobial prescribing, indicating room for additional publicity for the SAVI: The Stewardship of Antimicrobials by Veterinarians Initiative Firstline app for Canadian veterinarians (which provides this service free-of-charge to CVMA members) (2), in addition to the CVMA Guidelines for Veterinary Antimicrobial Use (15). Additional suggestions included tools to support prescribing and to track client antimicrobial inventories, client AMU, and disease incidence.

In conclusion, survey results indicated that the change in veterinary antimicrobial prescribing regulations in 2018 resulted in more beef cattle client needs for antimicrobials being met using the prescription procedures that were in place before 2018. Despite challenges encountered in complying with the new regulations, especially for smaller operations or infrequent clients, most survey participants were neutral to positive in their assessment of the impact on their own veterinary practice. The development of additional tools to support prescribing and to track declining client antimicrobial balances, client AMU, and disease incidence was suggested.

Funding Statement

Financial support was provided in part by the Beef Cattle Research Council and the Natural Sciences and Engineering Research Council of Canada.