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Evaluation of an OPEN Stewardship generated feedback intervention to improve antibiotic prescribing among primary care veterinarians in Ontario, Canada and Israel: protocol for evaluating usability and an interrupted time-series analysis
  1. Kamal Raj Acharya1,
  2. Gabrielle Brankston1,
  3. Jean-Paul R Soucy2,
  4. Adar Cohen3,
  5. Anette Hulth4,
  6. Sonja Löfmark4,
  7. Nadav Davidovitch5,
  8. Moriah Ellen6,7,8,
  9. David N Fisman2,
  10. Jacob Moran-Gilad5,
  11. Amir Steinman3,
  12. Derek R MacFadden9,
  13. Amy L Greer1
  1. 1Department of Population Medicine, University of Guelph, Guelph, Ontario, Canada
  2. 2Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
  3. 3Koret School of Veterinary Medicine, The Robert H. Smith Faculty of Agriculture, Food and Environment, The Hebrew University of Jerusalem, Rehovot, Israel
  4. 4Public Health Agency of Sweden, Stockholm, Sweden
  5. 5School of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
  6. 6McMaster Health Forum, McMaster University, Hamilton, Ontario, Canada
  7. 7Department of Health Systems Management, Guilford Glazer Faculty of Business and Management and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
  8. 8Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
  9. 9Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
  1. Correspondence to Dr Amy L Greer; agreer{at}


Introduction Antimicrobial resistance (AMR) impacts the health and well-being of animals, affects animal owners both socially and economically, and contributes to AMR at the human and environmental interface. The overuse and/or inappropriate use of antibiotics in animals has been identified as one of the most important drivers of the development of AMR in animals. Effective antibiotic stewardship interventions such as feedback can be adopted in veterinary practices to improve antibiotic prescribing. However, the provision of dedicated financial and technical resources to implement such systems are challenging. The newly developed web-based Online Platform for Expanding Antibiotic Stewardship (OPEN Stewardship) platform aims to automate the generation of feedback reports and facilitate wider adoption of antibiotic stewardship. This paper describes a protocol to evaluate the usability and usefulness of a feedback intervention among veterinarians and assess its impact on individual antibiotic prescribing.

Methods and analysis Approximately 80 veterinarians from Ontario, Canada and 60 veterinarians from Israel will be voluntarily enrolled in a controlled interrupted time-series study and their monthly antibiotic prescribing data accessed. The study intervention consists of targeted feedback reports generated using the OPEN Stewardship platform. After a 3-month preintervention period, a cohort of veterinarians (treatment cohort, n=120) will receive three feedback reports over the course of 6 months while the remainder of the veterinarians (n=20) will be the control cohort. A survey will be administered among the treatment cohort after each feedback cycle to assess the usability and usefulness of various elements of the feedback report. A multilevel negative-binomial regression analysis of the preintervention and postintervention antibiotic prescribing of the treatment cohort will be performed to evaluate the impact of the intervention.

Ethics and dissemination Research ethics board approval was obtained at each participating site prior to the recruitment of the veterinarians. The study findings will be disseminated through open-access scientific publications, stakeholder networks and national/international meetings.

  • public health
  • statistics & research methods
  • primary care

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  • Correction notice This article has been corrected since it first published. The provenance and peer review statement has been included.

  • Contributors KRA, GB, J-PRS, AC, AH, SL, ND, ME, DNF, JM-G, AS, DRM and ALG conceived the study and analysis. KRA codrafted the protocol with GB and ALG and will conduct the data analysis, J-PRS contributed to the refinement of the methodology section of the protocol, AC wrote the Israel specific part of the methodology section, AH and SL drafted the questionnaire and piloting protocol for the questionnaire and all the coauthors reviewed the questionnaire. All the authors reviewed the protocol and agree to the final version being submitted.

  • Funding This work was supported by the funding from the Canadian Institutes of Health Research (CIHR), under the European Commission's Joint Programming Initiative on Antimicrobial Resistance (5th Joint Call).

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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