Exploring challenges for infectious diseases diagnostics in human and veterinary medicine in 2023 in German speaking countries: A One-Health approach to Diagnostic Stewardship

Background Diagnostic steps are often overlooked in antimicrobial stewardship programs, however, incorrect tests may lead to unnecessary treatments, increased costs, adverse health outcomes, and reduced antimicrobial drug efficacy. This One-Health-oriented study addresses interprofessional cooperation, knowledge and needs for improvement, thereby identifying problems along the diagnostic pathway and potential targets for diagnostic stewardship interventions. Methods: A web-based survey (166 items) among German-speaking healthcare workers in human and veterinary medicine was conducted using a snowball sampling approach. Data were analyzed descriptively and using t-tests and chi-squared tests. Specific questions to assess diagnostic knowledge were included, error rates for the different groups were computed. This paper presents analyses of the domains ‘interprofessional cooperation’, ‘knowledge level’ and ‘perceived need for improvement’. Results: Responses from 2,464 people were analysed. The 2,091 senders of microbiological samples comprised approximately 70% prescribers (physicians, veterinarians) and 30% allied healthcare workers, e.g. nurses. Around 50% of prescribers and 30% of allied health care workers (nurses, medical assistants, etc.) rated their diagnostics knowledge as good. Physicians had higher error rates than veterinarians when answering questions testing the knowledge level; medical assistants had higher error rates than physicians. Physicians reported delegating diagnostic-related tasks more often than veterinarians. Major reasons for not delegating were personnel unavailability and poor perceived reliability of allied health care workers (p<0.001). Respondents indicated that they would appreciate additional information when requesting tests (cost, minimal sample volume, transport time, time-to-result) . Conclusions: Our data reveal knowledge gaps in all surveyed health care workers and a lack of available information in numerous domains at the time of testing, pointing towards possible targets for diagnostic stewardship interventions.