CVS reports that a project it has been running since 2019 to increase the use of ear cytology and support the appropriate use of antibiotics in treating otitis externa (OE) in first opinion practice has resulted in an increase in intervention rates from 11% to 54.2%.

CVS says the use of ear cytology in OE is beneficial, both as a diagnostic and to evaluate the response to therapy. 

However, in 2019 the company looked at 26,269 of its patients and found that ear cytology was only being used in 19.2% of cases, in line with the rest of the profession. 

Only 11% of cases were being provided with in-house point-of-care cytology, whilst 8.2% had it performed externally.

80.8% of patients with OE were being prescribed antibiotics without cytological support, with 5% of these the highest priority critically important antibiotics (HPCIAs).

This low level of cytology use in primary care was suspected to be a major contributory factor to the significant use of unnecessary antibiotics.

To support its practices, CVS first looked at the barriers to performing ear cytology interventions, which were identified as a lack of confidence in using the microscope (particularly focusing on x100 and identification of pathological events), a perceived lack of time, insufficient or poorly working equipment, a lack of access to equipment, and the perception that cytology does not change the treatment choice or outcome.

As a second step, a minimal list of cytology equipment was developed to ensure that all sites had the right kit.

New equipment was then supplied to a practice if it did not meet minimum standards.

The company then produced education and resource materials, including new guidelines, imagery and video guides, to upskill both its vets and nurses.

The training focused on: equipment maintenance, cleaning and troubleshooting, how to use the microscope – including x100 magnification and the slide oil immersion technique, how to identify pathological changes, and time management to get a consultation done – including swabbing, microscope analysis, diagnosis and client consultation.

Each site was then provided with its own data, so that it could monitor progress.

Elizabeth McLennan Green, CVS Clinical Director for the North, said: “One of our goals with this project was to minimise the number of antibiotics prescribed without associated diagnostics, and to use ear cytology to guide therapy and response to treatment for the benefit of our patients and clients.”

“We know that low ear cytology interventions are an issue across the profession. We wanted to do better. So ear cytology has been our first and longest running clinical improvement project.

"We’re thrilled with the brilliant results our colleagues are now achieving.”

There's a video presentation about the project here: 

Photo: Emily Spencer, Head Vet at Castle Vets

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