Individualized Graphical Feedback can Reduce Dentists' Antibiotic Prescriptions

Dentists in the UK prescribe about 10 percent of the antibiotics dispensed in community pharmacies. They prescribe antibiotics in the absence of clinical need.

Dentists who receive a personalized report detailing their past prescription rates are less likely to prescribe antibiotics, according to a randomized controlled trial of UK.

The randomized controlled trial was conducted by Linda Young, NHS Education for Scotland, UK, Jan Clarkson, University of Dundee and Craig Ramsay, Health Services Research Unit, University of Aberdeen, and colleagues.

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‘Dentists who received a written behavior change message were likely to reduce prescribing inappropriate antibiotics to their patients.’

Dentists prescribe about 10 percent of the antibiotics dispensed in UK community pharmacies. Previous studies have found that, despite clear clinical guidelines, they often prescribe antibiotics in the absence of clinical need.

To test an "audit and feedback" intervention to reduce these inappropriate prescriptions, the RAPiD (Reducing Antibiotic Prescribing in Dentistry) trial relied on dental prescribing and treatment claim data that was already routinely collected by the National Health Service.

The researchers are randomly assigned all 795 antibiotic prescribing general dentist practices in Scotland (a total of 2566 dentists) to either receive or not receive a graph plotting their monthly antibiotic prescribing rate. A random subset of practices in the intervention group also received a written behavior change message reiterating national recommendations.

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At the start of the trial, the total number of antibiotics prescribed per 100 NHS treatment claims was 8.3 in the control group and 8.5 in the intervention group. Over the 12 months following the start of the intervention, dentists in the control group practices prescribed antibiotics at a rate of 7.9 per 100 claims, and dentists in the intervention group practices at a rate of 7.5, representing a 5.7% reduction in antibiotic prescriptions in the intervention group about the control group. Furthermore, dentists who received a written behavior change message had an even greater reduction, of 6.1% about intervention dentists who did not receive this message.

While the findings suggest that providing individualized graphical feedback derived from routinely collected data can reduce the antibiotic prescribing rate of dentists, it was not possible to evaluate the impact on the quality or appropriateness of dentists' antibiotic prescribing in this study.

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"The feedback provided in this study is a relatively straightforward, low-cost public health and patient safety intervention that could potentially help the entire healthcare profession address the increasing challenge of antimicrobial resistance," the authors say.

The study is published in the PLOS Medicine.

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Source-Eurekalert