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Drug Prescribing

UntitledThe Scottish Dental Clinical Effectiveness Programme (SDCEP) first published Drug Prescribing for Dentistry in April 2008. A second edition was published in August 2011 and a newly updated third edition released in January 2016. An app (iPhone® and Android) is also available.

Despite the introduction of the guidance, there is wide variation in dental drug prescribing in Scotland and evidence from routinely collected dental prescribing data demonstrates that the guidance has had little impact on the number of antibiotics prescribed by primary care dentists in Scotland.

When considering how best to support the translation of guidance into practice there is evidence that audit and feedback (A&F) strategies (defined as ‘any summary of clinical performance of health care over a specified period of time’ aimed at changing health professional behaviour) have consistently demonstrated small to moderate sized effects.  However, there is still some uncertainty in predicting what type of A&F and in which clinical circumstances these strategies will be most effective*.

Reducing Antibiotic Prescribing in Dentistry (RAPiD)

TRiaDS conducted the RAPiD trial in NHS general dental practices during May 2013 – April 2014. RAPiD, a cluster, randomised controlled trial used national, routinely collected dental prescribing and treatment data to compare the effectiveness of individualised A&F strategies in reducing dental antibiotic prescribing by primary care dentists in Scotland. More information on the trial design and methods can be found in the study protocol [1].

The RAPiD study provides a robust evaluation of the impact of A&F on antibiotic prescribing in real-world dental practice. The results demonstrate that the provision of A&F resulted in a significant 6% reduction in antibiotic prescribing rates per 100 courses of NHS treatment. Extrapolated to all dentists in Scotland, this represents a reduction of approximately 20,000 antibiotic items over 12 months. To read more about the results please see the summary report and study publications [2,3]

Trial Registration: Current Controlled Trials ISRCTN 49204710

Study contact: Dr Paula Elouafkaoui, tel: +44 (0)1382 740917, e-mail: TRiaDS@nes.scot.nhs.uk

National Audit

In 2014, TRiaDS led the development of a national, pre-approved online audit on antibiotic prescribing. The aim of the audit is to help improve prescribing practices by dentists across Scotland. The audit requires dentists to review their current practices against recommended practices and to consider alternatives to prescribing antibiotics. Action planning to implement changes, if required, also makes up part of the audit.

The audit was closed to new participants at the end of January 2016. The data is currently being analysed and a summary report will be available in due course.

Publications and Presentations

[1] Prior M, Elouafkaoui P, Elders A, Young L, Duncan E, Newlands R, Clarkson JE, Ramsay CR, for the Translation Research in a Dental Setting (TRiaDS) Research Methodology Group. Evaluating an audit and feedback intervention for reducing antibiotic prescribing behaviour in general dental practice (the RAPiD trial): a partial factorial cluster randomised trial protocol. Implementation Science 2014, 9:50

[2] Newlands R, Duncan EM, Prior M, Elouafkaoui P, Elders A, Young L, et al. Barriers and facilitators of evidence-based management of patients with bacterial infections among general dental practitioners: a theory-informed interview study. Implementation Science 2016,11:11

[3] Elouafkaoui P, Young L, Newlands R, Duncan EM, Elders A, Clarkson JE, et al (2016). An Audit and Feedback Intervention for Reducing Antibiotic Prescribing in General Dental Practice. PLOS Med 13(8): e1002115. doi:10.1371/journal.pmed.1002115