A recent study out of the UK suggests that dentists may reduce the number of antibiotic prescriptions they hand out after being given a bad grade on a “report card” for their prescribing rates. In the UK, dentists prescribe about 10% of all antibiotics, but many are prescribed unnecessarily and are contributing to antibiotic resistance.
The study was focused in Scotland and covered all 795 antibiotic-prescribing dental practices under the National Health Service.
The dental practices were randomized into one of three groups: a control (163 practices with 567 dentists), a graph audit and feedback group (316 practices, 1,001 dentists), and a graph plus a written audit and feedback group (316 practices, 998 dentists).
The control group was left alone, while the graphical audit and feedback (A&F) practices were given a line graph plotting their individual dentists’ antibiotic prescribing rates. The graph plus written A&F group was given the same type of graph along with a written message summarizing national guidance for dental antibiotic prescriptions. Prescription rates were looked at before the audit and feedback was delivered one year afterwards.
At baseline, the control practices prescribed an average of 8.3 antibiotics for every 100 patients and the A&F practices were prescribing 8.5, indicating that they were about equal in habit. One year later, the A&F practices were found to be prescribing at a rate of 7.5 per 100 instead.
When the feedback group was broken down into the graph and graph plus written feedback, it was found that the written feedback group had a six percent lower prescribing rate (7.2 prescriptions per 100 patients versus 7.7). For comparison, the control group ended the study with an antibiotic prescription rate of 7.9.
What This Means
The differences between these figures may raise a few eyebrows. After all, there’s only a 0.4 difference between the control group and the average of the feedback groups. However, this is one of those situations where a little is a lot.
The researchers calculated that if every dental practice in Scotland, not just National Health Service practices, were given feedback, it would result in 20,000 fewer antibiotic prescriptions.
Since prescription data is already collected, this study suggests that giving antibiotic report cards to dentists could be an easy-to-implement way to get a modest reduction in antibiotic prescriptions.
Elouafkaoui, P., et. al., “An Audit and Feedback Intervention for Reducing Antibiotic Prescribing in General Dental Practice: The RAPiD Cluster Randomized Controlled Trial,” PLOS Medicine, 2016; http://dx.doi.org/10.1371/journal.pmed.1002115.
“Antibiotic ‘Report Card’ Drills Guidelines Into Dentists,” Pantagraph web site, last updated August 31, 2016; http://www.pantagraph.com/lifestyles/health-med-fit/antibiotic-report-card-drills-guidelines-into-dentists/article_2002722c-7361-5a9b-80a1-653d15c19385.html, last accessed September 2, 2016.