Impact of National Guidance for Drug Prescribing for Dentistry
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1 Impact of National Guidance for Drug Prescribing for Dentistry Samantha Rutherford Jan Clarkson, Doug Stirling, Linda Young, Paula Elouafkaoui, Anna Templeton, Craig Ramsay on behalf of the TRiaDS methodology group Scottish Dental Clinical Effectiveness Programme NHS Education for Scotland
2 Impact of National Guidance for Drug Prescribing for Dentistry SDCEP and TRiaDS Guidance on Drug Prescribing For Dentistry Analysis of routine data Implementation strategy I certify that, to the best of my knowledge, no aspect of my current personal or professional situation might reasonably be expected to affect significantly my views on the subject on which I am presenting.
3 Scottish Dental Clinical Effectiveness Programme (SDCEP) supporting the dental team to provide quality patient care Provide user-friendly, evidencebased guidance Priority topics for oral health Published guidance distributed to all dental practitioners in Scotland Relevant to other healthcare disciplines Used within Scotland and beyond Underpins education and informs policy
4 TRiaDS Translational Research in a Dental Setting A programme of knowledge translation research embedded within SDCEP guidance development. Uses a standardised process to inform development of guidance need for, and design of, KT strategies; evaluation of KT strategies. A multi-disciplinary research collaboration with public, academic, policy, service and professional members. Aims to improve knowledge translation into practice.
5 Drug Prescribing For Dentistry Guidance One of nine SDCEP guidance publications Improve access to dentally-relevant information on prescribing National quality improvement initiative on antimicrobial prescribing Concern about co-prescribing of warfarin and statins and associated drug interaction issues
6 Drug Prescribing For Dentistry Guidance Local measures highlighted Antibiotics only recommended for spreading, systemic infection References NICE recommendation on antibiotic prophylaxis First edition published in April 2008 Printed updates provided in line with changes to relevant prescribing advice in BNF or BNFC Second edition published August 2011 Has proved very popular
7 A5 spiral bound booklet Problem-oriented style with drug regimens presented as prescriptions Footnote highlights notable drug interactions and other relevant information To be used in association with BNF and BNFC for further interaction details
8 Dental Prescribing app Direct links to BNF website for drug interaction information Updated when new BNF released; updates are free >1100 downloads across the globe in first 4 months of release Very positive feedback from users on App Store SM Embedded analytics programme which allows analysis of app usage No dentist should be without this An English Dean
9 Monitoring of Prescribing SDCEP has access to prescribing data for all individual dentists in Scotland Routine prescribing data was monitored pre- and post-publication, analysed and trends identified Around 8% of antibiotic prescriptions in Scotland originate from dentists
10 120, ,000 80,000 60,000 40,000 20,000 0 Total prescribing by dentists SDCEP Ed 1 antibiotics ear, nose & oropharynx fluoride analgesics hypnotics other Apr Jun 08 Jul Sep 08 Oct Dec 08 Jan Mar 09 Apr Jun 09 Jul Sep 09 Oct Dec 09 Jan Mar 10 Apr Jun 10 Jul Sep 10 Oct Dec 10 Jan Mar 11 Apr Jun 11 Jul Sep 11 Oct Dec 11 Jan Mar 12 Jan Mar 08 Quarter Oct Dec 07 Apr Jun 07 Jul Sep 07 No. of items
11 70,000 60,000 50,000 40,000 30,000 20,000 10,000 0 Dental antibiotic prescribing by drug SDCEP Ed 1 AMOXICILLIN METRONIDAZOLE PHENOXYMETHYLPENICILL ERYTHROMYCIN OTHERS Jul Sep 07 Oct Dec 07 Jan Mar 08 Apr Jun 08 Jul Sep 08 Oct Dec 08 Jan Mar 09 Apr Jun 09 Jul Sep 09 Oct Dec 09 Jan Mar 10 Apr Jun 10 Jul Sep 10 Oct Dec 10 Jan Mar 11 Apr Jun 11 Jul Sep 11 Oct Dec 11 Jan Mar 12 Apr Jun 07 Quarter Number of Items
12 % reduction in prescribing of amoxicillin 3g following publication of national guidance NICE guidance SDCEP Ed 1 Number of Items Number of Dentists 01 Aug Oct Dec Feb Apr Jun Aug Oct Dec Feb Apr Jun Aug Oct Dec Feb Apr Jun Aug Oct Dec Feb Apr Jun Aug Oct Dec Feb Apr Apr Jun 07 Number
13 1,200 1, Changes in the prescribing of clindamycin and co-amoxiclav SDCEP Ed 1 CLINDAMYCIN CO AMOXICLAV Jan Mar 08 Apr Jun 08 Jul Sep 08 Oct Dec 08 Jan Mar 09 Apr Jun 09 Jul Sep 09 Oct Dec 09 Jan Mar 10 Apr Jun 10 Jul Sep 10 Oct Dec 10 Jan Mar 11 Apr Jun 11 Jul Sep 11 Oct Dec 11 Jan Mar 12 Quarter Oct Dec 07 Apr Jun 07 Jul Sep 07 Number of Items
14 Anti-fungal drugs SDCEP Ed 1 miconozole fluconazole nystatin Jul Sep 08 Oct Dec 08 Jan Mar 09 Apr Jun 09 Jul Sep 09 Oct Dec 09 Jan Mar 10 Apr Jun 10 Jul Sep 10 Oct Dec 10 Jan Mar 11 Apr Jun 11 Jul Sep 11 Oct Dec 11 Jan Mar 12 Quarter Apr Jun 08 Jan Mar 08 Oct Dec 07 Apr Jun 07 Jul Sep 07 No. of items
15 Data From Analytics Programme From this screen, users chose: Local Measures 25% 1 st Line Antibiotics 54% 2 nd Line Antibiotics 4% Other (end session, ANUG, etc.) 17%
16 Data From Analytics Programme From this screen, users chose: Amoxicillin 50% Phenoxymethylpenicillin 7% Metronidazole 12% Erythromycin 8% Other (end session, ANUG) 23%
17 Monitoring of Prescribing Total antibiotic prescribing by dentists has not decreased, except in case of amoxicillin 3g An additional KT intervention is required In the Cochrane Review Audit and Feedback: Effects on Professional Practice and Healthcare Outcomes A&F is said to be effective when baseline performance is low verbal and written delivery by a supervisor or senior colleague provided more than once aims to decrease current behaviours targets prescribing includes targets and an action plan
18 RAPiD Reducing Antibiotic Prescribing in Dentistry Control Group General Dental Practices Randomised Current Practice No A&F Audit & Feedback Audit & Feedback Audit & Feedback with Persuasive Message Report with comparison Report only Report with comparison Report only
19 In Conclusion Guidance for drug prescribing in dentistry was published in 2008 Routine monitoring of prescribing shows there has not been a reduction in dental antibiotic prescribing A further KT intervention (RAPiD) will be implemented which will encourage appropriate prescribing by audit and feedback assess A&F as a method to change professional behaviour Monitoring of routine data can be an invaluable tool to support guidance implementation
20 Thanks SDCEP Programme Development Team TRiaDS Methodology Group Drug Prescribing for Dentistry Guidance Development Group NHS Education for Scotland University of Dundee Dental Hospital and School Waracle
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