Quality Education for a Healthier Scotland
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 ProgrammeNHS Education for Scotland
Quality Education for a Healthier Scotland
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.
Quality Education for a Healthier Scotland
Scottish Dental Clinical Effectiveness Programme (SDCEP)
• Provide user-friendly, evidence- based 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
‘supporting the dental team to provide quality patient care’
Quality Education for a Healthier Scotland
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.
Quality Education for a Healthier Scotland
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
Quality Education for a Healthier Scotland
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
Quality Education for a Healthier Scotland
• 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
Quality Education for a Healthier Scotland
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 StoreSM
• Embedded analytics programme which allows analysis of app usage
“No dentist should be without this”An English Dean
Quality Education for a Healthier Scotland
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
Quality Education for a Healthier Scotland
Total prescribing by dentists
0
20,000
40,000
60,000
80,000
100,000
120,000
Apr‐J
un 07
Jul‐S
ep 07
Oct‐D
ec 07
Jan‐M
ar 08
Apr‐J
un 08
Jul‐S
ep 08
Oct‐D
ec 08
Jan‐M
ar 09
Apr‐J
un 09
Jul‐S
ep 09
Oct‐D
ec 09
Jan‐M
ar 10
Apr‐J
un 10
Jul‐S
ep 10
Oct‐D
ec 10
Jan‐M
ar 11
Apr‐J
un 11
Jul‐S
ep 11
Oct‐D
ec 11
Jan‐M
ar 12
Quarter
No. of items antibiotics
ear, nose & oropharynx
fluoride
analgesics
hypnotics
other
SDCEP Ed 1
Quality Education for a Healthier Scotland
Dental antibiotic prescribing by drug
0
10,000
20,000
30,000
40,000
50,000
60,000
70,000
Apr‐J
un 07
Jul‐S
ep 07
Oct‐D
ec 07
Jan‐M
ar 08
Apr‐J
un 08
Jul‐S
ep 08
Oct‐D
ec 08
Jan‐M
ar 09
Apr‐J
un 09
Jul‐S
ep 09
Oct‐D
ec 09
Jan‐M
ar 10
Apr‐J
un 10
Jul‐S
ep 10
Oct‐D
ec 10
Jan‐M
ar 11
Apr‐J
un 11
Jul‐S
ep 11
Oct‐D
ec 11
Jan‐M
ar 12
Quarter
Num
ber of Item
s
AMOXICILLIN
METRONIDAZOLE
PHENOXYMETHYLPENICILL
ERYTHROMYCIN
OTHERS
SDCEP Ed 1
Quality Education for a Healthier Scotland
70% reduction in prescribing of amoxicillin 3g following publication of national guidance
0
200
400
600
800
1000
1200
1400
1600
1800
01‐A
pr‐0
701
‐Jun‐
0701
‐Aug
‐0701
‐Oct‐
0701
‐Dec
‐07
01‐Fe
b‐08
01‐A
pr‐0
801
‐Jun‐
0801
‐Aug
‐0801
‐Oct‐
0801
‐Dec
‐08
01‐Fe
b‐09
01‐A
pr‐0
901
‐Jun‐
0901
‐Aug
‐0901
‐Oct‐
0901
‐Dec
‐09
01‐Fe
b‐10
01‐A
pr‐1
001
‐Jun‐
1001
‐Aug
‐1001
‐Oct‐
1001
‐Dec
‐10
01‐Fe
b‐11
01‐A
pr‐1
101
‐Jun‐
1101
‐Aug
‐1101
‐Oct‐
1101
‐Dec
‐11
01‐Fe
b‐12
01‐A
pr‐1
2Num
ber
Number of Items
Number of Dentists
SDCEP Ed 1
NICE guidance
Quality Education for a Healthier Scotland
Changes in the prescribing of clindamycin and co-amoxiclav
0
200
400
600
800
1,000
1,200
Apr‐J
un 07
Jul‐S
ep 07
Oct‐D
ec 07
Jan‐M
ar 08
Apr‐J
un 08
Jul‐S
ep 08
Oct‐D
ec 08
Jan‐M
ar 09
Apr‐J
un 09
Jul‐S
ep 09
Oct‐D
ec 09
Jan‐M
ar 10
Apr‐J
un 10
Jul‐S
ep 10
Oct‐D
ec 10
Jan‐M
ar 11
Apr‐J
un 11
Jul‐S
ep 11
Oct‐D
ec 11
Jan‐M
ar 12
Quarter
Num
ber of Item
s
CLINDAMYCIN
CO‐AMOXICLAV
SDCEP Ed 1
Quality Education for a Healthier Scotland
Anti-fungal drugs
0
200
400
600
800
1000
1200
1400
Apr‐J
un 07
Jul‐S
ep 07
Oct‐D
ec 07
Jan‐M
ar 08
Apr‐J
un 08
Jul‐S
ep 08
Oct‐D
ec 08
Jan‐M
ar 09
Apr‐J
un 09
Jul‐S
ep 09
Oct‐D
ec 09
Jan‐M
ar 10
Apr‐J
un 10
Jul‐S
ep 10
Oct‐D
ec 10
Jan‐M
ar 11
Apr‐J
un 11
Jul‐S
ep 11
Oct‐D
ec 11
Jan‐M
ar 12
Quarter
No. of items
miconozolefluconazolenystatin
SDCEP Ed 1
Quality Education for a Healthier Scotland
Data From Analytics Programme
Local Measures 25%
1st Line Antibiotics 54%
2nd Line Antibiotics 4%
Other(end session, ANUG, etc.)
17%
From this screen, users chose:
Quality Education for a Healthier Scotland
Data From Analytics Programme
From this screen, users chose:
Amoxicillin 50%
Phenoxymethyl- penicillin
7%
Metronidazole 12%
Erythromycin 8%
Other(end session, ANUG)
23%
Quality Education for a Healthier Scotland
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
Quality Education for a Healthier Scotland
RAPiD – Reducing Antibiotic Prescribing in Dentistry
Control Group
Current PracticeNo A&F
Audit & Feedback with Persuasive Message
Audit & Feedback
Audit & Feedback
General Dental PracticesRandomised
Report with comparison
Reportonly
Report with comparison
Report only
Quality Education for a Healthier Scotland
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
Quality Education for a Healthier Scotland
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
www.sdcep.org.uk
