Background – The literature shows that the prescription of antibiotics in dental care is often unnecessary or inappropriate. Indicators estimating the appropriateness of antibiotics prescribed by dentists based on routine databases are however not available in the literature. Our objectives were to: (i) design proxy indicators estimating the appropriateness of antibiotics prescribed by dentists; (ii) evaluate their clinimetric properties; and (iii) provide results for these proxy indicators for dentists located in a north-eastern French region.
Methods – We selected and adapted proxy indicators from the literature. Using 2019 Regional Health Insurance data, we evaluated the proxy indicators’ clinimetric properties (measurability, applicability, and potential room for improvement), their results with performance scores (% of dentists who reached the target value), and the case-mix stability.
Results – We included 3,014 general dental practitioners, who prescribed a total of 373,975 antibiotics to 308,123 patients in 2019. We identified four proxy indicators estimating antibiotic prescribing appropriateness in dental care. All proxy indicators had good clinimetric properties. Performance scores were generally low (10.5 to 73.0%, depending on the indicator), suggesting an important room for improvement. These results showed large variations between dentists (large interquartile ranges) and according to the patients’ characteristics (case-mix stability).
Conclusion – These four proxy indicators might be used to guide antibiotic stewardship interventions in dental care.
Background – The use of antibiotics in dental care is often unnecessary or inappropriate. Our objectives were to identify (i) clusters of dentists grouped according to their appropriateness score based on proxy indicators’ results; and (ii) dentists’ and patients’ characteristics associated with the appropriateness of antibiotic prescriptions.Methods – We used data of the Health Insurance reimbursement databases on antibiotics prescribed in 2019 by general dental practitioners of the Grand Est region in France. The appropriateness of antibiotic prescriptions was estimated by the results of recently published proxy indicators. We conducted a cluster analysis according to an appropriateness score calculated for each dentist, using the Ward method. We then conducted bivariate and multivariable analyses to identify characteristics associated with these clusters.Results – We included 3,014 dentists, which were grouped into three clusters. We identified several characteristics significantly associated with the appropriateness of antibiotic prescriptions. Overall, dentists had more appropriate prescription practices when they were male, having a predominant surgery practice in the Lorraine area for less years, when they had healthier patients (i.e. younger, with no chronic diseases, and who received less procedures), and when they had a more prudent use of drugs in general (i.e. less drug expenses, less prescriptions of all drugs, less prescriptions of antibiotics and less prescriptions of systemic non-steroidal anti-inflammatory drugs).Conclusions – We identified clusters and characteristics associated with the appropriateness of antibiotic prescriptions made by dentists, which might help guiding antimicrobial stewardship interventions.
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