A multicentre, multicycle audit of the prescribing practices of three paediatric dental departments in the North of England

Yesudian, Grainne; Gilchrist, Fiona; Bebb, Katie; Albadri, Sondos; Aspinall, Ann; Swales, Karen Louise; Deery, Chris

doi:10.1038/sj.bdj.2015.440

Cited by 8 publications

(6 citation statements)

References 23 publications

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“…However, merely listing practices to avoid does not solve the LVC problem (12). Other types of interventions that have been studied include clinical decision support (13), provider feedback (14), educational interventions for clinicians (15) and patients (16), and nancial incentives (17). In their systematic review, Colla et al (18) found that the most common intervention was clinical decision support and showed that there is considerable evidence for the effectiveness of clinical decision support and provider feedback.…”

Section: Different Attempts Have Been Made To Decrease the Use Of Lvcmentioning

confidence: 99%

Why Do They Do It? A Grounded Theory Study of the Use of Low-value Care Among Primary Health Care Physicians

Ingvarsson

Augustsson

Hasson

et al. 2020

Preprint

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Background The use of low-value care (LVC) is widespread and has an impact on both the use of resources and quality of care. However, few studies have thus far studied the factors influencing the use of LVC from the perspective of the practitioners themselves. The aim of this study is to understand why physicians within primary care use LVC. Methods Six primary health care centers in the Stockholm Region were purposively selected based on their level of prescription of three low-value lab tests (e.g., erythrocyte sedimentation rate, aspartate transaminase, vitamin D). FGDs were conducted with physicians (n = 31) working in the centers. The discussions were coded inductively using a grounded theory approach. Results Three main reasons for performing LVC were identified. Uncertainty and disagreement about what not to do was related to being unaware of the LVC status of a practice, guidelines perceived as conflicting, guidelines perceived to be irrelevant for the target patient population, or a lack of trust in the guidelines. Perceived pressure from others concerned patient pressure, pressure from other physicians, or pressure from the health care system. A desire to do something for the patients was associated with the fact that the visit in itself prompts action, symptoms to relieve, or emotions to calm. The three reasons are interdependent. Uncertainty and disagreement about what not to do have made it more difficult to handle the pressure from others and to refrain from doing something for the patients. The pressure from others and the desire to do something for the patients enhanced the uncertainty and disagreement about what not to do. Furthermore, the pressure from others influenced the desire to do something for the patients. Conclusions Three reasons work together to explain primary care physicians’ use of LVC: uncertainty and disagreement about what not to do, perceived pressure from others, and the desire to do something for the patients. The reasons may, in turn, be influenced by the health care system, but the decision nevertheless seemed to be up to the individual physician. The findings suggest that the de-implementation of LVC needs to address the three reasons from a systems perspective.

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Section: Different Attempts Have Been Made To Decrease the Use Of Lvcmentioning

confidence: 99%

Why Do They Do It? A Grounded Theory Study of the Use of Low-value Care Among Primary Health Care Physicians

Ingvarsson

Augustsson

Hasson

et al. 2020

Preprint

View full text Add to dashboard Cite

show abstract

“…However, merely listing practices to avoid does not solve the LVC problem [8]. Other types of strategies that have been studied include clinical decision support [9], provider feedback [10], education for clinicians [11] and patients [12], and financial incentives [13]. In their systematic review, Colla et al [14] found that the most common strategy was clinical decision support and showed that there is considerable evidence for the effectiveness of clinical decision support and provider feedback.…”

Section: Introductionmentioning

confidence: 99%

Why do they do it? A grounded theory study of the use of low-value care among primary health care physicians

et al. 2020

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Background The use of low-value care (LVC) is widespread and has an impact on both the use of resources and the quality of care. However, few studies have thus far studied the factors influencing the use of LVC from the perspective of the practitioners themselves. The aim of this study is to understand why physicians within primary care use LVC. Methods Six primary health care centers in the Stockholm Region were purposively selected. Focus group discussions were conducted with physicians (n = 31) working in the centers. The discussions were coded inductively using a grounded theory approach. Results Three main reasons for performing LVC were identified. Uncertainty and disagreement about what not to do was related to being unaware of the LVC status of a practice, guidelines perceived as conflicting, guidelines perceived to be irrelevant for the target patient population, or a lack of trust in the guidelines. Perceived pressure from others concerned patient pressure, pressure from other physicians, or pressure from the health care system. A desire to do something for the patients was associated with the fact that the visit in itself prompts action, symptoms to relieve, or that patients' emotions need to be reassured. The three reasons are interdependent. Uncertainty and disagreement about what not to do have made it more difficult to handle the pressure from others and to refrain from doing something for the patients. The pressure from others and the desire to do something for the patients enhanced the uncertainty and disagreement about what not to do. Furthermore, the pressure from others influenced the desire to do something for the patients. Conclusions Three reasons work together to explain primary care physicians’ use of LVC: uncertainty and disagreement about what not to do, perceived pressure from others, and the desire to do something for the patients. The reasons may, in turn, be influenced by the health care system, but the decision nevertheless seemed to be up to the individual physician. The findings suggest that the de-implementation of LVC needs to address the three reasons from a systems perspective.

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“…14 Of all of the included studies, only 9 were dedicated to dental specialty groups. [15][16][17][18][19][20][21][22][23] The specialties included oral and maxillofacial surgery (n = 4), 16,20,21,23 endodontics (n = 2), 15,18 pediatric dentistry (n = 2), 17,19 and periodontics (n = 1) 22 ; no studies were focused on dental public health, oral and maxillofacial pathology, oral and maxillofacial radiology, orthodontics and dentofacial orthopedics, or prosthodontics. Furthermore, 8 of the 9 studies were crosssectional surveys, which prevents evaluation of antibiotic prescribing trends over time.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, 8 of the 9 studies were crosssectional surveys, which prevents evaluation of antibiotic prescribing trends over time. [15][16][17][18][19][20][21][22] Despite the limitations, previous studies of antibiotic prescribing patterns among dental specialists had important findings. In 1 study of pediatric dentists, 30% reported prescribing antibiotics for a prolonged duration (10 days), and 15% reported prescribing antibiotics for dental pain.…”

Section: Discussionmentioning

confidence: 99%

Longitudinal antibiotic prescribing trends among US dental specialists within a pharmacy benefits manager, 2013 through 2015

Durkin¹,

Feng²,

Suda³

et al. 2019

The Journal of the American Dental Association

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Background.-Reducing inappropriate antibiotic prescriptions (Rxs) is a major quality improvement initiative in the United States. Tracking antibiotic prescribing trends is 1 method of assessing improvement in antibiotic prescribing. The purpose of this study was to assess longitudinal antibiotic prescribing practices among dental specialists.Methods.-This was a retrospective ecological longitudinal trend study. The authors calculated monthly systemic antibiotic Rx counts, and rates per 100,000 beneficiaries, from a pharmacy benefits manager in the United States from 2013 through 2015. The authors calculated average annual antibiotic Rx rates (AARs) for the 3-year study period. The authors used a quasi-Poisson regression model to analyze antibiotic Rx trends. The authors quantified seasonal trends, when present, via peak-to-trough ratios (PTTRs).Results.-Dental specialists prescribed 2.4 million antibiotics to the cohort of 38 million insurance beneficiaries during the 3-year study period (AAR = 2,086 Rxs per 100,000 beneficiaries). Oral and maxillofacial surgeons prescribed the most antibiotics (1,172,104 Rxs; AAR = 1,018 Rxs per 100,000 beneficiaries), followed by periodontists (527,038 Rxs; AAR = 457 Rxs per 100,000 beneficiaries), and endodontists (447,362 Rxs; AAR = 388 Rxs per 100,000 beneficiaries). Longitudinal antibiotic prescribing trends were stable among all dental specialties in the regression models (P > .05). The authors observed substantial seasonal variation in antibiotic Rxs in 2 specialties: pediatric dentistry (PTTR, 1.18; 95% confidence interval, 1.13 to 1.25) and orthodontics and dentofacial orthopedics (PTTR, 1.41; 95% confidence interval, 1.21 to 1.71), with the highest rates of antibiotic Rxs in the spring and winter.Conclusions.-Antibiotic prescribing practices for dental specialists remained stable. The authors observed seasonal trends in 2 specialties. Practical Implications.-Public health efforts are needed improve antibiotic prescribing among dental specialties.

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A multicentre, multicycle audit of the prescribing practices of three paediatric dental departments in the North of England

Abstract: Results revealed deficiencies in prescribing practices in all three centres. Following education and the provision of an aide-memoire in subsequent cycles, improvements were seen in appropriateness of prescribing, increasing from 28% in the first cycle, to 71% in the third cycle.

Cited by 8 publications

References 23 publications

Why Do They Do It? A Grounded Theory Study of the Use of Low-value Care Among Primary Health Care Physicians

Why Do They Do It? A Grounded Theory Study of the Use of Low-value Care Among Primary Health Care Physicians

Why do they do it? A grounded theory study of the use of low-value care among primary health care physicians

Longitudinal antibiotic prescribing trends among US dental specialists within a pharmacy benefits manager, 2013 through 2015

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