An Audit and Feedback Intervention for Reducing Antibiotic Prescribing in General Dental Practice: The RAPiD Cluster Randomised Controlled Trial
Dentists prescribe approximately 10% of antibiotics dispensed in UK community pharmacies. Despite clear clinical guidance, dentists often prescribe antibiotics inappropriately. This cluster-randomised controlled trial used routinely collected National Health Service (NHS) dental prescribing and trea...
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| Published in: | PLoS medicine Vol. 13; no. 8; p. e1002115 |
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| Main Authors: | , , , , , , |
| Format: | Journal Article |
| Language: | English |
| Published: |
United States
Public Library of Science
30-08-2016
Public Library of Science (PLoS) |
| Subjects: | |
| Online Access: | Get full text |
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| Summary: | Dentists prescribe approximately 10% of antibiotics dispensed in UK community pharmacies. Despite clear clinical guidance, dentists often prescribe antibiotics inappropriately. This cluster-randomised controlled trial used routinely collected National Health Service (NHS) dental prescribing and treatment claim data to compare the impact of individualised audit and feedback (A&F) interventions on dentists' antibiotic prescribing rates.
All 795 antibiotic prescribing NHS general dental practices in Scotland were included. Practices were randomised to the control (practices = 163; dentists = 567) or A&F intervention group (practices = 632; dentists = 1,999). A&F intervention practices were allocated to one of two A&F groups: (1) individualised graphical A&F comprising a line graph plotting an individual dentist's monthly antibiotic prescribing rate (practices = 316; dentists = 1,001); or (2) individualised graphical A&F plus a written behaviour change message synthesising and reiterating national guidance recommendations for dental antibiotic prescribing (practices = 316; dentists = 998). Intervention practices were also simultaneously randomised to receive A&F: (i) with or without a health board comparator comprising the addition of a line to the graphical A&F plotting the monthly antibiotic prescribing rate of all dentists in the health board; and (ii) delivered at 0 and 6 mo or at 0, 6, and 9 mo, giving a total of eight intervention groups. The primary outcome, measured by the trial statistician who was blinded to allocation, was the total number of antibiotic items dispensed per 100 NHS treatment claims over the 12 mo post-delivery of the baseline A&F. Primary outcome data was available for 152 control practices (dentists = 438) and 609 intervention practices (dentists = 1,550). At baseline, the number of antibiotic items prescribed per 100 NHS treatment claims was 8.3 in the control group and 8.5 in the intervention group. At follow-up, antibiotic prescribing had decreased by 0.4 antibiotic items per 100 NHS treatment claims in control practices and by 1.0 in intervention practices. This represents a significant reduction (-5.7%; 95% CI -10.2% to -1.1%; p = 0.01) in dentists' prescribing rate in the intervention group relative to the control group. Intervention subgroup analyses found a 6.1% reduction in the antibiotic prescribing rate of dentists who had received the written behaviour change message relative to dentists who had not (95% CI -10.4% to -1.9%; p = 0.01). There was no significant between-group difference in the prescribing rate of dentists who received a health board comparator relative to those who did not (-4.3%; 95% CI -8.6% to 0.1%; p = 0.06), nor between dentists who received A&F at 0 and 6 mo relative to those who received A&F at 0, 6, and 9 mo (0.02%; 95% CI -4.2% to 4.2%; p = 0.99). The key limitations relate to the use of routinely collected datasets which did not allow evaluation of any effects on inappropriate prescribing.
A&F derived from routinely collected datasets led to a significant reduction in the antibiotic prescribing rate of dentists.
Current Controlled Trials ISRCTN49204710. |
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| Bibliography: | ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-News-1 ObjectType-Feature-3 content type line 23 Conceived and designed the experiments: PE LY RN EMD AE JEC CRR. Analyzed the data: CRR PE AE. Wrote the first draft of the manuscript: PE. Contributed to the writing of the manuscript: PE LY RN EMD AE JEC CRR. Agree with the manuscript’s results and conclusions: PE LY RN EMD AE JEC CRR. Contributed to the conceptual and theoretical development of the study: PE LY RN EMD AE JEC CRR Responsible for the data management: PE Conducted the data linkage and created the A&F interventions: PE AE Responsible for the development of the written behaviour change intervention and contributed to the analysis of the process evaluation: ED Designed and conducted the statistical analyses: CRF AE PE Conducted and analysed the process evaluation: RN Drafted the manuscript: PE Contributed to the interpretation of the analyses, critically reviewed and revised manuscript drafts and read and approved the final version of the paper: PE LY RN EMD AE JEC CRR Guarantor: CRAll authors have read, and confirm that they meet, ICMJE criteria for authorship. I have read the journal's policy and the authors of this manuscript have the following competing interests: Authors LY and JEC are employed by NHS Education for Scotland, which is responsible for supporting NHS services in Scotland by developing and delivering education and training for those who work in NHS Scotland. Author AE declared that during the course of the study, he was in paid full-time employment firstly by the University of Aberdeen and subsequently by Glasgow Caledonian University. The research was carried out on behalf of the TRiaDS Research Methodology Group (of which AE is a member). This group is funded by NHS Education for Scotland. No other competing interests exist. Membership of the Translation Research in a Dental Setting (TRiaDS) Research Methodology Group is provided in the Acknowledgments. |
| ISSN: | 1549-1676 1549-1277 1549-1676 |
| DOI: | 10.1371/journal.pmed.1002115 |