TY - JOUR
T1 - Assessment of inappropriate antibiotic prescribing among a large cohort of general dentists in the United States
AU - Centers for Disease Control and Prevention Epicenters
AU - Durkin, Michael J.
AU - Feng, Qianxi
AU - Warren, Kyle
AU - Lockhart, Peter B.
AU - Thornhill, Martin H.
AU - Munshi, Kiraat D.
AU - Henderson, Rochelle R.
AU - Hsueh, Kevin
AU - Fraser, Victoria J.
N1 - Funding Information:
Disclosure. Dr. Durkin has received funds from Medscape to create continuing medical education materials about the management of acute bacterial skin and skin structure infections. These funds were provided to Medscape through an unrestricted educational grant from Merck. Dr. Munshi stated that outside of his work on this article, he is an employee of Express Scripts Holding Company and has received company stock and stock options as part of employee compensation. Dr. Fraser has received grants from the National Institutes of Health, Centers for Disease Control and Prevention, and the Foundation for Barnes-Jewish Hospital. In addition, her spouse is senior vice president and chief medical officer for Express Scripts Holding Company. None of the other authors reported any disclosures.
Funding Information:
Disclosure. Dr. Durkin has received funds from Medscape to create continuing medical education materials about the management of acute bacterial skin and skin structure infections. These funds were provided to Medscape through an unrestricted educational grant from Merck . Dr. Munshi stated that outside of his work on this article, he is an employee of Express Scripts Holding Company and has received company stock and stock options as part of employee compensation. Dr. Fraser has received grants from the National Institutes of Health, Centers for Disease Control and Prevention, and the Foundation for Barnes-Jewish Hospital . In addition, her spouse is senior vice president and chief medical officer for Express Scripts Holding Company. None of the other authors reported any disclosures.
Funding Information:
This study was funded by grant U54CK000482 (MJD, QF, KW, KH, and VJF) from the Centers for Disease Control and Prevention Epicenters. Research reported in this article also was supported by grant JL1TR000448 from the Washington University Institute for Translational Sciences and subaward KL2TR000450 from the National Center for Advancing Translational Sciences. The content is solely the responsibility of the authors and does not necessarily reflect the official views of the Centers for Disease Control and Prevention or the National Institutes of Health.
Publisher Copyright:
© 2018 American Dental Association
PY - 2018/5
Y1 - 2018/5
N2 - Background: The purpose of this study was to assess dental antibiotic prescribing trends over time, to quantify the number and types of antibiotics dentists prescribe inappropriately, and to estimate the excess health care costs of inappropriate antibiotic prescribing with the use of a large cohort of general dentists in the United States. Methods: We used a quasi-Poisson regression model to analyze antibiotic prescriptions trends by general dentists between January 1, 2013, and December 31, 2015, with the use of data from Express Scripts Holding Company, a large pharmacy benefits manager. We evaluated antibiotic duration and appropriateness for general dentists. Appropriateness was evaluated by reviewing the antibiotic prescribed and the duration of the prescription. Results: Overall, the number and rate of antibiotic prescriptions prescribed by general dentists remained stable in our cohort. During the 3-year study period, approximately 14% of antibiotic prescriptions were deemed inappropriate, based on the antibiotic prescribed, antibiotic treatment duration, or both indicators. The quasi-Poisson regression model, which adjusted for number of beneficiaries covered, revealed a small but statistically significant decrease in the monthly rate of inappropriate antibiotic prescriptions by 0.32% (95% confidence interval, 0.14% to 0.50%; P =.001). Conclusions: Overall antibiotic prescribing practices among general dentists in this cohort remained stable over time. The rate of inappropriate antibiotic prescriptions by general dentists decreased slightly over time. Practical Implications: From these authors’ definition of appropriate antibiotic prescription choice and duration, inappropriate antibiotic prescriptions are common (14% of all antibiotic prescriptions) among general dentists. Further analyses with the use of chart review, administrative data sets, or other approaches are needed to better evaluate antibiotic prescribing practices among dentists.
AB - Background: The purpose of this study was to assess dental antibiotic prescribing trends over time, to quantify the number and types of antibiotics dentists prescribe inappropriately, and to estimate the excess health care costs of inappropriate antibiotic prescribing with the use of a large cohort of general dentists in the United States. Methods: We used a quasi-Poisson regression model to analyze antibiotic prescriptions trends by general dentists between January 1, 2013, and December 31, 2015, with the use of data from Express Scripts Holding Company, a large pharmacy benefits manager. We evaluated antibiotic duration and appropriateness for general dentists. Appropriateness was evaluated by reviewing the antibiotic prescribed and the duration of the prescription. Results: Overall, the number and rate of antibiotic prescriptions prescribed by general dentists remained stable in our cohort. During the 3-year study period, approximately 14% of antibiotic prescriptions were deemed inappropriate, based on the antibiotic prescribed, antibiotic treatment duration, or both indicators. The quasi-Poisson regression model, which adjusted for number of beneficiaries covered, revealed a small but statistically significant decrease in the monthly rate of inappropriate antibiotic prescriptions by 0.32% (95% confidence interval, 0.14% to 0.50%; P =.001). Conclusions: Overall antibiotic prescribing practices among general dentists in this cohort remained stable over time. The rate of inappropriate antibiotic prescriptions by general dentists decreased slightly over time. Practical Implications: From these authors’ definition of appropriate antibiotic prescription choice and duration, inappropriate antibiotic prescriptions are common (14% of all antibiotic prescriptions) among general dentists. Further analyses with the use of chart review, administrative data sets, or other approaches are needed to better evaluate antibiotic prescribing practices among dentists.
KW - Antibiotics
KW - dentistry
KW - epidemiology
KW - prophylaxis
KW - public health
KW - treatment
UR - http://www.scopus.com/inward/record.url?scp=85045739076&partnerID=8YFLogxK
U2 - 10.1016/j.adaj.2017.11.034
DO - 10.1016/j.adaj.2017.11.034
M3 - Article
C2 - 29703279
AN - SCOPUS:85045739076
SN - 0002-8177
VL - 149
SP - 372-381.e1
JO - Journal of the American Dental Association
JF - Journal of the American Dental Association
IS - 5
ER -