Utilizing academic detailing to take a bite out of antibiotic prophylaxis prior to dental procedures.

Abstract

Background: Within the United States, dentists represent the top specialty prescriber of antibiotics in the ambulatory care setting. With the growth of antimicrobial stewardship programs an overall decrease in antibiotic prescribing has been observed. However, prescribing within the dental subset has remained steady.

Objective: To describe implementation of an antibiotic stewardship initiative targeting proper utilization of antibiotic prophylaxis by dentists prior to dental procedures.

Practice description: Academic detailing, a form of educational outreach, was utilized to facilitate prescribing behavior change. An academic detailer met with dental staff in a face-to-face one-on-one manner to align prescribing with current evidence-based practice. During the encounter, developed resources were utilized to deliver key messages focusing on specific prescribing improvements, while robust conversation allowed the detailer to identify and address any prescriber motivations and/or perceived barriers.

Practice innovation: An antimicrobial stewardship initiative specific to the dental setting, utilizing academic detailing, has not been previously described in the literature.

Evaluation methods: Comparisons of prescribing appropriateness before and after the intervention was performed using a one-way analysis of variance model. Additionally, a single-group generalized least-squares interrupted time series analysis was performed to estimate the impact of the intervention on the level and slope changes before and after implementation on the number of inappropriate prescriptions.

Results: There were 257 prescriptions for dental prophylaxis included in the preimplementation period and 42 prescriptions for dental prophylaxis included in the postimplementation period. Dental prophylaxis prescribing appropriateness was greater in the postimplementation period (17.6% vs. 89.8%; P < 0.001). The incidence of inappropriate prescriptions decreased by 25.39 per 1000 population (P < 0.001) between the periods.

Conclusion: Academic detailing improved the prescribing appropriateness of antibiotic prophylaxis prior to dental procedures at Veterans Affairs Butler Healthcare System.