scholarly journals Design of proxy indicators estimating the appropriateness of antibiotics prescribed by French dentists: a cross-sectional study based on reimbursement data

2021 ◽  
Author(s):  
Maïa Simon ◽  
Ouarda Pereira ◽  
Julie Guillet-Thibault ◽  
Marlies E. J. L. Hulscher ◽  
Céline Pulcini ◽  
...  
Keyword(s):  
Dental Care ◽  
Cross Sectional Study ◽  
Case Mix ◽  
Antibiotic Prescribing ◽  
Health Insurance Data ◽  
Cross Sectional ◽  
Dental Practitioners ◽  
North Eastern ◽  
Proxy Indicators ◽  
Insurance Data

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.

scholarly journals Proxy indicators to estimate appropriateness of antibiotic prescriptions by general practitioners: a proof-of-concept cross-sectional study based on reimbursement data, north-eastern France 2017

2020 ◽  
Vol 25 (27) ◽  
Author(s):  
Nathalie Thilly ◽  
Ouarda Pereira ◽  
Jeroen Schouten ◽  
Marlies EJL Hulscher ◽  
Céline Pulcini
Keyword(s):  
Antibiotic Use ◽  
Cross Sectional Study ◽  
Case Mix ◽  
Antibiotic Prescribing ◽  
Sectional Study ◽  
National Guidelines ◽  
Cross Sectional ◽  
Starting Point ◽  
North Eastern ◽  
Proxy Indicators

Background In most countries, including France, data on clinical indications for outpatient antibiotic prescriptions are not available, making it impossible to assess appropriateness of antibiotic use at prescription level. Aim Our objectives were to: (i) propose proxy indicators (PIs) to estimate appropriateness of antibiotic use at general practitioner (GP) level based on routine reimbursement data; and (ii) assess PIs’ performance scores and their clinimetric properties using a large regional reimbursement database. Methods A recent systematic literature review on quality indicators was the starting point for defining a set of PIs, taking French national guidelines into account. We performed a cross-sectional study analysing National Health Insurance data (available at prescriber and patient levels) on antibiotics prescribed by GPs in 2017 for individuals living in north-eastern France. We measured performance scores of the PIs and their case-mix stability, and tested their measurability, applicability, and room for improvement (clinimetric properties). Results The 3,087 GPs included in this study prescribed a total of 2,077,249 antibiotic treatments. We defined 10 PIs with specific numerators, denominators and targets. Performance was low for almost all indicators ranging from 9% to 75%, with values < 30% for eight of 10 indicators. For all PIs, we found large variation between GPs and patient populations (case-mix stability). Regarding clinimetric properties, all PIs were measurable, applicable, and showed high improvement potential. Conclusions The set of 10 PIs showed satisfactory clinimetric properties and might be used to estimate appropriateness of antibiotic prescribing in primary care, in an automated way within antibiotic stewardship programmes.

scholarly journals Knowledge, Experience and Confidence of Saudi Dental Practitioners towards Treating Patients on the Autism Spectrum; A Cross-Sectional Study

2021 ◽  
pp. 219-227
Author(s):  
Aziza Jamaan Alalmaie ◽  
Hind Khalaf Alkhalaf ◽  
Reema Mashhour Aldakheel ◽  
Roa’a Rafa Al Shehri ◽  
Shahzeb Hasan Ansari
Keyword(s):  
Dental Care ◽  
Behavioral Problems ◽  
Online Survey ◽  
Demographic Data ◽  
Cross Sectional Study ◽  
Autism Spectrum ◽  
Sectional Study ◽  
Online Questionnaire ◽  
Cross Sectional ◽  
Dental Practitioners

Introduction: Children with ASD face various obstacles to professional dental care that are prominent causes to stop seeking dental care. The main barriers are behavioral problems and trouble finding a dentist who treats ASD children. Materials and Methods: This is a cross sectional study conducted among the dental practitioners of Saudi Arabia using an online survey. Online questionnaire was constructed consisting of questions related to personal, professional, and demographic data followed by questions including knowledge, experience and confidence in managing patients with ASD. Results: Only 18% had previously treated an autistic child, 14% had treated autistic adults and 16% having treated both with 52% with no past exposure. Maximum score of 3.86 was attained when inquired about knowing where to find further information and guidance for treating autistic patients. Conclusion: Overall knowledge and confidence level of participants is low regarding autistic patients.

scholarly journals Proxy indicators to estimate the appropriateness of medications prescribed by paediatricians in infectious diseases: a cross-sectional observational study based on reimbursement data

2020 ◽  
Vol 2 (4) ◽  
Author(s):  
N Thilly ◽  
O Pereira ◽  
J Schouten ◽  
M E J L Hulscher ◽  
C Pulcini
Keyword(s):  
Observational Study ◽  
Infectious Diseases ◽  
Antibiotic Use ◽  
Paediatric Population ◽  
Health Insurance Data ◽  
Cross Sectional ◽  
Improvement Potential ◽  
North Eastern ◽  
Reimbursement Database ◽  
Proxy Indicators

Abstract Background We previously developed proxy indicators (PIs) that can be used to estimate the appropriateness of medications used for infectious diseases (in particular antibiotics) in primary care, based on routine reimbursement data that do not include clinical indications. Objectives To: (i) select the PIs that are relevant for children and estimate current appropriateness of medications used for infectious diseases by French paediatricians and its variability while using these PIs; (ii) assess the clinimetric properties of these PIs using a large regional reimbursement database; and (iii) compare performance scores for each PI between paediatricians and GPs in the paediatric population. Methods For all individuals living in north-eastern France, a cross-sectional observational study was performed analysing National Health Insurance data (available at prescriber and patient levels) regarding antibiotics prescribed by their paediatricians in 2017. We measured performance scores of the PIs, and we tested their clinimetric properties, i.e. measurability, applicability and room for improvement. Results We included 116 paediatricians who prescribed a total of 44 146 antibiotic treatments in 2017. For all four selected PIs (seasonal variation of total antibiotic use, amoxicillin/second-line antibiotics ratio, co-prescription of anti-inflammatory drugs and antibiotics), we found large variations between paediatricians. Regarding clinimetric properties, all PIs were measurable and applicable, and showed high improvement potential. Performance scores did not differ between these 116 paediatricians and 3087 GPs. Conclusions This set of four proxy indicators might be used to estimate appropriateness of prescribing in children in an automated way within antibiotic stewardship programmes.

scholarly journals Patient- and Prescriber-Related Factors Associated with Potentially Inappropriate Medications and Drug–Drug Interactions in Older Adults

2021 ◽  
Vol 10 (11) ◽  
pp. 2305
Author(s):  
Suhyun Jang ◽  
Sohyun Jeong ◽  
Sunmee Jang
Keyword(s):  
Older Adults ◽  
Drug Interactions ◽  
Inappropriate Medication ◽  
Cross Sectional Study ◽  
Potentially Inappropriate Medications ◽  
Health Insurance Data ◽  
Related Factors ◽  
Cross Sectional ◽  
Outpatient Prescription ◽  
Insurance Data

We aimed to evaluate the prevalence of potentially inappropriate medication (PIM) use and drug–drug interactions (DDIs) in older adults and their associated factors. This cross-sectional study used National Health Insurance data of older adults in South Korea. The 2015 AGS Beers Criteria were used to classify PIM use and DDIs. The associations of PIM use and DDIs with patient- and prescriber-related factors were evaluated using multiple logistic regression. Of the older adults who received at least one outpatient prescription (N = 1,277,289), 73.0% and 13.3% received one or more prescriptions associated with PIM use or DDIs, respectively. Chlorphenamine was most commonly associated with PIM, followed by diazepam. Co-prescriptions of corticosteroids and NSAIDs accounted for 82.8% of DDIs. Polypharmacy and mainly visiting surgeons or neurologists/psychiatrists were associated with a higher likelihood of prescriptions associated with PIM use or DDIs. Older age, high continuity of care (COC), and mainly visiting a hospital were associated with a lower likelihood of PIM use or DDIs. Prescriptions associated with PIM use and DDIS were more frequent for low COC patients or those who mainly visited clinics; therefore, patients with these characteristics are preferred intervention targets for reducing prescriptions associated with PIM use and DDIs.

scholarly journals Antibiotic prescribing practices of dentists for endodontic infections; a cross-sectional study

PLoS ONE ◽  
2020 ◽  
Vol 15 (12) ◽  
pp. e0244585
Author(s):  
Sheela B. Abraham ◽  
Nizam Abdulla ◽  
Wan Harun Himratul-Aznita ◽  
Manal Awad ◽  
Lakshman Perera Samaranayake ◽  
...  
Keyword(s):  
United Arab Emirates ◽  
Cross Sectional Study ◽  
Antibiotic Prescribing ◽  
Prescribing Practices ◽  
Online Questionnaire ◽  
Cross Sectional ◽  
Systemic Involvement ◽  
Dental Practitioners ◽  
Significant Difference ◽  
Endodontic Infections

Objective The indiscriminate prescription of antibiotics has led to the emergence of resistance microbes worldwide. This study aimed to investigate the antibiotic prescribing practices amongst general dental practitioners and specialists in managing endodontic infections in the United Arab Emirates (UAE). Design General dental practitioners and specialists in the UAE were invited to participate in an online questionnaire survey which included questions on socio-demographics, practitioner’s antibiotic prescribing preferences for various pulpal and periapical diseases, and their choice, in terms of the type, dose and duration of the antibiotic. The link to the survey questionnaire was sent to 250 invited dentists. Data were analyzed by descriptive statistics and chi-square tests for independence and level of significance was set at 0.05. Results A total of 174 respondents participated in the survey (response rate = 70%). The respondents who prescribed antibiotics at least once a month were 38.5% while 17.2% did so, more than three times a week; amoxicillin 500 mg was the antibiotic of choice for patients not allergic to penicillin (43.7%), and in cases of penicillin allergies, erythromycin 500 mg (21.3%). There was a significant difference in the antibiotic prescribing practices of GDPs compared to endodontists and other specialties especially in clinical cases such as acute apical abscesses with swelling and moderate to severe pre-operative symptoms and retreatment of endodontic cases (p<0.05). Approximately, three quarters of the respondents (78.7%) did not prescribe a loading dose when prescribing antibiotics. About 15% respondents prescribed antibiotics to their patients if they were not accessible to patients due to a holiday/weekend. Conclusions In general, the antibiotic prescribing practices of UAE dentists are congruent with the international norms. However, there were occasions of inappropriate prescriptions such as in patients with irreversible pulpitis, necrotic pulps with no systemic involvement and/or with sinus tracts.

scholarly journals Using statutory health insurance data to evaluate non-response in a cross-sectional study on depression among patients with diabetes in Germany

2020 ◽  
Vol 49 (2) ◽  
pp. 629-637 ◽  
Author(s):  
Ute Linnenkamp ◽  
Veronika Gontscharuk ◽  
Manuela Brüne ◽  
Nadezda Chernyak ◽  
Tatjana Kvitkina ◽  
...  
Keyword(s):  
Health Insurance ◽  
Cross Sectional Study ◽  
Response Analysis ◽  
Cross Sectional Survey ◽  
Health Insurance Data ◽  
Cross Sectional ◽  
Depression Diagnosis ◽  
Medication Utilization ◽  
Patients With Diabetes ◽  
Insurance Data

Abstract Background Low response rates do not indicate poor representativeness of study populations if non-response occurs completely at random. A non-response analysis can help to investigate whether non-response is a potential source for bias within a study. Methods A cross-sectional survey among a random sample of a health insurance population with diabetes (n = 3642, 58.9% male, mean age 65.7 years), assessing depression in diabetes, was conducted in 2013 in Germany. Health insurance data were available for responders and non-responders to assess non-response bias. The response rate was 51.1%. Odds ratios (ORs) for responses to the survey were calculated using logistic regression taking into consideration the depression diagnosis as well as age, sex, antihyperglycaemic medication, medication utilization, hospital admission and other comorbidities (from health insurance data). Results Responders and non-responders did not differ in the depression diagnosis [OR 0.99, confidence interval (CI) 0.82–1.2]. Regardless of age and sex, treatment with insulin only (OR 1.73, CI 1.36–2.21), treatment with oral antihyperglycaemic drugs (OAD) only (OR 1.77, CI 1.49–2.09), treatment with both insulin and OAD (OR 1.91, CI 1.51–2.43) and higher general medication utilization (1.29, 1.10–1.51) were associated with responding to the survey. Conclusion We found differences in age, sex, diabetes treatment and medication utilization between responders and non-responders, which might bias the results. However, responders and non-responders did not differ in their depression status, which is the focus of the DiaDec study. Our analysis may serve as an example for conducting non-response analyses using health insurance data.

scholarly journals Prescription Patterns of Dentists in Primary Care in Bahrain During COVID-19: A Cross Sectional Study.

2020 ◽  
Author(s):  
Gowri Sivaramakrishnan ◽  
Muneera Alsobaiei ◽  
Fatema AlSulaiti ◽  
Kannan Sridha
Keyword(s):  
Primary Care ◽  
Dental Care ◽  
Statistical Tests ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Prescription Practices ◽  
Dental Practitioners ◽  
Dental Intervention ◽  
Anonymized Data ◽  
Dental Practices

Abstract Background: Dentists have always been attributed to the ever rising global problem of antibiotic resistance. The recent pandemic due to COVID-19 has caused greater concern and primary dental care practices were suspended in the Ministry of Health in Bahrain between February to August 2020. Dental emergencies were addressed using a triage system and dentists were advised on avoiding invasive and aerosol generating procedures. This means that many dentists opted to prescribe medications without undertaking the necessary dental intervention. Aim: To identify the prescription and drug utilization of primary care dental practitioners during the temporary suspension of routine dental practices due to COVID-19.Method: Anonymized data from out-patient dental prescriptions from February 2020 to August 2020 were collected. Necessary data regarding the number, type and indication for prescription were collected and analyzed using appropriate statistical tests.Results: An average of two medications were prescribed for each patient, that included systemic and local analgesics and anti-microbials. 33.4% of patients were only prescribed medications without any dental intervention. Approximately 35% of the records showed inappropriate diagnosis and their rationale for prescription could not be determined. 100% of the patients with acute or chronic periapical abscess and 41% with gingivitis or periodontitis were prescribed medications without any dental intervention. Amoxicillin and amoxicillin/clavulanic acid amongst the antimicrobial class; and ibuprofen and acetaminophen amongst the analgesics accounted for 90% of prescribed drugs. Chlorhexidine mouth rinse seemed to be on the regular list for any diagnoses, prescribed between 7 and 14 days, twice or thrice daily. Conclusion: Suspension of dental practices can cause more harm in terms of overuse and unindicated prescription practices in primary dental care. The awareness of the recent guidelines is important to prevent unintended use. Effective infection control practices based on guideline should be in place to contain COVID-19 transmission rather than suspension of dental care.

Asymptomatic low-density Plasmodium infection during non-transmission season: a community-based cross-sectional study in two districts of North Eastern Region, India

2021 ◽  
Author(s):  
Hari Shankar ◽  
Sobhan Phookan ◽  
Mrigendra Pal Singh ◽  
Ram Suresh Bharti ◽  
Naseem Ahmed ◽  
...  
Keyword(s):  
Cross Sectional Study ◽  
Diagnostic Tools ◽  
Eastern Region ◽  
Low Density ◽  
Plasmodium Infection ◽  
Sectional Study ◽  
Cross Sectional ◽  
Health Agencies ◽  
North Eastern ◽  
Asymptomatic Infections

Abstract Background Malaria elimination requires targeting asymptomatic and low-density Plasmodium infections that largely remain undetected. Therefore we conducted a cross-sectional study to estimate the burden of asymptomatic and low-density Plasmodium infection using conventional and molecular diagnostics. Methods A total of 9118 participants, irrespective of age and sex, were screened for malaria using rapid diagnostic tests (RDTs), microscopy and polymerase chain reaction. Results Among the participants, 707 presented with symptoms and 8411 without symptoms, of which Plasmodium was present in 15.6% (110/707) and 8.1% (681/8411), respectively. Low-density infection was found in 5.1% (145/2818) of participants and 8327 of 9118 were Plasmodium negative. Endemicity was propotional to asymptomatic infections (high endemicity 11.1% [404/3633] vs low endemicity 5.8% [277/4778]; odds ratio [OR] 2.0 [95% confidence interval {CI} 1.7 to 2.4]) but inversely related to low-density infection (high endemicity 3.7% [57/1545] vs low endemicity 6.9% [88/1273]; OR 1.9 [95% CI 1.4 to 2.7]). The spleen rate in children 2–9 y of age was 17.9% (602/3368) and the enlarged spleen index was 1.6. Children between 8 and 14 y showed higher odds for asymptomatic (adjusted OR [aOR] 1.75 [95% CI 1.4 to 2.2]) and low-density infections (aOR 0.63 [95% CI 0.4 to 1.0)] than adults. Conclusions The prevalence of asymptomatic and low-density Plasmodium infection undermines the usefulness of standard diagnostic tools used by health agencies. This necessitates deploying molecular tools in areas where malaria microscopy/RDTs indicate a dearth of infection.

scholarly journals 218. Changes in Dental Antibiotic Prescribing in the United States, 2012–2017

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S111-S111
Author(s):  
Swetha Ramanathan ◽  
Connie H Yan ◽  
Colin Hubbard ◽  
Gregory Calip ◽  
Lisa K Sharp ◽  
...  
Keyword(s):  
The United States ◽  
Cross Sectional Study ◽  
Antibiotic Prescribing ◽  
Prescription Data ◽  
Oral Antibiotic ◽  
Sectional Study ◽  
Cross Sectional ◽  
Prescribing Trends ◽  
Adults And Children ◽  
Linear Regressions

Abstract Background Data suggest dental antibiotic prescribing is increasing with relatively less documented about prescribing trends in adults and children. Therefore, the aim was to evaluate trends in antibiotic prescribing by US dentists from 2012–2017. Methods This was a cross-sectional study of US dental prescribing using IQVIA Longitudinal Prescription Data from 2012 to 2017. Prescribing rates (prescriptions [Rx] per 100,000 dentists), mean days’ supply, and mean quantity dispensed were calculated monthly across eight oral antibiotic groups: amoxicillin, clindamycin, cephalexin, azithromycin, penicillin, doxycycline, fluoroquinolone, and other antibiotics. Descriptive frequencies and multiple linear regressions were performed to obtain trends overall and stratified by adults (≥ 18) and children (&lt; 18). Results 220, 325 dentists prescribed 135 million Rx (94.0% in adults). 61.0% were amoxicillin, 14.4% clindamycin, 11.7% penicillin, 4.4% azithromycin, 4.3% cephalexin, 2.0% other antibiotics, 1.4% doxycycline, and 0.7% fluoroquinolones. Prescribing increased by 33 Rx/100,000 dentists (p&lt; 0.0001) each month for all antibiotics. Amoxicillin (p&lt; 0.0001) and clindamycin (p=0.02) prescribing rate increased by 73 and 5 Rx/100,000 dentists, respectively. Prescribing decreased by 8, 12, and 2 Rx/100,000 dentists for cephalexin (p&lt; 0.0001), doxycycline (p&lt; 0.0001), and fluoroquinolones (p=0.008), respectively. Mean days’ supply increased for amoxicillin, penicillin, and clindamycin (p&lt; 0.0001), and decreased for cephalexin (p&lt; 0.0001).Mean quantity dispensed decreased (p&lt; 0.0001) for all groups except azithromycin and doxycycline. Among adults, cephalexin prescribing rates (7 Rx/100,000 dentist; p&lt; 0.0001) and other antibiotics days’ supply (p&lt; 0.0001) decreased. Among children, azithromycin prescribing rates (1 Rx/100,000 dentists, p=0.02), and fluoroquinolone and other antibiotics days’ supply (p&lt; 0.0001) decreased. Conclusion These findings support dental antibiotic prescribing is increasing, specifically for amoxicillin and clindamycin. Further, trends differed between adults and children. Understanding what is driving these trends is important to target dental antibiotic stewardship efforts. Disclosures All Authors: No reported disclosures

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