Clinician and Patient Factors Influencing Treatment Decisions: Ethnographic Study of Antibiotic Prescribing and Operative Procedures in Out-of-Hours and General Dental Practices

Operative treatment is indicated for most toothache/dental abscesses, yet antibiotics instead of procedures are often prescribed. This ethnographic study aimed to identify clinician and patient factors influencing urgent dental care for adults during actual appointments; and to identify elements sensitive to context. Appointments were observed in out-of-hours and general dental practices. Follow-up interviews took place with dentists, dental nurses, and patients. Dentist and patient factors were identified through thematic analysis of observation records and appointment/interview transcripts. Dentist factors were based on a published list of factors influencing antibiotic prescribing for adults with acute conditions across primary health care and presented within the Capability-Opportunity-Motivation-Behaviour model. Contextually sensitive elements were revealed by comparing the factors between settings. In total, thirty-one dentist factors and nineteen patient factors were identified. Beliefs about antibiotics, goals for the appointment and access to dental services were important for both dentists and patients. Dentist factors included beliefs about the lifetime impact of urgent dental procedures on patients. Patient factors included their communication and negotiation skills. Contextual elements included dentists’ concerns about inflicting pain on regular patients in general dental practice; and patients’ difficulties accessing care to complete temporary treatment provided out of hours. This improved understanding of factors influencing shared decisions about treatments presents significant opportunity for new, evidence-based, contextually sensitive antibiotic stewardship interventions.

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Adequacy and clarity of information on out-of-hours emergency dental services at Greater Manchester NHS dental practices: a cross-sectional study

BDJ ◽

10.1038/sj.bdj.2017.270 ◽

2017 ◽

Vol 222 (6) ◽

pp. 463-465

Author(s):

S. N. Aldallal ◽

F. N. Aldallal ◽

A. S. Khajah

Keyword(s):

Cross Sectional Study ◽

Sectional Study ◽

Dental Services ◽

Cross Sectional ◽

Out Of Hours ◽

Dental Practices

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Billed and Paid Amounts for Preventive Procedures in Dental Medicaid

JDR Clinical & Translational Research ◽

10.1177/2380084419842533 ◽

2019 ◽

Vol 4 (4) ◽

pp. 371-377 ◽

Cited By ~ 2

Author(s):

K. Wagner ◽

A. Szabo ◽

C. Zheng ◽

E. Okunseri ◽

C. Okunseri

Keyword(s):

American Indians ◽

Consumer Price Index ◽

Performance Measure ◽

Dental Services ◽

Preventive Dental Care ◽

Dental Procedures ◽

Dental Practices ◽

Preventive Dental ◽

Bureau Of Labor Statistics ◽

Over Time

Objective: To examine trends and variations in billed and paid amounts for preventive dental procedures by race/ethnicity, age, and sex in Wisconsin dental Medicaid. Methods: We analyzed data from the 2001 to 2013 Wisconsin Medicaid claims database for preventive dental procedures for children and adults. Billed and paid amounts for preventive dental procedures were aggregated over a visit and adjusted for inflation based on the Medical Care Consumer Price Index produced by the Bureau of Labor Statistics for 2013. Quantile regression was used to examine the trends over time and the effect of patient demographics. Result: At the 50th and 75th percentiles, the overall billed amounts for preventive dental procedures were $84.97 and $105.53, and the paid amounts were $35.80 and $41.66, respectively. At the 75th percentile, there was a $2.24 increase per year in the billed amount and a $26.88 overall increase from 2001 to 2013. In the paid amount, there was a $1.34 decrease per year for an overall $16.07 decrease from 2001 to 2013. Billed and paid claims for racial/ethnic minority enrollees were $1 to $3 higher per visit at the 75th percentile when compared with those of Whites. Regarding the billed:paid ratio, White, African American, and Hispanic enrollees had values of 50% to 52%, whereas American Indians had the lowest value at 47.7%. At the 75th percentile, children aged 10 to 19 y had significantly higher billed ($26.73) and paid ($9.92) amounts than did adults aged 20 to 69 y. Conclusion: The billed amount increased over time, and the paid amount decreased after adjustment for inflation. In addition, there was a wide gap between billed and paid amounts over time. Knowledge Transfer Statement: This study highlights clear differences between paid and billed amounts in Wisconsin dental Medicaid. The financial health of dental practices is dependent on appropriate reimbursement for dental services provided; thus, information of this nature could serve as a proxy performance measure for access to preventive dental care. Findings from this study could be used by policy makers and dental Medicaid program managers to develop outcome metrics to improve access to preventive dental services.

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Covid-19 and its financial effects on the dental fraternity and health-care workers: A literature review

International Journal of Research in Pharmaceutical Sciences ◽

10.26452/ijrps.v11ispl1.2883 ◽

2020 ◽

Vol 11 (SPL1) ◽

pp. 628-631

Author(s):

Devangi Agrawal ◽

Namisha Khara ◽

Bhushan Mundada ◽

Nitin Bhola ◽

Rajiv Borle

Keyword(s):

Health Care ◽

Health Care Providers ◽

Health Care Workers ◽

Care Providers ◽

Dental Procedures ◽

Care Workers ◽

Dental Practices ◽

Precautionary Measures ◽

The Government ◽

Set Up

In the wake of the current outbreak of novel Covid-19, which is now declared as a 'pandemic' by the WHO, people around the globe have been dealing with a lot of difficulties. This virus had come into light in December 2019 and since then has only grown exponentially. Amongst the most affected are the ones who have been working extremely hard to eradicate it, which includes the hospitals, dental fraternity and the health-care workers. These people are financially burdened due to limited practise. In the case of dentistry, to avoid the spread of the virus, only emergency treatments are being approved, and the rest of the standard procedures have been put on hold. In some cases, as the number of covid cases is rising, many countries are even trying to eliminate the emergency dental procedures to divert the finances towards the treatment of covid suffering patients. What we need to realise is that this is probably not the last time that we are facing such a situation. Instead of going down, we should set up guidelines with appropriate precautionary measures together with the use of standardised PPEs. The government should also establish specific policies to support dental practices and other health-care providers. Together, we can fight this pandemic and come out stronger.

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Trends in Antibiotic Prescribing in Out-of-Hours Primary Care in England from January 2016 to June 2020 to Understand Behaviours during the First Wave of COVID-19

Antibiotics ◽

10.3390/antibiotics10010032 ◽

2021 ◽

Vol 10 (1) ◽

pp. 32

Author(s):

Nina J. Zhu ◽

Monsey McLeod ◽

Cliodna A. M. McNulty ◽

Donna M. Lecky ◽

Alison H. Holmes ◽

...

Keyword(s):

Primary Care ◽

Time Series ◽

Patient Outcomes ◽

Broad Spectrum ◽

Antibiotic Prescribing ◽

Broad Spectrum Antibiotic ◽

Out Of Hours ◽

Broad Spectrum Antibiotics ◽

National Quality ◽

General Practices

We describe the trend of antibiotic prescribing in out-of-hours (OOH) general practices (GP) before and during England’s first wave of the COVID-19 pandemic. We analysed practice-level prescribing records between January 2016 to June 2020 to report the trends for the total prescribing volume, prescribing of broad-spectrum antibiotics and key agents included in the national Quality Premium. We performed a time-series analysis to detect measurable changes in the prescribing volume associated with COVID-19. Before COVID-19, the total prescribing volume and the percentage of broad-spectrum antibiotics continued to decrease in-hours (IH). The prescribing of broad-spectrum antibiotics was higher in OOH (OOH: 10.1%, IH: 8.7%), but a consistent decrease in the trimethoprim-to-nitrofurantoin ratio was observed OOH. The OOH antibiotic prescribing volume diverged from the historical trend in March 2020 and started to decrease by 5088 items per month. Broad-spectrum antibiotic prescribing started to increase in OOH and IH. In OOH, co-amoxiclav and doxycycline peaked in March to May in 2020, which was out of sync with seasonality peaks (Winter) in previous years. While this increase might be explained by the implementation of the national guideline to use co-amoxiclav and doxycycline to manage pneumonia in the community during COVID-19, further investigation is required to see whether the observed reduction in OOH antibiotic prescribing persists and how this reduction might influence antimicrobial resistance and patient outcomes.

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Understanding decisions about antibiotic prescribing in ICU: an application of the Necessity Concerns Framework

BMJ Quality & Safety ◽

10.1136/bmjqs-2020-012479 ◽

2021 ◽

pp. bmjqs-2020-012479

Author(s):

Alyssa M Pandolfo ◽

Robert Horne ◽

Yogini Jani ◽

Tom W Reader ◽

Natalie Bidad ◽

...

Keyword(s):

Focus Groups ◽

Antibiotic Prescribing ◽

Negative Consequences ◽

Out Of Hours ◽

Team Members ◽

Clinical Vignettes ◽

Molecular Microbiology ◽

Semistructured Interviews ◽

Decision Making Processes ◽

The Individual

BackgroundAntibiotics are extensively prescribed in intensive care units (ICUs), yet little is known about how antibiotic-related decisions are made in this setting. We explored how beliefs, perceptions and contextual factors influenced ICU clinicians’ antibiotic prescribing.MethodsWe conducted 4 focus groups and 34 semistructured interviews with clinicians involved in antibiotic prescribing in four English ICUs. Focus groups explored factors influencing prescribing, whereas interviews examined decision-making processes using two clinical vignettes. Data were analysed using thematic analysis, applying the Necessity Concerns Framework.ResultsClinicians’ antibiotic decisions were influenced by their judgement of the necessity for prescribing/not prescribing, relative to their concerns about potential adverse consequences. Antibiotic necessity perceptions were strongly influenced by beliefs that antibiotics would protect patients from deterioration and themselves from the ethical and legal consequences of undertreatment. Clinicians also reported concerns about prescribing antibiotics. These generally centred on antimicrobial resistance; however, protecting the individual patient was prioritised over these societal concerns. Few participants identified antibiotic toxicity concerns as a key influencer. Clinical uncertainty often complicated balancing antibiotic necessity against concerns. Decisions to start or continue antibiotics often represented ‘erring on the side of caution’ as a protective response in uncertainty. This approach was reinforced by previous experiences of negative consequences (‘being burnt’) which motivated prescribing ‘just in case’ of an infection. Prescribing decisions were also context-dependent, exemplified by a lower perceived threshold to prescribe antibiotics out-of-hours, input from external team members and local prescribing norms.ConclusionEfforts to improve antibiotic stewardship should consider clinicians’ desire to protect with a prescription. Rapid molecular microbiology, with appropriate communication, may diminish clinicians’ fears of not prescribing or of using narrower-spectrum antibiotics.

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967. Concordance of Antibiotic Prescribing with the Proposed American Dental Association Acute Oral Infection Guidelines within Veterans Affairs (VA) Dentistry

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz359.069 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S31-S32

Author(s):

Daniel Carlsen ◽

Katie J Suda ◽

Ursula C Patel ◽

Gretchen Gibson ◽

Marianne M Jurasic ◽

...

Keyword(s):

Dental Treatment ◽

Apical Periodontitis ◽

Antibiotic Prescribing ◽

Cross Sectional ◽

Oral Infections ◽

American Dental Association ◽

Dental Procedures ◽

Icd 10 ◽

Future Work ◽

Irreversible Pulpitis

Abstract Background US dentists prescribe 10% of outpatient antibiotics. However, assessing the appropriateness of dental antibiotic prescribing has been challenging due to a lack of guidelines for common infections. In 2019, the American Dental Association proposed clinical practice guidelines (CPG) on the management of common acute oral infections for the first time. Our objective was to describe national baseline antibiotic prescribing for the treatment of irreversible pulpitis, apical periodontitis, and acute apical abscess prior to the release of the proposed CPG. Methods We performed a cross-sectional analysis of national VA data from January 1, 2017 to December 31, 2017. We identified cases of irreversible pulpitis, apical periodontitis, and acute apical abscess using ICD-10-CM codes. Patient demographics, facility location, medical conditions, dental procedure codes (“CDTs”), and diagnostic (ICD-10-CM) codes were extracted from the VA Corporate Data Warehouse. Antibiotics prescribed by a dentist within 7 days of a visit were included. Multivariable logistic regression identified variables associated with antibiotic prescribing for each infection. Results Of the 470,039 VA dental visits with oral infections coded, 25% of irreversible pulpitis, 41% of apical periodontitis, and 61% of acute apical abscess visits received antibiotics. Amoxicillin was prescribed most frequently. Although the median days’ supply was 7 days, prolonged use of antibiotics was frequent (9.2% of irreversible pulpitis, 17.8% of apical periodontitis, 28.7% of acute apical abscess received antibiotics for ≥8 days). Of the irreversible pulpitis visits with antibiotics prescribed, 20.0% received ≥2 antibiotics. Patients with high-risk cardiac conditions, prosthetic joints, and certain dental procedures were associated with receipt of antibiotics (table). Conclusion Prior to the release of the ADA guidelines, 75.8% and 59.4% of irreversible pulpitis and apical periodontitis were concordant with proposed recommendations. These data identify opportunities to improve prescribing and serve as a benchmark for future outpatient antimicrobial stewardship efforts. Future work should assess definitive dental treatment and populations without access to oral health care. Disclosures All Authors: No reported Disclosures.

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Factors influencing antibiotic prescribing in long-term care facilities: a qualitative in-depth study

BMC Geriatrics ◽

10.1186/1471-2318-14-136 ◽

2014 ◽

Vol 14 (1) ◽

Cited By ~ 33

Author(s):

Laura W van Buul ◽

Jenny T van der Steen ◽

Sarah MMM Doncker ◽

Wilco P Achterberg ◽

François G Schellevis ◽

...

Keyword(s):

Long Term Care ◽

Antibiotic Prescribing ◽

Term Care ◽

Factors Influencing ◽

Care Facilities ◽

Depth Study

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Patient factors influencing variation in the use of preventive interventions for alcohol abuse by primary care physicians.

Journal of Studies on Alcohol ◽

10.15288/jsa.1996.57.203 ◽

1996 ◽

Vol 57 (2) ◽

pp. 203-209 ◽

Cited By ~ 44

Author(s):

R J Volk ◽

J R Steinbauer ◽

S B Cantor

Keyword(s):

Primary Care ◽

Alcohol Abuse ◽

Primary Care Physicians ◽

Preventive Interventions ◽

Patient Factors ◽

Factors Influencing

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Pagdihon: The Art and Language of Pottery Making in Bari, Sibalom, Antique

The GLOCAL in Asia 2020 ◽

10.47298/cala2020.8-1 ◽

2020 ◽

Author(s):

Edbert Jay M. Cabrillos ◽

◽

Rowena S. Cabrillos ◽

Keyword(s):

Participant Observation ◽

Video Recording ◽

Ethnographic Study ◽

The Other ◽

Educational Institutions ◽

Face To Face ◽

Factors Influencing ◽

Photo Documentation ◽

Language Pattern ◽

Art And Language

Pottery is seen as creation of ornamentals, cooking and storing materials. Yet, while economic gains are often considered from producing these materials, the artistic and linguistic aspects have been ignored. This study discusses the factors influencing the culture of pottery, the processes of pottery making, and seeks to uncover the language used in processes of pottery making in Bari, Sibalom, Antique. A qualitative research employing ethnographic study with participant observation and face to face interviews using photo documentation, video recording and open-ended questions in gathering the data was employed. There were five manugdihon, or potters, purposively selected as key informants of the study. The study revealed that environmental factors influenced the culture of pottery making in the barangay. There were seven main processes in pottery making. These included gathering and preparing of materials, mixing the needed materials, cleaning the mixed clay, forming of desired shape, detaching, drying, and polishing and varnishing. Further findings indicate that, together the other processes, the language used in poterry making was archaic Kinaray-a, the language of the province. This language pattern suggests a specialized pottery making. Ultimately, the study suggest that the manugdihon should continue their artistic talents so that the language may be preserved. The educational institutions of the province may provide ways to include pottery making in the curriculum so that the art and language of pottery making will be preserved and promoted.

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