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Drug prescribing

The Scottish Dental Clinical Effectiveness Programme (SDCEP) first published Drug Prescribing for Dentistry in April 2008. A second edition was published in August 2011 and an updated third edition released in January 2016. In 2023, a dedicated SDCEP Dental Prescribing website was launched for users in the UK.

Following publication of this guidance in 2008 feedback from stakeholders identified improvements to the prescribing of antibiotics by dentists to be a priority area for research.

Despite the introduction of the guidance, evidence from routinely collected dental prescribing data demonstrated that the guidance had little impact on the number of antibiotics prescribed by primary care dentists in Scotland.

When considering how best to support the translation of guidance into practice there is evidence that audit and feedback (A&F) strategies (defined as ‘any summary of clinical performance of health care over a specified period of time’ aimed at changing health professional behaviour) have consistently demonstrated small to moderate sized effects.  However, there is still some uncertainty in predicting what type of A&F and in which clinical circumstances these strategies will be most effective.

To support primary care dentists reduce their antibiotic prescribing and to help inform the evidence base TRiaDS has conducted two cluster randomised controlled trials of A&F for antibiotic prescribing

  • TiPTAP 2020-Present
  • RAPiD 2013-2014

and a National Audit between 2014-2016.

Training in Practice Targeting Antibiotic Prescribing (TiPTAP)

Between 2015 and 2019 the rate of antibiotic use by dentists had reduced by 17.7% with dentists responsible for 7.2% of total antibiotic use in primary care in 2019 [1]. However, when the COVID-19 pandemic struck, AAA (Advice, Analgesia and Antimicrobials) guidance had to be implemented. This therefore meant that there was an increase in antibiotic prescribing with Dentists being responsible for 10.4% of total antibiotic use in primary care in 2020/21 [2]. After the pandemic antibiotic prescribing rates reduced however they have never gone back down to pre-pandemic levels with prescribing sitting at 8.6% in 2022 [2]. The RAPiD trial previously demonstrated that the provision of individualised audit and feedback (A&F) resulted in a significant 6% reduction in antibiotic prescribing rates per 100 courses of NHS treatment. Therefore, the TiPTAP trial, a cluster randomised controlled trial, was developed to build on this by adding an educational component to further decrease antibiotic prescribing levels.

The aim of the TiPTAP trial is to evaluate the impact of the educational antibiotic prescribing component in addition to the receipt of individualised A&F.

What stage is the trial at?

  • Recruitment for the trial began in December 2021 and ceased in January 2024 with 197 practices in Scotland being recruited.
  • Delivery and analysis will be ongoing into 2025 with results expected to be available at the end of 2025.
  • A process evaluation of the trial is also being conducted.

More information on the trial design and methods can be found in the TiPTAP Study Protocol. And further details on the process evaluation of TiPTAP can be found in the TiPTAP Process Evaluation Protocol.

Trial Registration: ISRCTN16294743 https://doi.org/10.1186/ISRCTN16294743

Study contact: Claire Scott, e-mail: TIPTAP@nes.scot.nhs.uk

References:

[1] ARHAI Scotland. Scottish One Health Antimicrobial Use and Antimicrobial    Resistance Report 2019. ARHAI Scotland, 2019 [Report]

[2] Antimicrobial Resistance and Healthcare Associated Infection Scotland. Scottish One Health Antimicrobial Use and Antimicrobial Resistance in 2022. ARHAI Scotland, Glasgow 2023 [Report]

Reducing antibiotic prescribing in dentistry (RAPiD)

TRiaDS conducted the RAPiD trial in NHS general dental practices during May 2013 – April 2014. RAPiD, a cluster, randomised controlled trial used national, routinely collected dental prescribing and treatment data to compare the effectiveness of individualised A&F strategies in reducing dental antibiotic prescribing by primary care dentists in Scotland. More information on the trial design and methods can be found in the study protocol.

The RAPiD study provides a robust evaluation of the impact of A&F on antibiotic prescribing in real-world dental practice. The results demonstrate that the provision of A&F resulted in a significant 6% reduction in antibiotic prescribing rates per 100 courses of NHS treatment. Extrapolated to all dentists in Scotland, this represents a reduction of approximately 20,000 antibiotic items over 12 months. To read more about the results please see the summary report (PDF) and study publications listed below.

Trial Registration: Current Controlled Trials ISRCTN 49204710

Study contact: Dr Paula Elouafkaoui, tel: +44 (0)1382 740917, e-mail: TRiaDS@nes.scot.nhs.uk

National audit

In 2014, TRiaDS led the development of a national, pre-approved online audit on antibiotic prescribing. The aim of the audit is to help improve prescribing practices by dentists across Scotland. The audit requires dentists to review their current practices against recommended practices and to consider alternatives to prescribing antibiotics. Action planning to implement changes, if required, also makes up part of the audit.

The audit was closed to new participants at the end of January 2016. The data is currently being analysed and a summary report will be available in due course.

Publications and presentations

TiPTAP

  • Goulao B, Scott C, Black I, Clarkson J, McArthur L, Ramsay C, Young L, Duncan E. Audit and feedback with or without training in-practice targeting antibiotic prescribing (TiPTAP): a study protocol of a cluster randomised trial in dental primary care. Implement Sci. 2021 Mar 30;16(1):32. doi: 10.1186/s13012-021-01098-z. PMID: 33781284; PMCID: PMC8007384. https://pubmed.ncbi.nlm.nih.gov/33781284/
  • Scott C, Goulao B, McArthur L, Knights J, Konnyu K, Darlene V, et al. Protocol for the process evaluation of a cluster randomised trial of audit and feedback and in practice educational training to reduce antibiotic prescribing in dental primary care: the TiPTAP trial. Open Science Framework (OSF) Preprints; 2024. Available from: osf.io/u7pvs

RAPiD

 

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