A randomised controlled trial of clinical outreach education to rationalise antibiotic prescribing for acute dental pain in the primary care setting.
OBJECTIVE
To assess the effect of educational outreach visits on antibiotic prescribing for acute dental pain in primary care.


METHODS
RCT.


METHODS
General dental practices in four health authority areas in Wales.


METHODS
General dental practitioners were recruited to the study and randomly allocated to one of the three study groups (control group, guideline group or intervention group). Following the intervention, practitioners completed a standardised questionnaire for each patient that presented with acute dental pain.


METHODS
The control group received no intervention. The guideline group received educational material by post. The intervention group received educational material by post and an academic detailing visit by a trained pharmacist. The educational material included evidence-based guidelines on prescribing for acute dental pain and patient information leaflets.


METHODS
The number of antibiotic prescriptions issued to patients presenting with dental pain and the number of 'inappropriate' antibiotic prescriptions. Antibiotics were considered to be inappropriate if the patient did not have symptoms indicative of spreading infection.


RESULTS
A total of 1,497 completed questionnaires were received from 23, 20 and 27 general dental practitioners in the control, guideline and intervention group respectively. Patients in the intervention group received significantly fewer antibiotic prescriptions than patients in the control group (OR (95% CI) 0.63 (0.41, 0.95)) and significantly fewer inappropriate antibiotic prescriptions (OR (95% CI) 0.33 (0.21, 0.54)). However, antibiotic and inappropriate antibiotic prescribing were not significantly different in the guideline group compared to the control group (OR (95% CI) 0.83 (0.55, 1.21) and OR (95% CI) 0.82 (0.53, 1.29) respectively).


CONCLUSIONS
Strategies based upon educational outreach visits may be successfully employed to rationalise antibiotic prescribing by dental practitioners.
Seager
J M
JM
Department of Oral Surgery, Medicine and Pathology, Wales College of Medicine, Cardiff University, Cardiff, CF14 4XY.
Howell-Jones
R S
RS
Dunstan
F D
FD
Lewis
M A O
MA
Richmond
S
S
Thomas
D W
DW
D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D004498:Education, Dental, Continuing / Q000379:methods*; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D019239:Practice Patterns, Dentists'; D014098:Toothache / Q000188:drug therapy*; D014852:Wales
D000900:Anti-Bacterial Agents