Dental prescribing of antibiotics and opioids: high use in the absence of evidence

抗生素和阿片类药物是牙科医生开出的顶级治疗类别。有趣的是，相关因素- 这些药物类别的处方行为是相似的。我们的初步数据显示， 记录表明，阿片类药物的高处方者也是抗生素的高处方者。但 是我们对药物处方和过度处方的理解目前的知识差距（对于不恰当的， 私人适应症和/或过量/效力/持续时间）。这一差距很大，因为 在美国，牙医每10个处方（Rx）中就有1个处方用于抗生素和阿片类药物。不适当的， 抗生素和阿片类药物的私人和适当使用对患者安全是一种风险，包括：细菌耐药性， 艰难梭菌感染，阿片类药物过量，药物依赖和转移。阿片类药物过量是一种... 由于药物使用者通常从牙医那里寻求阿片类药物， 药物监测计划（PIMs）和继发于阿片类药物使用的死亡与牙科处方有关， ing.牙科手术前使用抗生素预防感染与C。很难 牙科手术期间预防感染性心内膜炎和人工关节感染的指南如下： 最近更新，大大减少了需要抗生素预防的患者数量。然而，德- 尽管预防感染是牙医开抗生素的主要适应症， 数据显示，牙科抗生素处方总量仅小幅下降（0.7%）。虽然努力在增加， 为了减少这些药物类别的不适当使用，大多数干预措施都集中在医生身上， 中级提供者（执业护士、医师助理）。根据初步数据，我们将继续 [2]具体目标：1）[评估]抗生素和阿片类药物的牙科处方，并确定患者 与高过量处方率相关的处方者特征和2）[比较对- 病房处方抗生素和阿片类药物的牙医与实践位于高和低处方com， 美国各地的城市）。拟议的研究与AHRQ的研究优先领域保持一致 （更安全的医疗保健;医疗保健实践的改善，特别是在流动护理方面）和2白宫 国家行动计划侧重于抗生素耐药性和与阿片类药物使用相关的药物不良事件。 我们建议进行一项混合方法研究，以评估抗生素和阿片类药物的牙科处方， 美国牙科协会的治疗建议，并确定有关处方的因素。前- 这项研究的预期结果包括提供抗生素和阿片类药物过度使用程度的基线数据， 牙医划线，确定改善抗生素和阿片类药物处方的障碍和促进因素 以及选择一个试点项目，以提高牙科保健的质量。我们的长期目标是 通过实施干预措施改善患者的牙科护理，增加谨慎的抗菌药物使用， 减少阿片类药物过量处方，减少严重不良事件。

Antibiotics and opioids are the top therapeutic categories prescribed by Dentists. Interestingly, factors associ- ated with prescribing behaviors of these medication classes are similar. Our preliminary data on dental pre- scribing demonstrates that high prescribers of opioids are also high prescribers of antibiotics. However, there is a current knowledge gap in our understanding of medication prescribing and overprescribing (for inappro- priate indications and/or excessive quantity/potency/duration) by Dentists. This gap is significant because Dentists prescribe 1 out of every 10 prescriptions (Rx) for both antibiotics and opioids in the US. Inappro- priate and appropriate use of antibiotic and opioids are a risk to patient safety, including: bacterial resistance, Clostridium difficile infection, opioid overdose, drug dependence and diversion. Opioid overprescribing is con- cerning because substance users commonly seek opioids from dentists, dentists infrequently use prescription drug monitoring programs (PDMP) and fatalities secondary to opioid use have been linked to dental prescrib- ing. Use of antibiotics for infection prophylaxis prior to dental procedures has been associated with C. difficile. Guidelines for infective endocarditis and prosthetic joint infection prophylaxis during dental procedures were recently updated, significantly reducing the number of patients requiring antibiotic prophylaxis. However, de- spite infection prophylaxis being the primary indication for antibiotics prescribed by dentists, our preliminary data shows only a small (0.7%) decrease in overall dental antibiotic prescribing. Although efforts are increas- ing to curtail inappropriate use of these medication classes, most interventions are focused on physicians and midlevel providers (nurse practitioners, physician assistants). Guided by preliminary data, we will be pursuing [2] specific aims: 1) [Assess] dental prescribing of antibiotics and opioid medications and identify patient and prescriber characteristics associated with high rates of overprescribing and 2) [Compare attitudes to- wards prescribing antibiotics and opioids for dentist with practices located in high and low prescribing com- munities across the United States.] The proposed study is aligned with the research priority areas of AHRQ (safer health care; improvements in health care practice, especially in ambulatory care) and 2 White House National Action Plans focused on antibiotic resistance and adverse drug events associated with opioid use. We propose to conduct a mixed-methods study to assess antibiotic and opioid dental prescribing based on American Dental Association treatment recommendations and identify factors related to prescribing. The ex- pected outcomes of this study include providing baseline data on the extent of antibiotic and opioid overpre- scribing by dentists, identification of barriers and facilitators to improving prescribing of antibiotics and opioids and selection of a pilot implementation project to improve the quality of dental care. Our long-term goal is to improve patient dental care by implementing interventions that will increase prudent antimicrobial use, de- crease opioid overprescribing and decrease serious adverse events.