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Angelici L, Angioletti C, Pinnarelli L, Colais P, de Belvis AG, Melnyk A, La Gatta E, Farchi S, Davoli M, Agabiti N, Acampora A. EASY-NET Program: Effectiveness of an Audit and Feedback Intervention in the Emergency Care for Acute Conditions in the Lazio Region. Healthcare (Basel) 2024; 12:733. [PMID: 38610155 PMCID: PMC11012083 DOI: 10.3390/healthcare12070733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 03/19/2024] [Accepted: 03/25/2024] [Indexed: 04/14/2024] Open
Abstract
The EASY-NET network program (NET-2016-02364191)-effectiveness of audit and feedback (A&F) strategies to improve health practice and equity in various clinical and organizational settings), piloted a novel and more structured A&F strategy. This study compared the effectiveness of the novel strategy against the sole periodic dissemination of indicators in enhancing the appropriateness and timeliness of emergency health interventions for patients diagnosed with acute myocardial infarction (AMI) and ischemic stroke in the Lazio Region. The efficacy of the intervention was assessed through a prospective quasi-experimental design employing a pre- and post-intervention (2021-2022) comparison with a control group. Participating hospitals in the Lazio Region, where professional teams voluntarily engaged in the intervention, constituted the exposed group, while the control group exclusively engaged in routine reporting activities. Effectiveness analysis was conducted at the patient level, utilizing regional health information systems to compute process and outcome indicators. The effectiveness of the intervention was evaluated using difference-in-difference models, comparing pre- and post-intervention periods between exposed and control groups. Estimates were calculated in terms of the difference in percentage points (PP) between absolute risks. Sixteen facilities for the AMI pathway and thirteen for the stroke pathway participated in the intervention. The intervention yielded a reduction in the proportion of 30-day readmissions following hospitalization for ischemic stroke by 0.54 pp in the exposed patients demonstrating a significant difference of -3.80 pp (95% CI: -6.57; -1.03; 5453 patients, 63.7% cases) in the exposed group compared to controls. However, no statistically significant differences attributable to the implemented A&F intervention were observed in other indicators considered. These results represent the first evidence in Italy of the impact of A&F interventions in an emergency setting, utilizing aggregated data from hospitals involved in the Lazio Region's emergency network.
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Affiliation(s)
- Laura Angelici
- Department of Epidemiology, Regional Health Service–Lazio, Via Cristoforo Colombo, 112, 00147 Rome, Italy; (L.P.); (P.C.); (M.D.); (N.A.); (A.A.)
| | - Carmen Angioletti
- Management and Health Laboratory, Institute of Management, Department Embeds, Sant’Anna School of Advanced Studies, Scuola Superiore Sant’Anna, 56127 Pisa, Italy;
| | - Luigi Pinnarelli
- Department of Epidemiology, Regional Health Service–Lazio, Via Cristoforo Colombo, 112, 00147 Rome, Italy; (L.P.); (P.C.); (M.D.); (N.A.); (A.A.)
| | - Paola Colais
- Department of Epidemiology, Regional Health Service–Lazio, Via Cristoforo Colombo, 112, 00147 Rome, Italy; (L.P.); (P.C.); (M.D.); (N.A.); (A.A.)
| | - Antonio Giulio de Belvis
- Critical Pathways and Evaluation Outcome Unit, Fondazione Policlinico Universitario “A. Gemelli”—IRCCS, 00168 Rome, Italy;
| | - Andriy Melnyk
- Faculty of Economics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (A.M.); (E.L.G.)
| | - Emanuele La Gatta
- Faculty of Economics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (A.M.); (E.L.G.)
| | - Sara Farchi
- Area Rete Ospedaliera E Specialistica, Direzione Regionale Salute E Integrazione Sociosanitaria Regione Lazio, 00168 Rome, Italy;
| | - Marina Davoli
- Department of Epidemiology, Regional Health Service–Lazio, Via Cristoforo Colombo, 112, 00147 Rome, Italy; (L.P.); (P.C.); (M.D.); (N.A.); (A.A.)
| | - Nera Agabiti
- Department of Epidemiology, Regional Health Service–Lazio, Via Cristoforo Colombo, 112, 00147 Rome, Italy; (L.P.); (P.C.); (M.D.); (N.A.); (A.A.)
| | - Anna Acampora
- Department of Epidemiology, Regional Health Service–Lazio, Via Cristoforo Colombo, 112, 00147 Rome, Italy; (L.P.); (P.C.); (M.D.); (N.A.); (A.A.)
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Contaldo M, D’Ambrosio F, Ferraro GA, Di Stasio D, Di Palo MP, Serpico R, Simeone M. Antibiotics in Dentistry: A Narrative Review of the Evidence beyond the Myth. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6025. [PMID: 37297629 PMCID: PMC10252486 DOI: 10.3390/ijerph20116025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 05/18/2023] [Accepted: 05/29/2023] [Indexed: 06/12/2023]
Abstract
Antibiotics have undoubtedly revolutionized medicine and the health and survival of patients with life-threatening infections, being nonetheless free from potential adverse effects, and the risk of intestinal dysbiosis, antimicrobial resistance, and the resulting consequences for the patient's health and the public purse. The present study narratively reviewed the epidemiological data on worldwide antibiotic consumption and administration in dental practice, patients' adherence to prescriptions, the antimicrobial resistance phenomenon in dentistry, and the evidence supporting and recommending appropriate antibiotic use in dental care. Eligible systematic reviews and original studies in humans published in the English language from January 2000 to 26 January 2023 were considered. A total of 78 studies, 47 on the epidemiology of antibiotic use and prescription in dentistry, 6 on antibiotic therapy in dentistry, 12 on antibiotic prophylaxis in dentistry, 0 on adherence of dental patients to antibiotic prescription, and 13 on antimicrobial resistance in dentistry, were presently considered. Retrieved evidence revealed that antibiotics are frequently overused and misused in dental practice, dental patients frequently do not adhere to prescriptions, and antimicrobial resistance in dentistry is a still rising phenomenon also secondary to improper oral antiseptics use. The present findings highlighted the need to establish more evidence-based and accurate antibiotic prescriptions to sensitize dentists and dental patients to minimize and rationalize the use of antibiotics only when it is indicated and necessary, improve patients' adherence, and enhance knowledge and awareness of the antimicrobial resistance in dentistry.
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Affiliation(s)
- Maria Contaldo
- Multidisciplinary Department of Medical-Surgical and Odontostomatological Specialities, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (G.A.F.); (D.D.S.); (R.S.)
| | - Francesco D’Ambrosio
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Salerno, Italy;
| | - Giuseppe A. Ferraro
- Multidisciplinary Department of Medical-Surgical and Odontostomatological Specialities, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (G.A.F.); (D.D.S.); (R.S.)
| | - Dario Di Stasio
- Multidisciplinary Department of Medical-Surgical and Odontostomatological Specialities, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (G.A.F.); (D.D.S.); (R.S.)
| | - Maria Pia Di Palo
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Salerno, Italy;
| | - Rosario Serpico
- Multidisciplinary Department of Medical-Surgical and Odontostomatological Specialities, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (G.A.F.); (D.D.S.); (R.S.)
| | - Michele Simeone
- Department of Neuroscience, Reproductive Science and Dentistry, University of Naples Federico II, 80138 Naples, Italy
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Sutherland S, Born K, Singhal S. Moving the needle on dental antibiotic overuse in Canada post COVID-19. CANADA COMMUNICABLE DISEASE REPORT = RELEVE DES MALADIES TRANSMISSIBLES AU CANADA 2022; 48:502-505. [PMID: 38173695 PMCID: PMC10760939 DOI: 10.14745/ccdr.v48i1112a02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Antimicrobial resistance due to over-prescribing in health care, including in dentistry, has been acknowledged as one of the top ten threats to global health by the World Health Organization. Dentistry is responsible for approximately 10% of antibiotics prescribed worldwide and research has shown up to 80% of antibiotics prescribed by dentists may be unnecessary. During the early months of the coronavirus disease 2019 pandemic, when dental offices handled only dental emergencies, it is probable that antibiotics were prescribed more readily and for longer duration to defer treatment for non-urgent cases. These unprecedented times strengthened the realization that strong dental antimicrobial stewardship practises are required in Canada to keep antimicrobial overuse under control. In countries, such as the United Kingdom and Australia, significant work is ongoing in this regard. Canada has made progress in developing tools for antimicrobial stewardship specifically for physicians in community settings, where the vast majority of antibiotics are prescribed, and it is now time to pay attention to antimicrobial stewardship in the field of dental care. Investments in developing a national level dental prescription database, along with monitoring, education and feedback mechanisms, can strongly support moving the needle on dentist-driven antibiotic overuse in Canada.
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Affiliation(s)
- Susan Sutherland
- Sunnybrook Health Sciences Centre, Toronto, ON
- Faculty of Dentistry, University of Toronto, Toronto, ON
| | - Karen Born
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON
| | - Sonica Singhal
- Faculty of Dentistry, University of Toronto, Toronto, ON
- Health Promotion, Chronic Disease, and Injury Prevention, Public Health Ontario, Toronto, ON
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Cassie H, Treweek S, McKee L, Ramsay C, Young L, Clarkson J. 'Well, in dentistry the dentist is always the boss': a multi-method exploration of which organisational characteristics of dental practices most influence the implementation of evidence-based guidance. BMJ Open 2022; 12:e059564. [PMID: 35922111 PMCID: PMC9352983 DOI: 10.1136/bmjopen-2021-059564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 07/20/2022] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To investigate which organisational characteristics of primary care dental practices influence the implementation of evidence-based guidance. DESIGN A multimethod study set within primary care dentistry in Scotland comprising: (1) Semistructured interviews with dental teams to inform development of a self-report questionnaire exploring the translation of guidance in primary care dentistry and (2) A questionnaire-based survey and case studies exploring which organisational characteristics influence knowledge translation. RESULTS Interview data identified three themes: leadership, communication and context. Survey data revealed compliance with recommendations from three topics of dental guidance to be variable, with only 41% (emergency dental care), 19% (oral health assessment and review) and 4% (drug prescribing) of respondents reporting full compliance. Analysis revealed no significant relationship between practice characteristics and compliance with emergency dental care or drug prescribing recommendations. Positive associations were observed between compliance with oral health assessment and review recommendations and having a practice manager, as well as with the type of treatment offered, with fully private practices more likely, and fully National Health Service practices less likely to comply, when compared with those offering a mixture of treatment. Synthesis of the data identified leadership and context as key drivers of guidance uptake. CONCLUSIONS Evidence-based dental recommendations are not routinely translated into practice, with variable leadership and differing practice contexts being central to poor uptake. Guidelines should aim to tailor recommendations and implementation strategies to reflect the complexities and varying contexts that exist in primary care dentistry, thus facilitating the implementation of evidence-based guidance.
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Affiliation(s)
- Heather Cassie
- School of Dentistry, University of Dundee, Dundee, Scotland
| | - Shaun Treweek
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Lorna McKee
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Craig Ramsay
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Linda Young
- Dental Clinical Effectiveness Workstream, Dundee Dental Education Centre, NHS Education for Scotlland, University of Dundee, Dundee, UK
| | - Jan Clarkson
- School of Dentistry, University of Dundee, Dundee, Scotland
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Thompson W, Howe S, Pitkeathley C, Coull C, Teoh L. Outcomes to evaluate care for adults with acute dental pain and infection: a systematic narrative review. BMJ Open 2022; 12:e057934. [PMID: 35190445 PMCID: PMC8860024 DOI: 10.1136/bmjopen-2021-057934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To identify outcomes reported in peer-reviewed literature for evaluating the care of adults with acute dental pain or infection.DesignSystematic narrative review. SETTING/PARTICIPANTS Primary research studies published in peer-reviewed literature and reporting care for adults with acute dental pain or infection across healthcare settings. Reports not in English language were excluded. STUDY SELECTION Seven databases (CINAHL Plus, Dentistry and Oral Sciences Source, EMBASE, MEDLINE, PsycINFO, Scopus, Web of Science) were searched from inception to December 2020. Risk of bias assessment used the Critical Appraisal Skills Programme checklist for randomised controlled trials and Quality Assessment Tool for Studies of Diverse Design for other study types. OUTCOMES Narrative synthesis included all outcomes of care for adults with acute dental pain or infection. Excluded were outcomes about pain management to facilitate treatment, prophylaxis of postsurgical pain/infection or traumatic injuries. RESULTS Searches identified 19 438 records, and 27 studies (dating from 1993 to 2020) were selected for inclusion. Across dental, pharmacy, hospital emergency and rural clinic settings, the studies were undertaken in high-income (n=20) and low/middle-income (n=7) countries. Two clinical outcome categories were identified: signs and symptoms of pain/infection and complications following treatment (including adverse drug reactions and reattendance for the same problem). Patient-reported outcomes included satisfaction with the care. Data collection methods included patient diaries, interviews and in-person reviews. DISCUSSION A heterogeneous range of study types and qualities were included: one study, published in 1947, was excluded only due to lacking outcome details. Studies from dentistry reported just clinical outcomes; across wider healthcare more outcomes were included. CONCLUSIONS A combination of clinical and patient-reported outcomes are recommended to evaluate care for adults with acute dental pain or infection. Further research is recommended to develop core outcomes aligned with the international consensus on oral health outcomes. PROSPERO REGISTRATION NUMBER CRD42020210183.
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Affiliation(s)
- Wendy Thompson
- The University of Manchester Faculty of Biology Medicine and Health, Manchester, UK
| | - Shaun Howe
- Public Dental Service, NHS Shetland, Lerwick, UK
| | | | - Carly Coull
- Oral and Maxillofacial Services, Manchester University NHS Foundation Trust, Manchester, UK
| | - L Teoh
- Melbourne Dental School, The University of Melbourne, Melbourne, Victoria, Australia
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Duncan EM, Goulao B, Clarkson J, Young L, Ramsay CR. 'You had to do something': prescribing antibiotics in Scotland during the COVID-19 pandemic restrictions and remobilisation. Br Dent J 2021:10.1038/s41415-021-3621-8. [PMID: 34815483 PMCID: PMC8609985 DOI: 10.1038/s41415-021-3621-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 10/18/2021] [Indexed: 11/09/2022]
Abstract
Introduction The COVID-19 pandemic brought about seismic change for dentistry including the direction to provide remote advice and prescribe analgesia and antimicrobials. The possibilities for care have widened, but the impact of both restrictions and remobilisation on antibiotic prescribing is not known.Aims To report the impact of COVID-19 restrictions and remobilisation on dental antibiotic prescriptions and explore dentists' intentions and attitudes towards antibiotic prescribing.Design and setting Public Health Scotland national prescribing and claims data are reported alongside an online survey of Scottish general and public health service dentists including closed and open-ended questions.Results Antibiotic prescribing rose by 49% following the suspension of routine dental care, to a peak of 34,993 antibiotics (July 2020). The data also show that since the remobilisation of NHS dental care, antibiotic prescribing remains raised at levels around 28% higher than pre-pandemic. The survey highlights dentists' frustrations and concerns about this increased use of antibiotics. Most dentists intend to reduce their prescribing; however, significant challenges to this being realised were raised.Conclusions The previous success within dentistry to protect against the development of antimicrobial resistance has suffered a knock-back during the pandemic. A renewed focus on reducing unnecessary antibiotics within dentistry is required but, crucially, needs to be approached sensitively alongside the current backdrop of challenges within the service.
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Affiliation(s)
- Eilidh M Duncan
- Health Services Research Unit, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK.
| | - Beatriz Goulao
- Health Services Research Unit, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Janet Clarkson
- NHS Education for Scotland, Edinburgh, UK; Dental Health Services Research Unit, School of Dentistry, University of Dundee, Dundee, UK
| | | | - Craig R Ramsay
- Health Services Research Unit, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
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