Abstract
Dentistry is responsible for around 10% of antibiotic prescribing across global healthcare, with up to 80% representing inappropriate use. Facilitating shared decision-making has been shown to optimise antibiotic prescribing (antibiotic stewardship) in primary medical care. Our aim was to co-develop a shared decision-making antibiotic stewardship tool for dentistry. Dentists, patients and other stakeholders prioritised factors to include in the new tool, based on previous research (a systematic review and ethnographic study) about dentists’ decision-making during urgent appointments. Candidate behaviour-change techniques were identified using the Behaviour Change Wheel and selected based on suitability for a shared decision-making approach. A ‘think aloud’ study helped fine-tune the tool design and Crystal Marking ensured clarity of messaging. The resulting paper-based worksheet for use at point-of-care incorporated various behaviour change techniques, such as: ’information about (and salience of) health consequences’, ‘prompts and cues’, ‘restructuring the physical (and social) environment’ and ‘credible sources’. The think aloud study confirmed the tool’s acceptability to dentists and patients, and resulted in the title: ‘Step-by-step guide to fixing your toothache.’ Further testing will be necessary to evaluate its efficacy at safely reducing dental antibiotic prescribing during urgent dental appointments in England and, with translation, to other dental contexts globally.
Highlights
Antimicrobial resistance is a significant threat to global health, wealth and well-being, and is driven by the use of antibiotics [1]
Patients and the other stakeholders reached a consensus on prioritisation of nine factors for inclusion in this new dental antibiotic stewardship tool: ‘antibiotic beliefs’, ‘competing demands’, ‘fix the problem’, ‘patient influence’, ‘patient management’, ‘peers and colleagues’, ‘planning and consent’, ‘procedure possible’ and ‘professional role’
Having reviewed antibiotic stewardship interventions developed for use in the primary medical care context, the stakeholders recommended translation of two key aspects for the new dental antibiotic stewardship tool: (1)
Summary
Antimicrobial resistance is a significant threat to global health, wealth and well-being, and is driven by the use of antibiotics [1]. The World Health Organisation global action plan on tackling antimicrobial resistance, seeks to optimise the use of antimicrobials in human and animal health (known as antimicrobial stewardship) [1]. Dentistry accounts for around 10% of antibiotic (antibacterial drug) prescribing across international healthcare, with up to 80% shown to represent overprescribing [3]. In England’s publicly funded National Health Service (NHS), urgent dental care for people with acute dental pain or infection accounts for most dental antibiotics, with around 90% of them for adults [4]. In 2020, 3.0 million antibiotics were dispensed to dental patients, costing NHS England £7.6M [5]
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