Abstract
BackgroundAntibiotic prescribing in dentistry accounts for 9% of total antibiotic prescriptions in Scottish primary care. The Scottish Dental Clinical Effectiveness Programme (SDCEP) published guidance in April 2008 (2nd edition, August 2011) for Drug Prescribing in Dentistry, which aims to assist dentists to make evidence-based antibiotic prescribing decisions. However, wide variation in prescribing persists and the overall use of antibiotics is increasing.MethodsRAPiD is a 12-month partial factorial cluster randomised trial conducted in NHS General Dental Practices across Scotland. Its aim is to compare the effectiveness of individualised audit and feedback (A&F) strategies for the translation into practice of SDCEP recommendations on antibiotic prescribing. The trial uses routinely collected electronic healthcare data in five aspects of its design in order to: identify the study population; apply eligibility criteria; carry out stratified randomisation; generate the trial intervention; analyse trial outcomes.Eligibility was determined on contract status and a minimum level of recent NHS treatment provision. All eligible dental practices in Scotland were simultaneously randomised at baseline either to current audit practice or to an intervention group. Randomisation was stratified by single-handed/multi-handed practices. General dental practitioners (GDPs) working at intervention practices will receive individualised graphical representations of their antibiotic prescribing rate from the previous 14 months at baseline and an update at six months. GDPs could not be blinded to their practice allocation. Intervention practices were further randomised using a factorial design to receive feedback with or without: a health board comparator; a supplementary text-based intervention; additional feedback at nine months. The primary outcome is the total antibiotic prescribing rate per 100 courses of treatment over the year following delivery of the baseline intervention.A concurrent qualitative process evaluation will apply theory-based approaches using the Consolidated Framework for Implementation Research to explore the acceptability of the interventions and the Theoretical Domains Framework to identify barriers and enablers to evidence-based antibiotic prescribing behaviour by GDPs.DiscussionRAPiD will provide a robust evaluation of A&F in dentistry in Scotland. It also demonstrates that linked administrative datasets have the potential to be used efficiently and effectively across all stages of an randomised controlled trial.Trial registrationCurrent Controlled Trials ISRCTN49204710
Highlights
Antibiotic prescribing in dentistry accounts for 9% of total antibiotic prescriptions in Scottish primary care
The Reducing antibiotic prescribing in dentistry (RAPiD) trial has been designed to test the effectiveness of individualised A&F strategies for the implementation of evidence-based guidance on antibiotic prescribing in real world dental practice
The trial is being conducted as part of the Translation research in a dental setting (TRiaDS) programme of multi-disciplinary implementation research embedded within the Scottish Dental Clinical Effectiveness Programme (SDCEP) guidance development process [12]
Summary
Trial Design The RAPiD trial is a 12-month partial factorial cluster randomised controlled trial conducted in NHS General Dental Practices across Scotland. Initial and follow-up procedures All GDPs working in the 632 practices allocated to an intervention group received feedback (i.e., feedback on antibiotic prescribing ± a comparator, ± a text based intervention) at baseline (May 2013) and updated feedback at six months (Nov 2013) (Figure 1). This is the required sample size to achieve 80% power (with two-sided alpha of 2.5% allowing for multiple comparisons) to detect a 10% difference in overall antibiotic prescribing between intervention groups This applies to the comparison between A&F only (n = 316) and A&F with a text-based intervention (n = 316), the comparison between feedback at zero, six, and nine months versus zero and six months only and the comparison between those with and without a Health Board comparator. A letter of invitation to take part in the interview study (with an option to opt out of being contacted further) will be sent initially to 100 of the 300 potential participants representative on the diversity variables of interest (e.g., prescribing level, health board) and on intervention/control allocation. Trial status To date (December 2013), baseline and six-month feedback interventions have been delivered
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