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‘Everyone plays defence’: a qualitative exploration of issues that influence the prescribing of antibiotics by Portuguese dentists

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Abstract

Objective

The aim of this study was to explore issues influencing antibiotic prescribing by Portuguese dentists.

Methods

Semi-structured qualitative interviews were conducted with 14 purposively selected dentists. Interviews were audio-recorded with consent, anonymised during verbatim transcription and analysed using the five-stage ‘Framework Approach’, with the aid of the software WebQDA. Ethical approval was granted.

Results

‘Defensive’ practice emerged as a significant influence on antibiotic prescribing by Portuguese dentists, based on concerns related to avoiding clinical complications and fears of losing patients. Analysis indicated a divide regarding the influence of guidelines on antibiotic prescribing; their influence seemed subtle, even among those who claimed to use them for decision-making. The influence of peers appeared minimal, although less experienced dentists considered it an issue. Dentists recognised the existence of patient pressure; patient demand for antibiotics was mentioned, as well as expectations of not being prescribed such drugs. Pressure from pharmaceutical sales representatives was not unanimously acknowledged; even those mentioning it attempted to demonstrate reluctance in changing prescribing habits. Clinical experience recurred in the dataset as an overarching influence on antibiotic prescribing.

Conclusions

The main factors that influence antibiotic prescribing appear to be issues intrinsic to dentists, such as a defensive practice and clinical experience; issues related to the environment seem less prominent. Multimodal interventions targeting both knowledge gaps and these intrinsic issues, such as audit and feedback combined with behaviour change messages, may be useful in optimising antibiotic prescribing in Portuguese dentistry.

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Notes

  1. In Portugal, systemic antibiotics are classified as prescription-only medicines.

References

  1. Dar-Odeh NS, Abu-Hammad OA, Al-Omiri MK, et al. Antibiotic prescribing practices by dentists: a review. Ther Clin Risk Manag. 2010;6:301–6.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Falkenstein S, Stein JM, Henne K, et al. Trends in antibiotic use and microbial diagnostics in periodontal treatment: comparing surveys of German dentists in a ten-year period. Clin Oral Investig. 2016;20:1–8.

    Article  Google Scholar 

  3. Pipalova R, Vlcek J, Slezak R. The trends in antibiotic use by general dental practitioners in the Czech Republic (2006–2012). Int Dent J. 2014;64:138–43.

    Article  PubMed  Google Scholar 

  4. Ford PJ, Saladine C, Zhang K, et al. Prescribing patterns of dental practitioners in Australia from 2001–2012. Part I: antimicrobials. Aust Dent J. 2016;61:1–6.

    Article  Google Scholar 

  5. Marra F, George D, Chong M, et al. Antibiotic prescribing by dentists has increased: why? J Am Dent Assoc. 2016;147:320–7.

    Article  PubMed  Google Scholar 

  6. Sweeney LC, Dave J, Chambers PA, et al. Antibiotic resistance in general dental practice: a cause for concern? J Antimicrob Chemother. 2004;5353:567–76.

    Article  Google Scholar 

  7. Poveda Roda R, Bagan JV, Sanchis Bielsa JM, et al. Antibiotic use in dental practice: a review. Med Oral Patol Oral Cir Bucal. 2007;12:E186–92.

    PubMed  Google Scholar 

  8. Goossens H, Ferech M, Vander Stichele R, et al. Outpatient antibiotic use in Europe and association with resistance: a cross-national database study. Lancet. 2005;365:579–87.

    Article  PubMed  Google Scholar 

  9. Costelloe C, Metcalfe C, Lovering A, et al. Effect of antibiotic prescribing in primary care on antimicrobial resistance in individual patients: systematic review and meta-analysis. BMJ. 2010;340:c2096.

    Article  PubMed  Google Scholar 

  10. Thornhill MH, Dayer MJ, Prendergast B, et al. Incidence and nature of adverse reactions to antibiotics used as endocarditis prophylaxis. J Antimicrob Chemother. 2015;70:2382–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Leite J. Antibioterapia em medicina dentária. M.Sc. thesis. Universidade Católica Portuguesa; 2014. http://repositorio.ucp.pt/bitstream/10400.14/16279/1/AntibioticoFinal2.pdf. Accessed 11 Aug 2016.

  12. European Centre for Disease Prevention and Control (ECDC). Surveillance of antimicrobial consumption in Europe 2012. ECDC; 2014.

  13. Ordem dos Médicos Dentistas. Os números da Ordem [Internet]. 2015. http://www.omd.pt/numeros. Accessed 13 Nov 2015.

  14. Arnold SR, Straus SE. Interventions to improve antibiotic prescribing practices in ambulatory care. Cochrane Database Syst Rev 2005;(4):CD003539.

  15. Lopez-Vazquez P, Vazquez-Lago JM, Figueiras A. Misprescription of antibiotics in primary care: a critical systematic review of its determinants. J Eval Clin Pract. 2012;18:473–84.

    Article  PubMed  Google Scholar 

  16. Teixeira A, Roque F, Falcão A. Understanding physician antibiotic prescribing behaviour : a systematic review of qualitative studies. Int J Antimicrob Agents. 2013;41:203–12.

    Article  Google Scholar 

  17. Cope A, Wood F, Francis NA, et al. General dental practitioners’ perceptions of antimicrobial use and resistance: a qualitative interview study. Br Dent J. 2014;217:E9.

    Article  CAS  PubMed  Google Scholar 

  18. Cope AL, Francis NA, Wood F, et al. Antibiotic prescribing in UK general dental practice: a cross-sectional study. Community Dent Oral Epidemiol. 2016;44:145–53.

    Article  PubMed  Google Scholar 

  19. Cope AL, Barnes E, Howells EP, et al. Antimicrobial prescribing by dentists in Wales, UK: findings of the first cycle of a clinical audit. Br Dent J. 2016;221:25–30.

    Article  CAS  PubMed  Google Scholar 

  20. Fielding N, Thomas H. Qualitative interviewing. In: Gilbert N, editor. Researching social life. 2nd ed. London: Sage; 2001.

    Google Scholar 

  21. Aparasu RR. Sampling methods. In: Aparasu RR, editor. Research methods for pharmaceutical practice and policy. London: Pharmaceutical Press; 2010.

    Google Scholar 

  22. Fontanella BJB, Luchesi BM, Saidel MGB, et al. Amostragem em pesquisas qualitativas: proposta de procedimentos para constatar saturação teórica. Cad Saude Publica. 2011;27:389–94.

    Google Scholar 

  23. Direção Geral da Saúde. Prescrição de antibióticos em patologia dentária [Internet]. Norma n.o 064/2011. 2011. http://www.dgs.pt/normas-clinicas/normas-clinicas.aspx. Accessed 23 May 2011.

  24. Ritchie J, Spencer L. Qualitative data analysis for applied policy research. In: Bryman A, Burgess R, editors. Analyzing qualitative data. London: Routledge; 1994.

    Google Scholar 

  25. Pope C, Ziebland S, Mays N. Analysing qualitative data. BMJ. 2000;320:114–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Gibbs GR. Qualitative data analysis: explorations with NVIVO. Maidenhead: Open University Press; 2002.

    Google Scholar 

  27. O’Brien BC, Harris IB, Beckman TJ, et al. Standards for reporting qualitative research. Acad Med. 2014;89:1245–51.

    Article  PubMed  Google Scholar 

  28. Russell CK, Gregory DM. EBN users’ guide: evaluation of qualitative research studies. Evid Based Nurs. 2003;6:36–40.

    Article  PubMed  Google Scholar 

  29. Richards H, Emslie C. The ‘doctor’ or the ‘girl from the University’? Considering the influence of professional roles on qualitative interviewing. Fam Pract. 2000;17(1):71–5.

    Article  CAS  PubMed  Google Scholar 

  30. Löffler C, Böhmer F, Hornung A, et al. Dental care resistance prevention and antibiotic prescribing modification: the cluster-randomised controlled DREAM trial. Implement Sci. 2014;9:27. doi:10.1186/1748-5908-9-27.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Lewis PJ, Tully MP. The discomfort of an evidence-based prescribing decision. J Eval Clin Pract. 2009;15:1152–8.

    Article  PubMed  Google Scholar 

  32. Sbarbaro J. Can we influence prescribing patterns? Clin Infect Dis. 2001;33(Suppl 3):S240–4.

    Article  PubMed  Google Scholar 

  33. Cope A, Chestnutt I. Inappropriate prescribing of antibiotics in primary dental care: reasons and resolutions. Prim Dent J. 2014;3:33–7.

    Article  PubMed  Google Scholar 

  34. Elouafkaoui P, Young L, Newlands R, et al. An audit and feedback intervention for reducing antibiotic prescribing in general dental practice: the RAPiD cluster randomised controlled trial. PLoS Med. 2016;13:e1002115.

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

The authors are very grateful to all the dentists who participated in the study. The help of Dr Cynthia Menezes in translating quotations from Portuguese to colloquial English was very much appreciated.

Author information

Authors and Affiliations

  1. Faculdade de Farmácia, Universidade de Lisboa, Avenida Gama Pinto, 1600-190, Lisbon, Portugal

    Ana Sofia Oliveira

  2. Unidade de Investigação e Desenvolvimento em Enfermagem (ui&de) and Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Escola Superior de Enfermagem de Lisboa (ESEL) and Instituto Superior de Ciências da Saúde Egas Moniz (ISCSEM), ESEL, Avenida Professor Egas Moniz, 1600-190, Lisbon, Portugal

    Mara Pereira Guerreiro

Authors
  1. Ana Sofia Oliveira
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Corresponding author

Correspondence to Mara Pereira Guerreiro.

Ethics declarations

Approval from the Faculty of Pharmacy, University of Lisbon ethics committee was granted (CEFFUL001). Written consent was obtained prior to the interviews. This paper follows the standards for reporting qualitative research [27].

Funding

This work was supported by the Research Institute for Medicines and Pharmaceutical Sciences, Faculty of Pharmacy, University of Lisbon. The funder had no role in data collection, interpretation or reporting.

Conflict of interest

Ana Sofia Oliveira and Mara Pereira Guerreiro declare that they have no conflict of interest.

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Oliveira, A.S., Guerreiro, M.P. ‘Everyone plays defence’: a qualitative exploration of issues that influence the prescribing of antibiotics by Portuguese dentists. Drugs Ther Perspect 33, 234–240 (2017). https://doi.org/10.1007/s40267-017-0388-8

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  • DOI: https://doi.org/10.1007/s40267-017-0388-8

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