Informatics Approaches to Understand and Reduce Inappropriate Antibiotic Prescribing by Dentists - Informatics Approaches to Understand and Reduce Inappropriate Antibiotic Prescribing by Dentists
Project Summary
Although antibiotics (ABx) have saved many lives, their inappropriate use contributes to antimicrobial
resistance. Overprescribing ABx can also lead to allergic reactions and adverse events (AEs) such as
Clostridiodes difficile infection (CDI). Antibiotic stewardship reduces negative health effects of ABx use, thus
preserving its future utility and is supported by the American Dental Association (ADA). Antibiotic prophylaxis
prior to dental procedures should be reserved for patients at high risk of post-treatment complications. Despite
these recommendations, inappropriate ABx prescribing for prophylaxis before dental procedures is common,
with 70-80% of prophylactic ABx prescribed outside guidelines
Our group has conducted relevant pivotal work and have found that dentistry lags in fostering the
uptake of research-informed treatments. We have found that initiatives to improve evidence-based dental
practice are often developed and implemented without a deep understanding of the problem, including reasons
why dentists deviate from established prescribing guidelines. Our long-term goal is to build a sustainable
national dental Learning Health System (LHS) focused on continuous quality improvement that facilitates
providing patients with high quality, affordable, evidence-based oral healthcare. To do this, we first need to
establish a practice-level LHS supported by an effective informatics infrastructure, relevant data governance
and a culture of learning that drives evidence-based dental practice.
In this project, we seek to quantify and understand guideline discordant antibiotic prescribing, and to
iteratively develop improvement strategies to appropriately target prescribing to the right patients with the right
ABx at the right time. Through a deep understanding of why antibiotics are so frequently prescribed outside of
the guidelines, we expect to engage the dental team and patients to develop feasible interventions. We will
conduct the research at two large group practices: HealthPartners (HP) and Willamette Dental Group (WDG)
which together have over 900,000 patient visits per year. Our project team comprises of experts in dental
informatics, pharmacology, healthcare quality and safety, and human factors. In Aim 1, we develop and
validate an EHR-based algorithm/quality measure to determine concordance with current evidence-based
antibiotic prescribing guidelines. In Aim 2, we identify and understand factors associated with guideline
concordant/discordant prescribing of antibiotics through patient and provider interviews, and targeted clinic
observations. In Aim 3, using a participatory human-centered design process, we design improvement
strategies to increase concordance with evidence-based ABx guidelines. The outcomes of our research will
arm the dental field with both the knowledge and know-how to measure and reduce inappropriate ABx
prescribing by dentists resulting in better oral health, and subsequently better general health, for our patients.
