Dental care resistance prevention and antibiotic prescribing modification—the cluster-randomised controlled DREAM trial

Implementation Science

Attila Altiner¹  Günther Kundt²  Anja Wollny¹  Andreas Podbielski³  Ulrike Burmeister⁴  Hermann Lang⁴  Anne Hornung¹  Femke Böhmer⁴  Christin Löffler¹ 

[1] Institute of General Practice, Rostock University Medical Center, Postfach 100888, 18055 Rostock, Germany;Institute of Biostatistics and Informatics in Medicine and Ageing Research, Rostock University Medical Center, Rostock, Germany;Institute of Medical Microbiology, Virology and Hygiene, Rostock University Medical Center, Rostock, Germany;Department of Conservative Dentistry and Periodontology, Rostock University Medical Center, Rostock, Germany

关键词: Drug resistance;    Health communication;    Antibiotic prophylaxis;    Anti-bacterial agents;    Dental care for chronically ill;    Public health dentistry;    Dentistry;   

Others  :  805347
DOI  :  10.1186/1748-5908-9-27

 received in 2013-12-16, accepted in 2014-02-18,  发布年份 2014

【 摘 要 】

Background

Bacterial resistance development is one of the most urgent problems in healthcare worldwide. In Europe, dentistry accounts for a comparatively high amount of antibiotic prescriptions. In light of increasing levels of bacterial resistance, this development is alarming. So far, very few interventional studies have been performed, and further research is urgently needed. By means of a complex educational intervention, the DREAM trial aims at optimising antibiotic prescribing behaviour of general dentists in Germany.

Method

This is a cluster-randomised controlled trial, where each cluster consists of one dental practice and all of its patients in a defined period. Participants are general dentists practicing in the German region of Mecklenburg-Western Pomerania. Randomisation takes place after baseline data collection (6 months) and will be stratified by the antibiotic prescribing rates of the participating dental practices. Dentists randomised into the intervention group will participate in a complex small group educational seminar that aims at: increasing knowledge on bacterial resistance, pharmacology, and prophylaxis of infectious endocarditis; increasing awareness of dentist-patient communication using video-taped vignettes of dentist-patient communication on antibiotic treatment; improving collaboration between general dentists, general practitioners, and practice-based cardiologists on the necessity of antibiotic prophylaxis; enhancing awareness of the dentists’ own prescribing habits by providing antibiotic prescribing feedback; and increasing patient knowledge on antibiotic treatment by providing patient-centred information material on antibiotic prophylaxis of endocarditis. The dentists randomised into the control group will not receive any educational programme and provide care as usual. Primary outcome is the overall antibiotic prescribing rate measured at T1 (period of six months after intervention). In a subgroup of adult patients affected by odontogenic infections, microbiological analyses for antibiotic resistance of oral streptococci are performed.

Discussion

Major aim of the study is to improve the process of decision making with regard to antibiotic prescribing. The approach is simple to implement and might be used rapidly in graduate and post-graduate medical education. We expect the results of this trial to have a major impact on antibiotic prescription strategies and practices in Germany.

Trial registration

Current Controlled Trials ISRCTN09576376

【 授权许可】

   
2014 Löffler et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

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