Design of Proxy Indicators Estimating the Appropriateness of Antibiotics Prescribed by French Dentists: a Cross-Sectional Study Based on Reimbursement Data

Abstract

Background – The literature shows that the prescription of antibiotics in dental care is often unnecessary or inappropriate. Indicators estimating the appropriateness of antibiotics prescribed by dentists based on routine databases are however not available in the literature. Our objectives were to: (i) design proxy indicators estimating the appropriateness of antibiotics prescribed by dentists; (ii) evaluate their clinimetric properties; and (iii) provide results for these proxy indicators for dentists located in a north-eastern French region. Methods – We selected and adapted proxy indicators from the literature. Using 2019 Regional Health Insurance data, we evaluated the proxy indicators’ clinimetric properties (measurability, applicability, and potential room for improvement), their results with performance scores (% of dentists who reached the target value), and the case-mix stability. Results – We included 3,014 general dental practitioners, who prescribed a total of 373,975 antibiotics to 308,123 patients in 2019. We identified four proxy indicators estimating antibiotic prescribing appropriateness in dental care. All proxy indicators had good clinimetric properties. Performance scores were generally low (10.5 to 73.0%, depending on the indicator), suggesting an important room for improvement. These results showed large variations between dentists (large interquartile ranges) and according to the patients’ characteristics (case-mix stability). Conclusion – These four proxy indicators might be used to guide antibiotic stewardship interventions in dental care.

Characteristics of dentists and patients associated with appropriate antibiotic prescriptions by French dentists: a cross-sectional study using Health Insurance databases

“…Additional file 1 : Table S2 presents the results for the four proxy indicators [ 17 ]. Important variations between dentists were noted, with large interquartile ranges.…”

“…We previously developed and validated four PIs estimating the appropriateness of antibiotic prescriptions at the dentist level, calculable without information on clinical diagnoses and using routine reimbursement databases [ 17 ]. These PIs, selected from the literature and based on national guidelines [ 20 ], cover the most frequent situations of inappropriate prescribing in dental care.…”

“…Performance was defined as the percentage of dentists who reached the target. Additional file 1 : Table S1 presents the definition (numerator/denominator) of the four PIs and their associated target [ 17 ].…”

“…Additional file 1: Supplementary Table S1. Definition of the four PIs and their target [17]. Supplementary Table S2.…”

“…To overcome this issue, our team recently developed four proxy indicators (PIs) estimating the appropriateness of antibiotic prescriptions at the dentist level, calculable without requiring information on clinical diagnoses, and using routine reimbursement databases. A cross-sectional study, conducted in two north-eastern French regions in 2019 and using these four PIs, showed that antibiotic prescriptions by primary care dentists were suboptimal and important variations between practitioners were highlighted [ 17 ].…”