Antibiotic Prescribing : Towards a reducTion during Urgent NHS Dental appointments in England (The APTiTUDE Study)

Health problem: Slowing the development and spread of infections resistant to antibiotics is an urgent public health and patient safety need. Clinicians are encouraged to use antibiotics wisely but unnecessary antibiotic use by dentists remains high. In 2015, dentists issued 1-in-20 of all NHS antibiotic prescriptions, totalling 3.4 million per year. Approaches to date, such as issuing clinical guidance advising dental procedures rather than using antibiotics for toothache/infection, have been inadequate. Aim of the research: To develop ways to support reduced antibiotic prescribing for adults with acute conditions during urgent NHS dental appointments in England. How did I approach it? To understand the factors associated with dentists' antibiotic prescribing behaviour, influences on treatment decisions were explored during urgent dental appointments in NHS high-street practices and out-of-hours dental clinics. Based on observations and follow-up interviews with patients, dentists and dental nurses, a list of factors influencing treatment decisions was produced. Next, people with experience of receiving urgent dental care, dental team members and service/policy managers prioritised the factors and identified those potentially amenable to modification. Finally, behavioural science was applied to underpin the development of an intervention to reduce dental antibiotic prescribing. What was the outcome? A logic model was produced describing the theory of change and intervention components to reduce antibiotic prescribing by dentists for adults with acute conditions during urgent dental appointments in England. This will inform development of a complex intervention aimed at individual dentists and patients, the dentist-patient dyad and at organisational level for future evaluation after completion of this doctoral research. Dissemination: Co-production with patients and key stakeholders has provided a wide network for disseminating the findings of this research, including addition to the national dental antimicrobial stewardship toolkit. Presentations at national and international dental, and antimicrobial stewardship conferences have generated extensive interest in the research.