Peer Comparison Intervention to Improve Antibiotic Prescribing in Dentistry

Abstract

Background: Dentists prescribe an estimated 13% of outpatient antibiotic courses, many of which may be unnecessary. Health departments are in a unique position to support implementation of antibiotic stewardship across healthcare facilities, including in dental offices. A customized peer comparison message with feedback regarding prescribing frequencies was effective in reducing inappropriate prescribing among primary care physicians in Massachusetts and California. We tested the effect of a peer comparison message for antibiotic prescribing on dentists in the Massachusetts Medicaid program. Methods: We analyzed data from September 2018 to July 2019 for prescriptions of antibiotic courses by dentists to identify the highest prescribing dentists. We used their national provider identifier (NPI) to deduplicate providers and we searched for addresses using the CMS online database. On March 25, 2019, the high prescribers were sent a hard copy letter from the Massachusetts Department of Public Health stating that they were “among the 1% of frequent prescribers.” In addition, the letter provided citations to professional guidelines and prescribing best practices and invited participation in health department–sponsored training for continuing education credits. We tracked the monthly number of antibiotics prescribed by provider before and after the mailing and compared those who received the letter (intervention) to those whose address was either out of state or undeliverable (comparison). Results: Prescribing records for 3,008 dentists were available from September 2018 through July 2019. Most (67%) prescribed <10 antibiotic courses in the 11-month period; the mean monthly antibiotic courses prescribed ranged from 1.2 to 1.6, and the median monthly prescriptions was 0. However, 33% prescribed 10–199 antibiotics, and 1% prescribed >200. Of these 28 comprising the highest 1% , 15 received the intervention letter. The others were either out of state (N = 3) or the letter was returned undelivered (N = 10). The average monthly number of antibiotic courses prescribed before the intervention was similar in the intervention and comparison groups (25.0 and 24.2, respectively). In the 4 months after the intervention, the average did not change in the intervention group but increased slightly in the comparison group (25.2 and 26.2, respectively). The intervention had no significant effect (P = .80). Conclusions: We observed no effect of this peer comparison message among a small sample of dentists in the Massachusetts Medicaid program. This finding may be due to multiple factors, including the small number of the targeted prescribers, the use of a relatively friendly message for communicating with the high prescribers, and the possibility that other forms of communication would be more effective.

Funding: None

Disclosures: None