Background
Methods
Study setting and population
Data source and study design
Proxy indicators (PIs)
Cluster analysis
Dentists’ and patients’ characteristics
Dentists’ drug prescribing profiles
Statistical analyses
Results
Characteristics of dentists and their patients
Appropriateness of antibiotic prescriptions
Global N = 3,014 dentists | Cluster 1 “Better than average practices” N = 686 dentists (22.8%) Score a: 3/4 (3/4; 3/4) | Cluster 2 “Average practices” N = 1241 dentists (41.2%) Score a: 2/4 (2/4; 2/4) | Cluster 3 “Worse than average practices” N = 1087 dentists (36.1%) Score a: 1/4 (1/4; 1/4) | |
---|---|---|---|---|
Proxy indicator (PI) | Performances (% of dentists who reached the acceptable target) | |||
PI 1–Amoxicillin / amoxicillin-clavulanate (ratio)* | 39.6% | 81.4% | 38.8% | 10.8% |
PI 2–Estimated duration of antibiotic prescriptions (%)* | 62.8% | 92.4% | 73.7% | 31.6% |
PI 3–Prescriptions of not indicated antibiotics (%)* | 73.0% | 96.7% | 86.0% | 43.3% |
PI 4–Prescriptions of rarely indicated antibiotics (%)* | 10.5% | 31.1% | 7.3% | 1.1% |
Cluster analysis
Dentists’ and patients’ characteristics associated with the appropriateness of antibiotic prescriptions
Characteristics in 2019 | Cluster 1 “Better than average practices” N = 686 dentists (22.8%) | Cluster 2 “Average practices” N = 1241 dentists (41.2%) | Cluster 3 “Worse than average practices” N = 1087 dentists (36.1%) | p-value | |
---|---|---|---|---|---|
Dentists’ characteristics | |||||
Geographic area % | Alsace | 33.1 | 39.4 | 44.0 | < 0.0001 |
Champagne-Ardenne | 14.7 | 18.4 | 24.4 | ||
Lorraine | 52.2 | 42.2 | 31.7 | ||
Dentist’s gender % | Male | 57.8 | 59.3 | 53.6 | 0.019 |
Female | 42.2 | 40.8 | 46.5 | ||
Practice setting % | Rural (< 5,000 inhabitants) | 35.1 | 35.2 | 33.7 | 0.265 |
Suburban (5,000–20,000 inhabitants) | 31.5 | 31.1 | 28.7 | ||
Urban (> 20,000 inhabitants) | 33.4 | 33.7 | 37.6 | ||
Type of procedure a % | Prosthetic | 3.2 | 3.9 | 4.3 | 0.028 |
Prevention | 45.5 | 46.2 | 49.7 | ||
Operative dentistry | 48.5 | 48.6 | 45.0 | ||
Surgery | 2.8 | 1.4 | 1.0 | ||
Number of years of practice Median (1st quartile; 3rd quartile) | 14 (3; 29) | 16 (6; 29) | 18 (8; 30) | < 0.0001 | |
Number of patients Median (1st quartile; 3rd quartile) | 744 (504; 992) | 791 (557; 1025) | 720 (512; 1018) | 0.001 | |
Number of procedures per patient Median (1st quartile; 3rd quartile) | 2.9 (2.6; 3.3) | 3.0 (2.7; 3.4) | 3.0 (2.6; 3.5) | 0.004 | |
Patients’ characteristics | |||||
% of patients with chronic diseases Median (1st quartile; 3rd quartile) | 11.3 (9.3; 13.5) | 11.9 (9.9; 14.0) | 11.8 (9.9; 14.2) | 0.0003 | |
% of patients with low income Median (1st quartile; 3rd quartile) | 5.0 (2.4; 10.4) | 4.9 (2.3; 9.4) | 4.4 (2.1; 9.3) | 0.073 | |
% of patients < 16 years old Median (1st quartile; 3rd quartile) | 15.3 (11.2; 19.5) | 14.8 (11.0; 18.8) | 15.0 (10.7; 18.6) | 0.197 | |
% of patients > 65 years old Median (1st quartile; 3rd quartile) | 16.3 (11.5; 21.8) | 17.3 (12.6; 22.4) | 17.5 (12.7; 22.4) | 0.008 |
Characteristics in 2019* | Multivariable analysis | ||||
---|---|---|---|---|---|
Cluster 2 “average practices” VS Cluster 1 “better than average practices” | Cluster 3 “worse than average practices” VS Cluster 1 “better than average practices” | ||||
Odds Ratio (95% confidence interval) | p-value | Odds Ratio (95% confidence interval) | p-value | ||
Geographic area | Lorraine | 1 (reference) | – | 1 (reference) | – |
Alsace | 1.43 (1.16; 1.77) | 0.0009 | 2.15 (1.72; 2.68) | < 0.0001 | |
Champagne-Ardenne | 1.55 (1.18; 2.03) | 0.002 | 2.83 (2.14; 3.73) | < 0.0001 | |
Dentist’s gender | Male | 1 (reference) | – | 1 (reference) | – |
Female | 1.06 (0.87; 1.29) | 0.596 | 1.37 (1.12; 1.69) | 0.003 | |
Number of years of practice a | 1.01 (1.00; 1.01) | 0.219 | 1.02 (1.01; 1.03) | 0.0002 | |
Number of patients | 1.000 (1.000; 1.001) | 0.004 | 1.000 (1.000; 1.000) | 0.532 | |
Number of procedures per patient | 1.16 (1.01; 1.34) | 0.041 | 1.17 (1.01; 1.35) | 0.037 | |
% of patients with chronic diseases | 1.04 (1.01; 1.07) | 0.020 | 1.04 (1.01; 1.08) | 0.023 |
Dentists’ drug prescribing profiles associated with the appropriateness of antibiotic prescriptions
Characteristics in 2019 | Cluster 1 “Better than average practices” N = 686 dentists (22.8%) | Cluster 2 “Average practices” N = 1241 dentists (41.2%) | Cluster 3 “Worse than average practices” N = 1087 dentists (36.1%) | p-value |
---|---|---|---|---|
Total drug expenses (€) per patient Median (1st quartile; 3rd quartile) | 9.0 (7.5; 11.0) | 9.9 (8.1; 12.0) | 10.9 (8.9; 13.0) | < 0.0001a |
Number of units of all drugs per patient Median (1st quartile; 3rd quartile) | 3.6 (2.9; 4.4) | 3.7 (3.0; 4.6) | 3.9 (3.2; 4.7) | < 0.0001a |
Number of antibiotic prescriptions per 1000 patients Median (1st quartile; 3rd quartile) | 125.6 (83.0; 182.9) | 143.4 (101.2; 201.1) | 133.4 (91.5; 191.7) | < 0.0001 |
Number of systemic non-steroidal anti-inflammatory prescriptions per 1000 patients Median (1st quartile; 3rd quartile) | 22.0 (6.7; 50.0) | 28.3 (9.7; 60.3) | 25.0 (9.3; 57.9) | 0.0005 |
Number of systemic corticosteroids prescriptions per 1000 patients Median (1st quartile; 3rd quartile) | 0.0 (0.0; 8.4) | 0.9 (0.0; 7.5) | 0.9 (0.0; 6.5) | 0.724 |