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

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 northeastern French region. 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 (percentage of dentists who reached the target value), and the case-mix stability. 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 important room for improvement. These results showed large variations between dentists (large interquartile ranges) and according to the patients' characteristics (case-mix stability). These four proxy indicators might be used to guide antibiotic stewardship interventions in dental care.

Automated summary

The study found that antibiotic prescriptions in dental care are often unnecessary or inappropriate, but there is a lack of standardized indicators for evaluating the appropriateness of antibiotics prescribed by dentists. By designing and evaluating proxy indicators, the research revealed significant variations among dentists, indicating room for improvement.