Institute of General Practice, Rostock University Medical Center, Postfach 100888, 18055 Rostock, Germany.
Implement Sci. 2014 Feb 22;9:27. doi: 10.1186/1748-5908-9-27.
Bacterial resistance development is one of the most urgent problems in healthcare worldwide. In Europe, dentistry accounts for a comparatively high amount of antibiotic prescriptions. In light of increasing levels of bacterial resistance, this development is alarming. So far, very few interventional studies have been performed, and further research is urgently needed. By means of a complex educational intervention, the DREAM trial aims at optimising antibiotic prescribing behaviour of general dentists in Germany.
This is a cluster-randomised controlled trial, where each cluster consists of one dental practice and all of its patients in a defined period. Participants are general dentists practicing in the German region of Mecklenburg-Western Pomerania. Randomisation takes place after baseline data collection (6 months) and will be stratified by the antibiotic prescribing rates of the participating dental practices. Dentists randomised into the intervention group will participate in a complex small group educational seminar that aims at: increasing knowledge on bacterial resistance, pharmacology, and prophylaxis of infectious endocarditis; increasing awareness of dentist-patient communication using video-taped vignettes of dentist-patient communication on antibiotic treatment; improving collaboration between general dentists, general practitioners, and practice-based cardiologists on the necessity of antibiotic prophylaxis; enhancing awareness of the dentists' own prescribing habits by providing antibiotic prescribing feedback; and increasing patient knowledge on antibiotic treatment by providing patient-centred information material on antibiotic prophylaxis of endocarditis. The dentists randomised into the control group will not receive any educational programme and provide care as usual. Primary outcome is the overall antibiotic prescribing rate measured at T1 (period of six months after intervention). In a subgroup of adult patients affected by odontogenic infections, microbiological analyses for antibiotic resistance of oral streptococci are performed.
Major aim of the study is to improve the process of decision making with regard to antibiotic prescribing. The approach is simple to implement and might be used rapidly in graduate and post-graduate medical education. We expect the results of this trial to have a major impact on antibiotic prescription strategies and practices in Germany.
Current Controlled Trials ISRCTN09576376.
细菌耐药性的发展是全球医疗保健领域最紧迫的问题之一。在欧洲，牙科领域开具的抗生素处方数量相对较高。鉴于细菌耐药性的不断提高，这种发展令人担忧。迄今为止，开展的干预研究很少，因此迫切需要进一步的研究。通过一项复杂的教育干预措施，DREAM 试验旨在优化德国普通牙医的抗生素处方行为。
这是一项集群随机对照试验，每个集群由一个牙科诊所及其在特定时间段内的所有患者组成。参与者为在德国梅克伦堡-前波美拉尼亚州执业的普通牙医。在基线数据收集（6 个月）后进行随机分组，并按参与牙科诊所的抗生素处方率进行分层。随机分组为干预组的牙医将参加一个复杂的小组教育研讨会，旨在：增加对抗生素耐药性、药理学和感染性心内膜炎预防的了解；通过记录牙医与患者关于抗生素治疗的沟通视频片段，提高牙医与患者沟通的意识；加强普通牙医、全科医生和以诊所为基础的心脏病专家之间在抗生素预防必要性方面的合作；通过提供抗生素处方反馈，提高牙医对自己处方习惯的认识；通过提供关于心内膜炎抗生素预防的以患者为中心的信息材料，提高患者对抗生素治疗的认识。随机分组为对照组的牙医不会接受任何教育计划，照常提供护理。主要结局是在 T1 时（干预后 6 个月期间）测量的总体抗生素处方率。在受牙源性感染影响的成年患者亚组中，对口腔链球菌的抗生素耐药性进行微生物分析。
研究的主要目的是改善抗生素处方决策过程。该方法简单易用，可在毕业后医学教育中迅速推广。我们预计该试验的结果将对德国抗生素处方策略和实践产生重大影响。
当前对照试验 ISRCTN09576376。
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