Hussein Rugzan Jameel, Krohn Robert, Kaufmann-Kolle Petra, Willms Gerald
AQUA - Institut für angewandte Qualitätsförderung und Forschung im Gesundheitswesen GmbH, Göttingen, Germany.
IQTIG, Institut für Qualitätssicherung und Transparenz im Gesundheitswesen, Berlin, Germany.
Z Evid Fortbild Qual Gesundhwes. 2017 May;122:1-8. doi: 10.1016/j.zefq.2017.04.007. Epub 2017 May 16.
Risks resulted from using systemic antibiotics such as increasing rates of bacterial resistance, allergy and side effects should be always weighed individually for each patient against any potential benefits. Routine antibiotic prescribing must be therefore discouraged. The Federal Joint Committee ("Gemeinsamer Bundesauschuss", G-BA) commissioned the AQUA-Institute with the development of an external quality assurance procedure, examining systemic antibiotic use in periodontal, conservative and surgical treatments in ambulatory dental health care. The aim of the procedure was to increase patient safety through rational use of systemic antibiotics and increasing the use of first line medications.
The process of developing the quality indicators included searching for relevant literature and quality indicators, analyzing dental claims data (2013) and antibiotic prescriptions, and finally evaluating the proposed quality indicators in an expert panel. The analysis examined patients who received dental treatments and a prescription for systemic antibiotics. The indicator set consisted of three indicators: usage of systemic antibiotics in dental treatments without indication for antibiotics, the percentage of penicillin prescriptions in dental treatments and the percentage of clindamycin prescriptions in dental treatments.
The analysis showed that about 574 million claims on conservative and surgical treatments were made for about 60 million patients. In total, about 4.7 million systemic antibiotics prescriptions were issued for 3.5 million patients with dental treatments. The percentage of patients given a systemic antibiotic as an adjunct to dental treatments, usually without indication, was 3.4 %. The percentage of penicillin prescriptions (as a whole therapeutic/pharmacological subgroup) of the total systemic antibiotic use in dental treatments was 46.3 %; for clindamycin it was 47.0 %.
Clindamycin is preferred by German dentists, and its overprescription represents an inappropriate use of antibiotics. Optimizing antibiotics prescriptions in dental care through rational use decreases bacterial resistance, increases patient safety and the overall quality of dental care. Future analysis and reporting of the indicators will draw a clear picture of dental antibiotic use, i.e. using a risk adjustment for the first indicator and the implementation of a consistent identification system for dentists in the statutory health insurance (SHI). This will enable a direct connection between dentists and their respective antibiotic prescriptions (causal relationship) and thus highlight areas of need for quality improvement. As such targeted educational activities can be developed on an individual basis.
使用全身性抗生素带来的风险，如细菌耐药率上升、过敏反应及副作用，必须针对每位患者，将其与任何潜在益处进行单独权衡。因此，应避免常规抗生素处方。联邦联合委员会（“Gemeinsamer Bundesauschuss”，G-BA）委托水与健康促进研究所制定一项外部质量保证程序，以检查门诊牙科保健中牙周、保守及外科治疗中全身性抗生素的使用情况。该程序的目的是通过合理使用全身性抗生素及增加一线药物的使用来提高患者安全性。
制定质量指标的过程包括检索相关文献和质量指标、分析牙科理赔数据（2013年）及抗生素处方，最后在专家小组中评估所提议的质量指标。该分析考察了接受牙科治疗并开具全身性抗生素处方的患者。指标集包括三个指标：牙科治疗中无抗生素使用指征时全身性抗生素的使用情况、牙科治疗中青霉素处方的百分比以及牙科治疗中克林霉素处方的百分比。
分析表明，约6000万患者接受了约5.74亿次保守及外科治疗理赔。总共为350万接受牙科治疗的患者开具了约470万份全身性抗生素处方。在牙科治疗中作为辅助用药（通常无使用指征）给予全身性抗生素的患者百分比为3.4%。牙科治疗中全身性抗生素总使用量中青霉素处方（作为整个治疗/药理亚组）的百分比为46.3%；克林霉素为47.0%。
德国牙医更倾向于使用克林霉素，其过度处方代表了抗生素的不当使用。通过合理使用优化牙科保健中的抗生素处方可降低细菌耐药性，提高患者安全性及牙科保健的整体质量。未来对这些指标的分析和报告将清晰呈现牙科抗生素的使用情况，即对第一个指标进行风险调整，并为法定医疗保险（SHI）中的牙医实施统一识别系统。这将使牙医与其各自的抗生素处方之间建立直接联系（因果关系），从而突出需要改进质量的领域。这样就可以开展有针对性的个性化教育活动。
