Martine Christiana, Sutherland Susan, Born Karen, Thompson Wendy, Teoh Leanne, Singhal Sonica
Faculty of Dentistry, University of Toronto, 124 Edward St., Toronto M5G 1X3, ON, Canada.
Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto M5T 3M6, ON, Canada.
JAC Antimicrob Resist. 2024 May 22;6(3):dlae082. doi: 10.1093/jacamr/dlae082. eCollection 2024 Jun.
Dentistry is a significant contributor to the burden of antimicrobial overprescribing and hence to the global problem of antimicrobial resistance. However, antimicrobial stewardship in Canadian dentistry is nascent, with an acknowledged need for research and coordinated stewardship efforts. This study aimed to gain insights into the perspectives of Canadian dentistry sector leaders and experts on the main drivers of dental antibiotic overprescribing and potential stewardship strategies.
Exploratory qualitative design. Data collection: four one-time, 1 h focus group discussions with 22 experts and stakeholders in antimicrobial stewardship in Canada, recruited through a mix of purposive and snowball sampling. Data analysis: inductive thematic analysis.
The analysis yielded five themes: outdated patterns; antimicrobials as a Band-Aid; fear and risk aversion; behavioural change; and why reinvent the wheel? Overprescription in dentistry stems primarily from a perpetuation of outdated prescribing patterns, ubiquitous use of antibiotics as a temporary solution, and an overly cautious antibiotic use by risk-averse providers. Stewardship strategies should be grounded on behavioural change (motivation, robust data and enactment of new behaviours) and may be modelled after tested medical interventions.
This study presents a roadmap for behavioural change in dental antibiotic prescribing, and points to the fact that the success of a stewardship actionable plan for Canadian dentistry may depend more on concerted efforts for change than on the creation of novel strategies. Hence, contextualizing and testing medical stewardship programmes in Canadian dentistry may be effective in combatting antibiotic overprescription, thereby contributing to global efforts to reduce antimicrobial resistance.
牙科在抗菌药物过度处方负担方面起到了重要作用，进而对全球抗菌药物耐药性问题产生影响。然而，加拿大牙科领域的抗菌药物管理尚处于起步阶段，公认需要开展研究并进行协调管理工作。本研究旨在深入了解加拿大牙科领域领导者和专家对于牙科抗生素过度处方的主要驱动因素以及潜在管理策略的看法。
采用探索性定性设计。数据收集：通过目的抽样和滚雪球抽样相结合的方式，与22位加拿大抗菌药物管理方面的专家和利益相关者进行了4次为时1小时的一次性焦点小组讨论。数据分析：归纳主题分析。
分析得出五个主题：过时模式；将抗菌药物当作创可贴；恐惧与风险规避；行为改变；以及为何要 reinvent the wheel（此处可能有误，未明确准确意思，暂保留英文）？牙科过度处方主要源于过时处方模式的持续存在、普遍将抗生素用作临时解决方案以及风险规避型提供者过度谨慎地使用抗生素。管理策略应以行为改变为基础（动机、有力数据和新行为的实施），并且可以效仿经过验证的医疗干预措施。
本研究提出了牙科抗生素处方行为改变的路线图，并指出加拿大牙科管理行动计划的成功可能更多地取决于协同变革努力，而非创造新策略。因此，将医疗管理计划因地制宜并在加拿大牙科领域进行测试，可能有助于对抗生素过度处方起到有效作用，从而为全球减少抗菌药物耐药性的努力做出贡献。
