September 2018

In This Issue: Improving Opioid Safety
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Increasing Dental Stewardship of Antibiotics and Opioids

Feature Article

Antibiotics and opioids are the top therapeutic categories prescribed by dentists. Preliminary data gathered by study investigators on dental prescribing demonstrates that:

• In Medicare Part D beneficiaries, high prescribers of opioids are also high prescribers of antibiotics, and
• Research has shown that over-prescribing of antibiotics and opioids is common. However, there is a knowledge gap in our understanding of medication prescribing and overprescribing (for inappropriate indications and/or excessive quantity/potency/duration) by dentists.

This gap is significant because dentists prescribe 1 out of every 10 prescriptions for both antibiotics and opioids in the US. Although efforts are increasing to curtail overuse of these medication classes, most interventions are focused on medical providers. Thus, the goal of this ongoing HSR&D study (2018–2022) is to develop actionable findings for decision-makers that can be implemented to improve evidence-based prescribing of antibiotics and opioids by dentists. The aims of this study are to:

• Assess dental prescribing of antibiotic and opioid medications and identify characteristics associated with high rates of overprescribing;
• Describe dentists' attitudes towards prescribing antibiotics and opioids among those with high and low prescribing patterns in high and low prescribing facilities; and
• Develop a pilot implementation study to improve dental prescribing.

Study investigators will use VA administrative data to assess antibiotic and opioid dental prescribing based on American Dental Association recommendations, and will work to identify factors related to prescribing. One-on-one qualitative interviews with 'high-' and 'low'-prescribing dentists at 'high-' and 'low'-prescribing facilities will assess perceptions of antibiotic and opioid prescribing, adverse drug events, as well as facilitators and barriers to the use of prescribing resources. This study’s operational partners include VA Dentistry, VA MedSafe, and the Antimicrobial Stewardship Task Force, representing the first collaboration between these partners. 

Findings:
No findings to report at this time.

Impact:
VA provides a unique opportunity to study dental prescribing because ICD9/10 coding by private sector dentists is rare. In addition, most dental patients self-report their medical diagnoses, but the dental record is linked to the Veteran’s medical record in the VA healthcare system. Thus, the impact of study results is likely to be far-reaching. This also is the first study to use national VA databases to answer research questions on dental prescribing of antibiotics and opioids.

Principal Investigator: Katie Suda, PharmD, MS, is part of HSR&D’s Center of Innovation for Complex Chronic Healthcare (CINICHH) in Hines, IL.

Publications: Koppen L, Suda KJ, Rowan S, McGregor J, Evans CT.  “Dentist prescribing of antibiotics and opioids to Medicare Part D beneficiaries: Medications of high impact to public health.”  Journal of the American Dental Association. 2018;149:721-730.

Additional Resources

• VHA Pain Management. Opioid Safety Initiative Toolkit.
• Veterans Crisis Line 1-800-273-8255 (press 1) or Text message to 838255.