Barriers and facilitators of evidence-based management of patients with bacterial infections among general dental practitioners

a theory-informed interview study

Rumana Newlands, Eilidh M. Duncan, Maria Prior, Paula Elouafkaoui, Andrew Elders, Linda Young, Jan E. Clarkson, Craig R. Ramsay, Translation Research in a Dental Setting (TRiaDS) Research Methodology Group

Research output: Contribution to journalArticle

18 Citations (Scopus)
8 Downloads (Pure)

Abstract

BACKGROUND: General dental practitioners (GDPs) regularly prescribe antibiotics to manage dental infections although most infections can be treated successfully by local measures. Published guidance to support GDPs to make appropriate prescribing decisions exists but there continues to be wide variation in dental antibiotic prescribing. An interview study was conducted as part of the Reducing Antibiotic Prescribing in Dentistry (RAPiD) trial to understand the barriers and facilitators of using local measures instead of prescribing antibiotics to manage bacterial infections.

METHODS: Thirty semi-structured one-to-one telephone interviews were conducted using the Theoretical Domains Framework (TDF). Responses were coded into domains of the TDF and sub-themes. Priority domains (high frequency: ≥50 % interviewees discussed) relevant to behaviour change were identified as targets for future intervention efforts and mapped onto 'intervention functions' of the Behaviour Change Wheel system.

RESULTS: Five domains (behavioural regulation, social influences, reinforcement, environmental context and resources, and beliefs about consequences) with seven sub-themes were identified as targets for future intervention. All participants had knowledge about the evidence-based management of bacterial infections, but they reported difficulties in following this due to patient factors and time management. Lack of time was found to significantly influence their decision processes with regard to performing local measures. Beliefs about their capabilities to overcome patient influence, beliefs that performing local measures would impact on subsequent appointment times as well as there being no incentives for performing local measures were also featured. Though no knowledge or basic skills issues were identified, the participants suggested some continuous professional development programmes (e.g. time management, an overview of published guidance) to address some of the barriers. The domain results suggest a number of intervention functions through which future interventions could change GDPs' antibiotic prescribing for bacterial infections: imparting skills through training, providing an example for GDPs to imitate (i.e. modelling) or creating the expectation of a reward (i.e. incentivisation).

CONCLUSIONS: This is the first theoretically informed study to identify barriers and facilitators of evidence-based management of patients with bacterial infections among GDPs. A pragmatic approach is needed to address the modifiable barriers in future interventions intended to change dentists' inappropriate prescribing behaviour.

Original languageEnglish
Article number11
Pages (from-to)1-12
Number of pages12
JournalImplementation Science
Volume11
DOIs
Publication statusPublished - 29 Jan 2016

Fingerprint

Bacterial Infections
General Practitioners
Tooth
Interviews
Anti-Bacterial Agents
Time Management
Inappropriate Prescribing
Dentistry
Infection
Dentists
Reward
Motivation
Appointments and Schedules

Keywords

  • Infection
  • Bacterial
  • Dental
  • Prescribing
  • Antibiotics
  • Drug resistance
  • Theoretical Domains Framework
  • Intervention design

Cite this

Barriers and facilitators of evidence-based management of patients with bacterial infections among general dental practitioners : a theory-informed interview study. / Newlands, Rumana; Duncan, Eilidh M.; Prior, Maria; Elouafkaoui, Paula; Elders, Andrew; Young, Linda; Clarkson, Jan E.; Ramsay, Craig R.; Translation Research in a Dental Setting (TRiaDS) Research Methodology Group.

In: Implementation Science, Vol. 11, 11, 29.01.2016, p. 1-12.

Research output: Contribution to journalArticle

Newlands, R, Duncan, EM, Prior, M, Elouafkaoui, P, Elders, A, Young, L, Clarkson, JE, Ramsay, CR & Translation Research in a Dental Setting (TRiaDS) Research Methodology Group 2016, 'Barriers and facilitators of evidence-based management of patients with bacterial infections among general dental practitioners: a theory-informed interview study', Implementation Science, vol. 11, 11, pp. 1-12. https://doi.org/10.1186/s13012-016-0372-z
Newlands, Rumana ; Duncan, Eilidh M. ; Prior, Maria ; Elouafkaoui, Paula ; Elders, Andrew ; Young, Linda ; Clarkson, Jan E. ; Ramsay, Craig R. ; Translation Research in a Dental Setting (TRiaDS) Research Methodology Group. / Barriers and facilitators of evidence-based management of patients with bacterial infections among general dental practitioners : a theory-informed interview study. In: Implementation Science. 2016 ; Vol. 11. pp. 1-12.
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title = "Barriers and facilitators of evidence-based management of patients with bacterial infections among general dental practitioners: a theory-informed interview study",
abstract = "BACKGROUND: General dental practitioners (GDPs) regularly prescribe antibiotics to manage dental infections although most infections can be treated successfully by local measures. Published guidance to support GDPs to make appropriate prescribing decisions exists but there continues to be wide variation in dental antibiotic prescribing. An interview study was conducted as part of the Reducing Antibiotic Prescribing in Dentistry (RAPiD) trial to understand the barriers and facilitators of using local measures instead of prescribing antibiotics to manage bacterial infections.METHODS: Thirty semi-structured one-to-one telephone interviews were conducted using the Theoretical Domains Framework (TDF). Responses were coded into domains of the TDF and sub-themes. Priority domains (high frequency: ≥50 {\%} interviewees discussed) relevant to behaviour change were identified as targets for future intervention efforts and mapped onto 'intervention functions' of the Behaviour Change Wheel system.RESULTS: Five domains (behavioural regulation, social influences, reinforcement, environmental context and resources, and beliefs about consequences) with seven sub-themes were identified as targets for future intervention. All participants had knowledge about the evidence-based management of bacterial infections, but they reported difficulties in following this due to patient factors and time management. Lack of time was found to significantly influence their decision processes with regard to performing local measures. Beliefs about their capabilities to overcome patient influence, beliefs that performing local measures would impact on subsequent appointment times as well as there being no incentives for performing local measures were also featured. Though no knowledge or basic skills issues were identified, the participants suggested some continuous professional development programmes (e.g. time management, an overview of published guidance) to address some of the barriers. The domain results suggest a number of intervention functions through which future interventions could change GDPs' antibiotic prescribing for bacterial infections: imparting skills through training, providing an example for GDPs to imitate (i.e. modelling) or creating the expectation of a reward (i.e. incentivisation).CONCLUSIONS: This is the first theoretically informed study to identify barriers and facilitators of evidence-based management of patients with bacterial infections among GDPs. A pragmatic approach is needed to address the modifiable barriers in future interventions intended to change dentists' inappropriate prescribing behaviour.",
keywords = "Infection, Bacterial, Dental, Prescribing, Antibiotics, Drug resistance, Theoretical Domains Framework, Intervention design",
author = "Rumana Newlands and Duncan, {Eilidh M.} and Maria Prior and Paula Elouafkaoui and Andrew Elders and Linda Young and Clarkson, {Jan E.} and Ramsay, {Craig R.} and {Translation Research in a Dental Setting (TRiaDS) Research Methodology Group}",
note = "Acknowledgements We thank all the participants for their contribution to the study. We thank the TRiaDS Research methodology group including I Black, D Bonetti, H Cassie, M Eccles, S Eldridge, JJ Francis, JM Grimshaw, L Macpherson, L McKee, S Michie, N Pitts, D Richards, D Stirling, C Tilley, C Torgerson, S Treweek, L Vale and A Walker for their guidance and contribution to the design and development of the study. We would also like to thank Sarah Blackburn, Lorna Barnsley and Jill Farnham for providing invaluable administrative support for this study.",
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TY - JOUR

T1 - Barriers and facilitators of evidence-based management of patients with bacterial infections among general dental practitioners

T2 - a theory-informed interview study

AU - Newlands, Rumana

AU - Duncan, Eilidh M.

AU - Prior, Maria

AU - Elouafkaoui, Paula

AU - Elders, Andrew

AU - Young, Linda

AU - Clarkson, Jan E.

AU - Ramsay, Craig R.

AU - Translation Research in a Dental Setting (TRiaDS) Research Methodology Group

N1 - Acknowledgements We thank all the participants for their contribution to the study. We thank the TRiaDS Research methodology group including I Black, D Bonetti, H Cassie, M Eccles, S Eldridge, JJ Francis, JM Grimshaw, L Macpherson, L McKee, S Michie, N Pitts, D Richards, D Stirling, C Tilley, C Torgerson, S Treweek, L Vale and A Walker for their guidance and contribution to the design and development of the study. We would also like to thank Sarah Blackburn, Lorna Barnsley and Jill Farnham for providing invaluable administrative support for this study.

PY - 2016/1/29

Y1 - 2016/1/29

N2 - BACKGROUND: General dental practitioners (GDPs) regularly prescribe antibiotics to manage dental infections although most infections can be treated successfully by local measures. Published guidance to support GDPs to make appropriate prescribing decisions exists but there continues to be wide variation in dental antibiotic prescribing. An interview study was conducted as part of the Reducing Antibiotic Prescribing in Dentistry (RAPiD) trial to understand the barriers and facilitators of using local measures instead of prescribing antibiotics to manage bacterial infections.METHODS: Thirty semi-structured one-to-one telephone interviews were conducted using the Theoretical Domains Framework (TDF). Responses were coded into domains of the TDF and sub-themes. Priority domains (high frequency: ≥50 % interviewees discussed) relevant to behaviour change were identified as targets for future intervention efforts and mapped onto 'intervention functions' of the Behaviour Change Wheel system.RESULTS: Five domains (behavioural regulation, social influences, reinforcement, environmental context and resources, and beliefs about consequences) with seven sub-themes were identified as targets for future intervention. All participants had knowledge about the evidence-based management of bacterial infections, but they reported difficulties in following this due to patient factors and time management. Lack of time was found to significantly influence their decision processes with regard to performing local measures. Beliefs about their capabilities to overcome patient influence, beliefs that performing local measures would impact on subsequent appointment times as well as there being no incentives for performing local measures were also featured. Though no knowledge or basic skills issues were identified, the participants suggested some continuous professional development programmes (e.g. time management, an overview of published guidance) to address some of the barriers. The domain results suggest a number of intervention functions through which future interventions could change GDPs' antibiotic prescribing for bacterial infections: imparting skills through training, providing an example for GDPs to imitate (i.e. modelling) or creating the expectation of a reward (i.e. incentivisation).CONCLUSIONS: This is the first theoretically informed study to identify barriers and facilitators of evidence-based management of patients with bacterial infections among GDPs. A pragmatic approach is needed to address the modifiable barriers in future interventions intended to change dentists' inappropriate prescribing behaviour.

AB - BACKGROUND: General dental practitioners (GDPs) regularly prescribe antibiotics to manage dental infections although most infections can be treated successfully by local measures. Published guidance to support GDPs to make appropriate prescribing decisions exists but there continues to be wide variation in dental antibiotic prescribing. An interview study was conducted as part of the Reducing Antibiotic Prescribing in Dentistry (RAPiD) trial to understand the barriers and facilitators of using local measures instead of prescribing antibiotics to manage bacterial infections.METHODS: Thirty semi-structured one-to-one telephone interviews were conducted using the Theoretical Domains Framework (TDF). Responses were coded into domains of the TDF and sub-themes. Priority domains (high frequency: ≥50 % interviewees discussed) relevant to behaviour change were identified as targets for future intervention efforts and mapped onto 'intervention functions' of the Behaviour Change Wheel system.RESULTS: Five domains (behavioural regulation, social influences, reinforcement, environmental context and resources, and beliefs about consequences) with seven sub-themes were identified as targets for future intervention. All participants had knowledge about the evidence-based management of bacterial infections, but they reported difficulties in following this due to patient factors and time management. Lack of time was found to significantly influence their decision processes with regard to performing local measures. Beliefs about their capabilities to overcome patient influence, beliefs that performing local measures would impact on subsequent appointment times as well as there being no incentives for performing local measures were also featured. Though no knowledge or basic skills issues were identified, the participants suggested some continuous professional development programmes (e.g. time management, an overview of published guidance) to address some of the barriers. The domain results suggest a number of intervention functions through which future interventions could change GDPs' antibiotic prescribing for bacterial infections: imparting skills through training, providing an example for GDPs to imitate (i.e. modelling) or creating the expectation of a reward (i.e. incentivisation).CONCLUSIONS: This is the first theoretically informed study to identify barriers and facilitators of evidence-based management of patients with bacterial infections among GDPs. A pragmatic approach is needed to address the modifiable barriers in future interventions intended to change dentists' inappropriate prescribing behaviour.

KW - Infection

KW - Bacterial

KW - Dental

KW - Prescribing

KW - Antibiotics

KW - Drug resistance

KW - Theoretical Domains Framework

KW - Intervention design

U2 - 10.1186/s13012-016-0372-z

DO - 10.1186/s13012-016-0372-z

M3 - Article

VL - 11

SP - 1

EP - 12

JO - Implementation Science

JF - Implementation Science

SN - 1748-5908

M1 - 11

ER -