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Antimicrobial stewardship in dentistry: an arts-based approach to intervention development
Meeting Abstracts
Antimicrobial stewardship in dentistry: an arts-based approach to intervention development Wendy Thompson, Sue Pavitt, Jonathan Sandoe, Rosemary McEachan, Gail Douglas
Abstract Published Online November 29, 2019 School of Dentistry (W Thompson BDS, Prof S Pavitt PhD, Prof G Douglas PhD), and School of Medicine (J Sandoe PhD), University of Leeds, Leeds, UK; and Bradford Institute for Health Research, Bradford, UK (R McEachan PhD) Correspondence to: Mrs Wendy Thompson, School of Dentistry, University of Leeds, Leeds LS2 9LU, UK [email protected]
Background Excessive antibiotic prescribing is a global public health and patient safety problem. Around 10% of all antibiotic prescriptions worldwide are from primary dental care, with 80% estimated to be unnecessary. Earlier research identified 34 factors associated with dentists’ decisions on whether to prescribe antibiotics for adults with acute dental problems. We aimed to develop an evidence-based, theory-informed, story-based intervention to reduce antibiotic prescribing for adults during urgent dental appointments. Methods Coproduction stakeholders included four people with lived experience of acute dental problems, four dentists, three dental nurses, three health-care researchers, two service managers, and two national policy makers. Two workshops were held: prioritising which of the 34 factors to target through the intervention; and developing narratives for the story-based intervention. A live scribe produced a graphic record of small-group discussions during the first meeting, which was followed by a full-group prioritisation exercise using nominal group technique. A theatrecompany led the second workshop in which stakeholders assisted in developing the narratives through a values-based exercise and role play. A script was then commissioned. Findings Complex relations between the factors influencing prescribing were captured by the graphic record which stimulated additional insight from group discussion. Stakeholders prioritised 11 factors for the intervention and advised that engaging the target audience about the risks of antibiotics (rather than just broadcasting messages to them) was particularly important. By exploiting the so-called stickiness of stories for sharing information, role play provided a rich source of narratives from which the professional script writer developed a series of nested video monologues called Quick Fix Frank. Interpretation As well as focusing complex intervention development on issues important to end users, coproduction provided additional insight about antibiotic prescribing behaviours within the dynamic system of urgent dental appointments beyond that achieved from a previous systematic review and ethnographic study. The video monologues produced are part of a complex intervention (currently in development) for inclusion in the national dental antimicrobial stewardship toolkit. Testing and evaluation of the complex interventions will build on the experience of a similar online resource from primary medical care (Treating Antibiotics Responsibly: Guidance, Education & Tools). Its design makes it appropriate for engaging the wider population, including health-care professionals, in the messages that: antibiotics have risks as well as benefits, and antibiotics do not cure toothache. Funding WT was funded by a National Institute for Health Research (NIHR) Doctoral Research Fellowship (DRF-2016-09-148). This manuscript presents independent research funded by the NIHR. The views expressed are those of the authors and not necessarily those of the National Health Services, the NIHR, or the Department of Health and Social Care. Contributors All authors contributed to the design of the research. WT organised and facilitated the stakeholder workshop and worked closely with Theatre of Debate (ToD) to develop the video monologue scripts and produce the videos and podcasts. SP, JS, and RM participated in the workshops, contributed to analysis of the results, and proofread the video monologue scripts. In addition, WT and SP arranged contracts with LiveIllustration for the graphic recording and ToD for production of the video monologues. WT wrote the Abstract with input from SP. All authors have seen and approved the final version of the Abstract for publication Declaration of interests We declare no competing interests.
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www.thelancet.com
Antimicrobial stewardship in dentistry: an arts-based approach to intervention development Wendy Thompson, Sue Pavitt, Jonathan Sandoe, Rosemary McEachan, Gail Douglas
Abstract Published Online November 29, 2019 School of Dentistry (W Thompson BDS, Prof S Pavitt PhD, Prof G Douglas PhD), and School of Medicine (J Sandoe PhD), University of Leeds, Leeds, UK; and Bradford Institute for Health Research, Bradford, UK (R McEachan PhD) Correspondence to: Mrs Wendy Thompson, School of Dentistry, University of Leeds, Leeds LS2 9LU, UK [email protected]
Background Excessive antibiotic prescribing is a global public health and patient safety problem. Around 10% of all antibiotic prescriptions worldwide are from primary dental care, with 80% estimated to be unnecessary. Earlier research identified 34 factors associated with dentists’ decisions on whether to prescribe antibiotics for adults with acute dental problems. We aimed to develop an evidence-based, theory-informed, story-based intervention to reduce antibiotic prescribing for adults during urgent dental appointments. Methods Coproduction stakeholders included four people with lived experience of acute dental problems, four dentists, three dental nurses, three health-care researchers, two service managers, and two national policy makers. Two workshops were held: prioritising which of the 34 factors to target through the intervention; and developing narratives for the story-based intervention. A live scribe produced a graphic record of small-group discussions during the first meeting, which was followed by a full-group prioritisation exercise using nominal group technique. A theatrecompany led the second workshop in which stakeholders assisted in developing the narratives through a values-based exercise and role play. A script was then commissioned. Findings Complex relations between the factors influencing prescribing were captured by the graphic record which stimulated additional insight from group discussion. Stakeholders prioritised 11 factors for the intervention and advised that engaging the target audience about the risks of antibiotics (rather than just broadcasting messages to them) was particularly important. By exploiting the so-called stickiness of stories for sharing information, role play provided a rich source of narratives from which the professional script writer developed a series of nested video monologues called Quick Fix Frank. Interpretation As well as focusing complex intervention development on issues important to end users, coproduction provided additional insight about antibiotic prescribing behaviours within the dynamic system of urgent dental appointments beyond that achieved from a previous systematic review and ethnographic study. The video monologues produced are part of a complex intervention (currently in development) for inclusion in the national dental antimicrobial stewardship toolkit. Testing and evaluation of the complex interventions will build on the experience of a similar online resource from primary medical care (Treating Antibiotics Responsibly: Guidance, Education & Tools). Its design makes it appropriate for engaging the wider population, including health-care professionals, in the messages that: antibiotics have risks as well as benefits, and antibiotics do not cure toothache. Funding WT was funded by a National Institute for Health Research (NIHR) Doctoral Research Fellowship (DRF-2016-09-148). This manuscript presents independent research funded by the NIHR. The views expressed are those of the authors and not necessarily those of the National Health Services, the NIHR, or the Department of Health and Social Care. Contributors All authors contributed to the design of the research. WT organised and facilitated the stakeholder workshop and worked closely with Theatre of Debate (ToD) to develop the video monologue scripts and produce the videos and podcasts. SP, JS, and RM participated in the workshops, contributed to analysis of the results, and proofread the video monologue scripts. In addition, WT and SP arranged contracts with LiveIllustration for the graphic recording and ToD for production of the video monologues. WT wrote the Abstract with input from SP. All authors have seen and approved the final version of the Abstract for publication Declaration of interests We declare no competing interests.
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www.thelancet.com