An analysis of the clinical appropriateness of out-of-hours emergency dental prescribing of antibiotics in Northern Ireland.

Introduction The inappropriate prescribing of antibiotics in dentistry is potentially linked to the development of antimicrobial resistance, as well as being a considerable cost to healthcare. This study analysed the clinical appropriateness of antibiotics prescribed from 'walk-in' and telephone triage out-of-hours emergency dental clinics in Northern Ireland.Methods Patient and prescribing data were collected from two out-of-hour emergency dental clinics over a two-month period between September and December 2017. In total, 434 prescriptions were analysed. Clinical appropriateness was determined on a case-by-case basis for each prescription by referencing dental prescribing guidelines.Results Over half of the prescriptions analysed (52.77%) were judged as clinically inappropriate. A total of 19.12% of prescriptions were judged as inappropriate, as the antibiotic prescribed was not indicated for the diagnosis recorded by the clinician. Local measures were not attempted in 36.6% of cases. A significant difference (p = 0.002) was observed between the clinical appropriateness of prescriptions issued via walk-in and triage appointments with triage appointments issuing more clinically appropriate prescriptions.Conclusions A significant number of prescriptions provided in out-of-hours emergency dental clinics in Northern Ireland were judged to be inappropriate according to current dental prescribing guidelines.

Does capitation affect the delivery of oral healthcare and access to services? Evidence from a pilot contact in Northern Ireland.

BACKGROUND: In May 2009, the Northern Ireland government introduced General Dental Services (GDS) contracts based on capitation in dental practices newly set up by a corporate dental provider to promote access to dental care in populations that had previously struggled to secure service provision. Dental service provision forms an important component of general health services for the population, but the implications of health system financing on care delivered and the financial cost of services has received relatively little attention in the research literature. The aim of this study is to evaluate the policy effect capitation payment in recently started corporate practices had on the delivery of primary oral healthcare in Northern Ireland and access to services. METHODS: We analysed the policy initiative in Northern Ireland as a natural experiment to find the impact on healthcare delivery of the newly set up corporate practices that use a prospective capitation system to remunerate primary care dentists. Data was collected from GDS claim forms submitted to the Business Services Organisation (BSO) between April 2011 and October 2014. Health and Social Care Board (HSCB) practices operating within a capitation system were matched to a control group, who were remunerated using a retrospective fee-for-service system. RESULTS: No evidence of patient selection was found in the HSCB practices set up by a corporate provider and operated under capitation. However, patients were less likely to visit the dentist and received less treatment when they did attend, compared to those belonging to the control group (P < 0.05). The extent of preventive activity offered and the patient payment charge revenue did not differ between the two practice groups. CONCLUSION: Although remunerating NHS primary care dentists in newly set up corporate practices using a prospective capitation system managed costs within healthcare, there is evidence that this policy may have reduced access to care of registered patients.