A review of antibacterialprescribing by dentists in Wales

Gareth Holyfield

Principal Pharmacist in Public Health

Outline

• Background

• Main findings from review

• Potential factors

• Summary

• Future developments

Background (1)

• NHS dental prescribing data is not routinelyavailable in the UK

– data recently produced for England by the NHSInformation Centre

– Brief summary of dental antibacterial prescribingproduced by the All Wales Medicines Strategy Group(AWMSG)

• National Public Health Service (NPHS)pharmaceutical and dental public health teamsdecided to investigate situation in Wales

Background (2)

• Community dental practitioners may onlyprescribe via the NHS if the item is listed in theDental Practitioner’s Formulary (DPF)

• Dental prescribing data is only available at AllWales level as current reimbursement systemsdo not identify the practice or Local HealthBoard (LHB) of the dental prescriber

• Dental data is available at LHB level based onwhere it has been dispensed.

In 2008:

• 363,739 prescription items were dispensed in Wales onWP10D dental prescriptions (+7.5% over 2007).

• This equates to 0.56% of ALL community prescriptionsdispensed.

• 242,065 (67%) of these items were for antibacterials.

• Dental prescribing accounted for 9% of ALLantibacterials prescribed in primary care.

Main findings

Dental antibacterial drug prescribing from Jan 2007 to Dec 2008

19,603

17,254

19,44518,513

20,317 19,97220,920

20,15319,504

21,92821,156

20,201

22,115

20,36819,912

21,256

19,44019,892

20,486

18,167

20,00620,716

18,761

20,946

£46,539.55

£42,048.69

£46,953.95

£48,948.26

£54,494.36£53,724.69

£51,335.18

£47,766.16

£46,192.91

£47,783.71

£43,139.52

£40,933.72

£48,885.83£49,395.48

£44,606.27

£45,727.14

£41,247.85 £41,314.54

£38,451.20

£36,657.43

£39,748.00

£36,569.43

£32,987.31

£37,068.12

0

10,000

20,000

30,000

40,000

50,000

60,000

Jan-0

7

Feb-0

7

Mar-

07

Apr-

07

May-0

7

Jun-0

7

Jul-

07

Aug-0

7

Sep-0

7

Oct-

07

Nov-0

7

Dec-0

7

Jan-0

8

Feb-0

8

Mar-

08

Apr-

08

May-0

8

Jun-0

8

Jul-

08

Aug-0

8

Sep-0

8

Oct-

08

Nov-0

8

Dec-0

8

Antibacterial drugs Items Antibacterial drugs Costs

NICE Guidance

Cat M changes (quarterly)

Number of dental items dispensed by BNF Chapter 5 subsections,2007 and 2008

+1.3%100%242,065100%238,966Total

0.0%0%00%0Urinary-tract infections

0.0%0%00%0Sulphonamides and Trimethoprim

0.0%0%00%0Quinolones

-12.1%1%1,9391%2,205Tetracyclines

1.5%1%1,9661%1,937Cephalosporins and other Beta Lactams

-23.7%2%4,2152%5,522Clindamycin

-0.9%5%12,7375%12,852Macrolides

7.5%25%60,23223%56,050Metronidazole and Tinidazole

0.4%67%160,97667%160,400Penicillins

% annualincrease/decrease

% of allsectionitems2008

% of allsectionitems2007Sub-section