Key Points
-
The appropriateness of the NICE guideline in all cases, particularly for those with the highest risk, was an important concern in the absence of strong evidence.
-
Conflicting advice from cardiologists clearly influenced dentists' ability to implement the guideline.
-
Professionals felt responsibility to take into account individual patient's needs and requests and adapt the guideline to suit circumstances.
Abstract
Background The NICE guideline for antibiotic prophylaxis before dental treatment has made a substantive change and fundamental departure from previous practice that affects long-standing beliefs and practice patterns. There is potential difficulty for healthcare professionals explaining the new guidance to patients who have long believed that they must receive antibiotics before their dental treatment.
Aim To explore clinicians' attitudes towards the NICE guidance on antibiotic prophylaxis, their use of the guideline in clinical practice, barriers to the implementation of the guideline, and how best to overcome any perceived barriers.
Methods In-depth interviews were conducted with seven dental care professionals, two cardiologists and a cardiac care nurse. The data were analysed using the framework method to extract central themes and opinions.
Results Clinicians generally perceived that initially patients would be reluctant to follow the NICE guidance. This was felt to be particularly true of the patient cohort that had previously been prescribed prophylactic antibiotics. They found it difficult to explain the new guidance to patients who have had infective endocarditis and have long believed that they must receive antibiotics before their dental treatment. Concerns were also raised about the legal position of a clinician who did not follow the guidance. Clinicians generally suggested that the provision of accurate information in the form of leaflets and valid websites would be the best way to advise patients about the new guidance.
Conclusions Clinicians anticipated difficulties in explaining to patients the change in clinical practice necessitated by adherence to the NICE guidance, most notably for patients with a history of infective endocarditis or where the patient's cardiologist did not agree with the NICE guidance. They placed particular emphasis on the provision of accurate information in order to reassure patients.
Similar content being viewed by others
Log in or create a free account to read this content
Gain free access to this article, as well as selected content from this journal and more on nature.com
or
References
Harrison J L, Hoen B, Prendergast B D . Antibiotic prophylaxis for infective endocarditis. Lancet 2008; 371 (9621): 1317–1319.
Wilson W, Taubert K A, Gewitz M et al. Prevention of infective endocarditis: guidelines from the American Heart Association. Circulation 2007; 116: 1736–1754.
Gould K F, Elliott T S J, Foweraker J et al. Guidelines for the prevention of endocarditis: report of the working party of the British Society for Antimicrobial Chemotherapy. J Antimicrob Chemother 2006; 57: 1035–1042.
Lauber C, Lalh S S, Grace M et al. Antibiotic prophylaxis practices in dentistry: a survey of dentists and physicians. J Can Dent Assoc 2007; 73: 245.
Soheilipour S, Dunne S M, Newton J T, Jabbarifar S E . Implementation of clinical practice guidelines in dental settings. J Evid Based Dent Pract 2009; 9: 183–193.
National Institute for Health and Clinical Excellence. Prophylaxis against infective endocarditis. Antimicrobial prophylaxis against infective endocarditis in adults and children undergoing interventional procedures. Clinical guideline 64. London: NICE, 2008.
Watkin R W, Roberts G J, Elliott T S J . New guidance from NICE regarding antibiotic prophylaxis for infective endocarditis – response by the BSAC working party. J Antimicrob Chemother 2008; 62: 1477–1478.
Boon N . British Cardiovascular Society antibiotic prophylaxis against infective endocarditis position statement. London: British Cardiovascular Society, 2008.
Joint Formulary Committee. British national formulary 55. London: British Medical Association and Royal Pharmaceutical Society of Great Britain, 2008.
Ashrafian H, Bogle R G . Antimicrobial prophylaxis for endocarditis: emotion or science? Heart 2007; 93: 5–6.
Martin M V . An end to antimicrobial prophylaxis against infective endocarditis for dental procedures? Br Dent J 2008; 204: 107.
Ní Ríordáin R, McCreary C . NICE guideline on antibiotic prophylaxis against infective endocarditis: attitudes to the guideline and implications for dental practice in Ireland. Br Dent J 2009; 206: E11.
McGlone P, Watt R, Sheiham A . Evidence-based dentistry: an overview of the challenges in changing professional practice. Br Dent J 2001; 190: 636–639.
Clarkson J E . Getting research into clinical practice – barriers and solutions. Caries Res 2004; 38: 321–324.
NHS Centre for Reviews and Dissemination. Getting evidence into practice. Effective Health Care 1999; 5(1). http://www.york.ac.uk/inst/crd/EHC/ehc51.pdf
Newton T, Scambler S . Use of qualitative data in oral health research. Community Dent Health 2010; 27: 66–67.
Pope C, Zeibland S, Mays N . Analysing qualitative data. BMJ 2000; 320: 114–116.
Ritchie J, Spencer L . Qualitative data analysis for applied policy research. In Bryman A, Burgess R (eds) Analysing qualitative data. pp 173–194. London: Routledge, 1994.
Shovlin C, Bamford K, Wray D . Post-NICE 2008: antibiotic prophylaxis before dental procedures for patients with pulmonary arteriovenous malformations (PAVMs) and hereditary haemorrhagic telangiectasia. Br Dent J 2008; 205: 531–533.
Carlsen B, Glenton C, Pope C . Thou shalt versus thou shalt not: a meta-synthesis of GPs' attitudes to clinical practice guidelines. Br J Gen Pract 2007; 57(545): 971–978.
Carlsen B, Norheim O F . “What lies beneath it all?” – an interview study of GPs' attitudes to the use of guidelines. BMC Health Serv Res 2008; 8: 218.
Stewart R E, Vroegop S, Kamps G B, van der Werf G T, Meyboom-de Jong B . Factors influencing adherence to guidelines in general practice. Int J Technol Assess Health Care 2003; 19: 546–554.
Cabana M D, Rand C S, Powe N R et al. Why don't physicians follow clinical practice guidelines? A framework for improvement. JAMA 1999; 282: 1458–1465.
Rashidian A, Eccles M P, Russell I . Falling on stony ground? A qualitative study of implementation of clinical guidelines' prescribing recommendations in primary care. Health Policy 2007; 85: 148–161.
Dental Protection Ltd. Antibiotic prophylaxis against infective endocarditis position statement. London: Dental Protection Ltd, 2008.
Schattner A, Fletcher R . Research evidence and the individual patient. QJM 2003; 96: 1–5.
Acknowledgements
The study was supported by the Ministry of Health and Medical Education, Tehran, Iran as part of the PhD project of the first author (SS) in King's College London. The authors would like to acknowledge the contribution of all those clinicians who participated in this study.
Author information
Authors and Affiliations
Corresponding author
Additional information
Refereed paper
Rights and permissions
About this article
Cite this article
Soheilipour, S., Scambler, S., Dickinson, C. et al. Antibiotic prophylaxis in dentistry: part I. A qualitative study of professionals' views on the NICE guideline. Br Dent J 211, E1 (2011). https://doi.org/10.1038/sj.bdj.2011.524
Accepted:
Published:
Issue date:
DOI: https://doi.org/10.1038/sj.bdj.2011.524
This article is cited by
-
Effect of an educational intervention among Lebanese dentists on antibiotic prescribing: a randomized controlled study
Clinical Oral Investigations (2022)
-
The knowledge mobilisation challenge: does producing evidence lead to its adoption within dentistry?
British Dental Journal (2018)
-
Preprocedure Prophylaxis Against Endocarditis Among United States Pediatric Cardiologists
Pediatric Cardiology (2014)
-
Communicating new policy on antibiotic prophylaxis with patients: a randomised controlled trial
British Dental Journal (2013)
-
NICE guideline and current practice of antibiotic prophylaxis for high risk cardiac patients (HRCP) among dental trainers and trainees in the United Kingdom (UK)
British Dental Journal (2012)
