Community Outreach for Dental Antibiotic Stewardship

Segment Description: Debra Goff, PharmD, describes the success of a community outreach approach to spreading the word about antimicrobial stewardship among dentists and orthopedic surgeons.

Interview Transcript (modified slightly for readability):

Goff: We did a unique approach, community outreach. My husband is a private practice dentist, my neighbor is an internal medicine physician that works for the largest orthopedic surgery practice in town, and also is head of all the nursing homes so he has a relationship with all the orthopedic surgeons.

And they really applied to dental stewardship what I call handshake stewardship. They called their friends and said we need to get together. We had an evening program, we invited the CDC [US Centers for Disease Control and Prevention] who's responsible for outpatient stewardship in our country. And together I worked with an ID physician that does stewardship with me.

We prepared about a one-hour didactic presentation on bringing the physicians in attendance and dentists up to speed on community rates of antibiotic resistance, which they were not aware of, the consequences of prescribing antibiotics and adverse events and some of those consequences being contributing to antibiotic resistance in our community. And also the development of C diff [Clostridiodes difficile], many had no idea could actually die from C diff. We brought them up to speed on recent data in our own community.

The CDC brought the perspective of the need for outpatient stewardship from a global and national perspective. Then we broke them up into working groups, dentists and orthopedic surgeons, we developed patient cases, and they had to see if they could come to a consensus on the antibiotic prophylaxis need. We gave them 10 thought-provoking questions to try to understand how they came to their answers.

Then they presented to the group and it was just amazing when they meet face to face, it's a little different than when you're talking to people over a phone call. Now I know you and I understand your thought process. They were actually able to come to consensus. And one orthopedic surgeon actually said, "We reviewed this case. If you asked me yesterday, I would have said antibiotic prophylaxis before a dental procedure for life. But I learned new information today. And we came to an agreement, no antibiotic prophylaxis for this patient." That was huge. By really meeting each other, handshake stewardship, it actually works.