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- Adverse Drug Events (ADE) (3)
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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 15 of 15 Research Studies DisplayedRamanathan S, Evans CT, Hershow RC
Guideline concordance and antibiotic-associated adverse events between Veterans administration and non-Veterans administration dental settings: a retrospective cohort study.
The study aimed to evaluate antibiotic prophylaxis adherence and associated adverse drug events (ADEs) in dental settings. A retrospective cohort study of adults with cardiac conditions or prosthetic joints from 2015 to 2017 was conducted. Of 61,124 patients receiving antibiotic prophylaxis, 62 (0.1%) experienced ADEs. Guideline concordance was not linked to ADEs (adjusted OR: 0.78, 95% CI: 0.25-2.46), and this was consistent across different dental settings.
AHRQ-funded; HS025177.
Citation: Ramanathan S, Evans CT, Hershow RC .
Guideline concordance and antibiotic-associated adverse events between Veterans administration and non-Veterans administration dental settings: a retrospective cohort study.
Front Pharmacol 2024 Jan 16; 15:1249531. doi: 10.3389/fphar.2024.1249531.
Keywords: Antibiotics, Medication, Adverse Drug Events (ADE), Guidelines, Dental and Oral Health, Practice Patterns
Ramanathan S, Yan CH, Hubbard C
Changes in antibiotic prescribing by dentists in the United States, 2012-2019.
Dentists are the top specialty prescriber of antibiotics in the United States, prescribing 10% of all outpatient antibiotics. The purpose of this retrospective study was to assess trends in the rates of antibiotic prescribing by dentists. The researchers also evaluated if trends varied by agent, specialty, and patient characteristics. The study found that between 2012 and 2019 dentists wrote more than 216 million antibiotic prescriptions. The annual rate of dental antibiotic prescribing remained steady over time. However, the dental prescribing rate increased in the Northeast, among oral and maxillofacial surgeons, prosthodontists, endodontists, periodontists, and for amoxicillin. The mean days' supply significantly decreased over the study period by 0.023 days per 1,000 dentists per year.
AHRQ-funded; HS025177.
Citation: Ramanathan S, Yan CH, Hubbard C .
Changes in antibiotic prescribing by dentists in the United States, 2012-2019.
Infect Control Hosp Epidemiol 2023 Nov; 44(11):1725-30. doi: 10.1017/ice.2023.151..
Keywords: Antibiotics, Antimicrobial Stewardship, Medication, Dental and Oral Health
Yan CH, Hubbard CC, Lee TA
Impact of hydrocodone rescheduling on dental prescribing of opioids.
In 2014, the United States Drug Enforcement Administration rescheduled hydrocodone’s controlled substance schedule from III to II, introducing increasing regulations in prescribing and dispensing. In the U.S., dentists often prescribe hydrocodone, and these changes in scheduling may have altered dental prescribing of opioids. The purpose of this study was to assess the impact of the hydrocodone rescheduling on dental prescribing of opioids in the United States. Across the 49-month study period, dentists prescribed 50,412,942 opioid prescriptions. Hydrocodone was the most prescribed opioid, followed by codeine, oxycodone, and tramadol. At index, hydrocodone prescribing immediately decreased by -834.8 Rx/1,000 dentists with increased prescribing of codeine, oxycodone, and tramadol. The mean MME increased at index for all opioids except for hydrocodone, and dosages subsequently decreased during the postindex period.
AHRQ-funded; HS025177.
Citation: Yan CH, Hubbard CC, Lee TA .
Impact of hydrocodone rescheduling on dental prescribing of opioids.
JDR Clin Trans Res 2023 Oct; 8(4):402-12. doi: 10.1177/23800844221102830..
Keywords: Opioids, Medication, Dental and Oral Health, Practice Patterns
Ramanathan S, Evans CT, Hershow RC
Comparison of guideline concordant antibiotic prophylaxis in Veterans Affairs and non-Veterans Affairs dental settings among those with cardiac conditions or prosthetic joints.
The objective of this retrospective study was to compare prescribing of antibiotic prophylaxis in Veterans Affairs (VA) and non-VA settings. Subjects were veteran and non-veteran dental patients with cardiac conditions or prosthetic joints; most were males aged 55 years older. The results showed that VA settings had a higher prevalence of guideline concordant prescribing among those with prosthetic joints, and when assessing dosing errors. The authors recommended that future studies focus on the extent to which integrated electronic health records may be responsible for increased guideline concordant prescribing in the VA setting.
AHRQ-funded; HS025177.
Citation: Ramanathan S, Evans CT, Hershow RC .
Comparison of guideline concordant antibiotic prophylaxis in Veterans Affairs and non-Veterans Affairs dental settings among those with cardiac conditions or prosthetic joints.
BMC Infect Dis 2023 Jun 23; 23(1):427. doi: 10.1186/s12879-023-08400-y..
Keywords: Dental and Oral Health, Antibiotics, Medication, Prevention, Cardiovascular Conditions, Practice Patterns
Kim KC, Khouja T, Burgette JM
Trends in dispensed prescriptions for opioids, sedatives, benzodiazepines, gabapentin, and stimulants to children by general dentists, 2012-2019.
This study examined trends in prescription fills for opioids, benzodiazepines, gabapentin, and stimulants to children <18 years from 2012 to 2019 in a national dataset comprising 92% of dispensed outpatient prescriptions by dentists. During this time, 3.8 million children filled prescriptions for high-alert drugs from general dentists. Opioids accounts for 69.4% of high-alert prescriptions, however from 2012 to 2019 fills for opioids, sedatives, benzodiazepines, and stimulants decreased by 65.2%, 43.4%, 43.6% and 89.3%, respectively. Gabapentin prescriptions increased by 8.1%. Older teenagers (15-17 years) received 42.5% of high-alert prescriptions. Low-income counties in Southern states were overrepresented among top-prescribing areas in 2019.
AHRQ-funded; HS025177.
Citation: Kim KC, Khouja T, Burgette JM .
Trends in dispensed prescriptions for opioids, sedatives, benzodiazepines, gabapentin, and stimulants to children by general dentists, 2012-2019.
Pharmacoepidemiol Drug Saf 2023 Jun; 32(6):625-34. doi: 10.1002/pds.5589..
Keywords: Children/Adolescents, Dental and Oral Health, Opioids, Medication, Practice Patterns
Yan CH, Ramanathan S, Suda KJ
Barriers to and facilitators of opioid prescribing by dentists in the United States: a qualitative study.
In this study, a national sample of US dentists was interviewed to understand the barriers and facilitators to opioid prescribing. Findings showed that dentists' opioid decision making is influenced by a range of real-world practice experiences and patient and clinic factors. Recommendations included targeting knowledge gaps in dentistry for education, clinical guidelines, and policy interventions in order to ensure safe and appropriate prescribing of opioids.
AHRQ-funded; HS025177.
Citation: Yan CH, Ramanathan S, Suda KJ .
Barriers to and facilitators of opioid prescribing by dentists in the United States: a qualitative study.
J Am Dent Assoc 2022 Oct;153(10):957-69.e1. doi: 10.1016/j.adaj.2022.05.009..
Keywords: Dental and Oral Health, Opioids, Medication
Khouja T, Polk DE, Suda KJ
Opioid prescribing by oral and maxillofacial surgeons in the United States, 2016-2019.
The objective of this study was to describe opioid prescribing trends among oral and maxillofacial surgeons (OMFS). The IQVIA Longitudinal Prescription Dataset, 2016-2019, was used to identify prescriptions written by OMFS. The results indicated that while OMFS-prescribed hydrocodone and oxycodone decreased in most states, 12 percent of states showed increases. Tramadol and codeine prescriptions also increased. From these findings, the authors concluded that targeted interventions are warranted in some areas.
AHRQ-funded; HS025177.
Citation: Khouja T, Polk DE, Suda KJ .
Opioid prescribing by oral and maxillofacial surgeons in the United States, 2016-2019.
J Public Health Dent 2022 Sep;82(4):491-94. doi: 10.1111/jphd.12544..
Keywords: Opioids, Medication, Practice Patterns, Orthopedics, Surgery, Dental and Oral Health, Provider: Physician
Khouja T, Zhou J, Gellad WF
Serious opioid-related adverse outcomes associated with opioids prescribed by dentists.
This study’s objective was to evaluate adverse outcomes and persistent opioid use (POU) after opioid prescriptions by dentists, based on whether opioids were overprescribed or within recommendations. A cross-sectional analysis of adults with dental visit and corresponding opioid prescription from 2011 to 2017 within a nationwide commercial claims database was conducted. As per CDC guidelines, opioid overprescribing was defined as >120 morphine milligram equivalents. Of 633,387 visits, 16.6% had POU and 2.6% experienced an adverse outcome. POU was higher when opioids were overprescribed with visits associated with mild pain and those with substance use disorders having the highest risk of both outcomes.
AHRQ-funded; HS025177.
Citation: Khouja T, Zhou J, Gellad WF .
Serious opioid-related adverse outcomes associated with opioids prescribed by dentists.
Pain 2022 Aug 1;163(8):1571-80. doi: 10.1097/j.pain.0000000000002545..
Keywords: Opioids, Dental and Oral Health, Substance Abuse, Behavioral Health, Practice Patterns, Pain, Medication, Adverse Drug Events (ADE), Adverse Events
Teoh L, Thompson W, Hubbard CC
Comparison of dental benzodiazepine prescriptions from the U.S., England, and Australia from 2013 to 2018.
Benzodiazepines contribute to substance use disorder and are often part of polydrug abuse, most frequently with opioids. Although dental opioid prescribing differs significantly between countries, little is known about the patterns of dental benzodiazepine prescribing. The aim of this study was to compare dental prescribing of benzodiazepines among the U.S., England, and Australia in 2013-2018.
AHRQ-funded; HS025177.
Citation: Teoh L, Thompson W, Hubbard CC .
Comparison of dental benzodiazepine prescriptions from the U.S., England, and Australia from 2013 to 2018.
Am J Prev Med 2021 Jul;61(1):73-79. doi: 10.1016/j.amepre.2021.01.025..
Keywords: Opioids, Medication, Practice Patterns, Dental and Oral Health
Gross AE, Suda KJ, Zhou J
Serious antibiotic-related adverse effects following unnecessary dental prophylaxis in the United States.
The majority of antibiotics prescribed before a dental visit are considered unnecessary (80.9%). This study characterized adverse effects related to unnecessary dental prophylaxis. This retrospective cohort study used data from dental visits between 2011 and 2015 from the IBM Watson Health Marketscan Commercial Claims/Encounters, Medicare Supplemental, Coordination of Benefits Research databases. Antibiotics prescribed included amoxicillin (67.9%), clindamycin (15.5%), cephalexin (8.6%), azithromycin (2.8%), and penicillin (1.5). Antibiotic adverse effects (AAEs) were found in 1.4% of unnecessary prescriptions. The most common AAEs were emergency department (ED) visits, allergic reactions, 14 cases of C. difficile infection, and 5 anaphylactic reactions. AAEs were more common with clindamycin than amoxicillin.
AHRQ-funded; HS025177.
Citation: Gross AE, Suda KJ, Zhou J .
Serious antibiotic-related adverse effects following unnecessary dental prophylaxis in the United States.
Infect Control Hosp Epidemiol 2021 Jan;42(1):110-12. doi: 10.1017/ice.2020.1261..
Keywords: Antimicrobial Stewardship, Antibiotics, Medication, Dental and Oral Health, Adverse Drug Events (ADE), Adverse Events
Zhou J, Calip GS, Rowan S
Potentially inappropriate medication combination with opioids among older dental patients: a retrospective review of insurance claims data.
Opioid prescribing by dentists for older patients receiving medications with potential contraindications and the subsequent impact on acute care outcomes is not well described. The objective of this paper was to evaluate the use of potentially inappropriate medication combinations (PIMCs) involving opioids prescribed by dentists according to the Beers Criteria and risks of 30-day emergency department (ED) visits and all-cause hospitalization among commercially insured dental patients ages 65 years and older.
AHRQ-funded; HS025177.
Citation: Zhou J, Calip GS, Rowan S .
Potentially inappropriate medication combination with opioids among older dental patients: a retrospective review of insurance claims data.
Pharmacotherapy 2020 Oct;40(10):992-1001. doi: 10.1002/phar.2452..
Keywords: Elderly, Opioids, Dental and Oral Health, Medication: Safety, Medication, Practice Patterns
Suda KJ, Zhou J, Rowan SA
Overprescribing of opioids to adults by dentists in the U.S., 2011-2015.
Dentists prescribe 1 in 10 opioid prescriptions in the U.S. When opioids are necessary, national guidelines recommend the prescription of low-dose opioids for a short duration. This study assessed the appropriate prescribing of opioids by dentists before guideline implementation. The investigators concluded that between 1 in 4 and 1 in 2 opioids prescribed to adult dental patients are overprescribed.
AHRQ-funded; HS025177.
Citation: Suda KJ, Zhou J, Rowan SA .
Overprescribing of opioids to adults by dentists in the U.S., 2011-2015.
Am J Prev Med 2020 Apr;58(4):473-86. doi: 10.1016/j.amepre.2019.11.006..
Keywords: Opioids, Dental and Oral Health, Provider, Practice Patterns, Medication
Suda KJ, Calip GS, Zhou J
Assessment of the appropriateness of antibiotic prescriptions for infection prophylaxis before dental procedures, 2011 to 2015.
This retrospective cohort study examined the use of antibiotic prophylaxis prescribed before dental procedures with patients who have commercial dental insurance. Data from the Truven insurance network was used for claims from 2009 to 2015. Patients in the study were given an antibiotic prescription 7 days before a dental visit. These patients have an appropriate cardiac diagnosis and the median age was 63 and majority female. The majority of dental visits were classified as diagnostic (70.2%) or and/or preventive (58.8%). There were prevalent comorbidities in some patients including prosthetic joint devices (42.5%) and cardiac conditions at higher risk of adverse outcome from infections (20.9%). It was found that 80.9% of antibiotic prescriptions were deemed to be unnecessary based on guidelines.
AHRQ-funded; HS025177.
Citation: Suda KJ, Calip GS, Zhou J .
Assessment of the appropriateness of antibiotic prescriptions for infection prophylaxis before dental procedures, 2011 to 2015.
JAMA Netw Open 2019 May 3;2(5):e193909. doi: 10.1001/jamanetworkopen.2019.3909..
Keywords: Shared Decision Making, Dental and Oral Health, Medication, Practice Patterns, Prevention
Suda KJ, Durkin MJ, Calip GS
Comparison of opioid prescribing by dentists in the United States and England.
The goal of this cross-sectional study was to compare opioid prescribing rates by dentists in the US and England, using data on prescriptions dispensed from outpatient pharmacies and health care settings in 2016 by dentists in both countries. Findings show that the proportion of prescriptions for opioids written by US dentists was 37 times greater than the proportion written by English dentists. US dentists also had a higher number of opioid prescriptions per 1000 population and number of prescriptions per dentist. Dihydrocodeine was the only opioid prescribed by English dentists, while US dentists prescribed a range of opioids containing hydrocodone, codeine, oxycodone, and tramadol, as well as long-acting opioids. The researchers conclude that US dentists adopt measures similar to those used in England to reduce dental opioid prescribing in the United States.
AHRQ-funded; HS025177.
Citation: Suda KJ, Durkin MJ, Calip GS .
Comparison of opioid prescribing by dentists in the United States and England.
JAMA Netw Open 2019 May 3;2(5):e194303. doi: 10.1001/jamanetworkopen.2019.4303..
Keywords: Dental and Oral Health, Medication, Opioids, Pain, Practice Patterns, Provider
Gross AE, Hanna D, Rowan SA
Successful implementation of an antibiotic stewardship program in an academic dental practice.
Researchers created a comprehensive antibiotic stewardship program (ASP) for dental practices. A baseline needs assessment and literature evaluation was conducted by a team of dentists, pharmacists, and physician leaders. An academic dental center in Illinois that is the state’s largest oral health provider for Medicaid recipients was used. After intervention with the ASP, there was a 72.9% decrease in antibiotic prescribing for urgent care visits.
AHRQ-funded; HS025177.
Citation: Gross AE, Hanna D, Rowan SA .
Successful implementation of an antibiotic stewardship program in an academic dental practice.
Open Forum Infect Dis 2019 Mar;6(3):ofz067. doi: 10.1093/ofid/ofz067..
Keywords: Antibiotics, Antimicrobial Stewardship, Dental and Oral Health, Medication, Patient Safety