Effectiveness of strategies to disseminate and implement clinical guidelines for the management of impacted and unerupted third molars in primary dental care, a cluster randomised controlled trial

Bahrami, Mehdi; Deery, Chris; Clarkson, Jan E; Pitts, Nigel; Johnston, Marie; Ricketts, Ian W.; MacLennan, Graeme; Nugent, Zoann; Tilley, Colin; Bonetti, Debbie; Ramsay, Craig R

doi:10.1038/sj.bdj.4811858

Cited by 50 publications

(76 citation statements)

References 25 publications

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“…Data from multifaceted intervention trials in dentistry are limited (Bahrami et al, 2004;van der Sanden et al, 2005), so we cannot compare our results with those of others.…”

Section: Discussioncontrasting

confidence: 57%

Impact of Guideline Implementation on Patient Care: a Cluster RCT

et al. 2009

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In Western European countries, dentists use standardized procedures, rather than individualized risk assessment, for routine oral examinations. The predictive hypothesis was that guideline implementation strategies based on multifaceted interventions would be more effective in patient care than the dissemination of guidelines only. A cluster-randomized trial was conducted, with groups of general dental practitioners (GDPs) as the unit of randomization. Patients were clustered within practices and prospectively enrolled in the trial. Patient data were collected from registration forms. The primary outcome measure was guideline-adherent recall assignment, and a secondary outcome measure was guideline-adherent bitewing frequency. The interventions consisted of online training, guideline dissemination, and educational sessions. For low-risk patients, guideline-adherent recall increased in the intervention group (+8%), which differed from the control group (-6.1%) (p = 0.01). Guideline-adherent bitewings showed mixed results. We conclude that multifaceted intervention had a moderate but relevant effect on the performance of GDPs, which is consistent with other findings in primary care.

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“…Data from multifaceted intervention trials in dentistry are limited (Bahrami et al, 2004;van der Sanden et al, 2005), so we cannot compare our results with those of others.…”

Section: Discussioncontrasting

confidence: 57%

Impact of Guideline Implementation on Patient Care: a Cluster RCT

et al. 2009

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“…Audit and feedback and computer-aided learning were two strategies employed in a parent trial [17] to increase evidence-based extracting of third molars. Both interventions failed to significantly influence the target behavior.…”

Section: Discussionmentioning

confidence: 99%

“…The parent study was a randomized controlled trial with a 2×2 factorial design, which investigated the effects of audit and feedback (A&F) and computer-aided learning (CAL) on evidence-based wisdom (third molar) teeth management [17]. Participants, 63 general dental practitioners across Scotland, were randomly allocated to groups experiencing either, both, or neither intervention.…”

Section: Participants and Proceduresmentioning

confidence: 99%

“…A randomized controlled trial [17] examined the effects of two interventions (audit and feedback/computer-aided learning) on the management of wisdom teeth (third molars), in particular, evidence-based extracting behavior. Although neither intervention were designed using cognitive behavioral theories, the aim of the current study was to see if it was possible to further an understanding of intervention effects.…”

Section: Introductionmentioning

confidence: 99%

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Knowledge May Not Be the Best Target for Strategies to Influence Evidence-Based Practice: Using Psychological Models to Understand RCT Effects

et al. 2009

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“…The vast majority of the included studies involved doctors, mainly in a practice setting, however, there were two that involved dentists; one that involved recording periodontal care 5 and another compliance with a guideline for impacted molars 6 . Most trials measured professional practice, such as prescribing or the use of laboratory tests, but in 112 of the 140 studies it was unclear how the feedback was given.…”

Section: Summary Review/effective Practice and Organisation Of Carementioning

confidence: 99%

Audit and feedback had small but potentially important improvements in professional practice

Hurst

2013

Evid Based Dent

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league, that it is provided more than once, it is given both verbally and in writing and it includes clear targets and an action plan.How does audit compare to other ways of changing clinician performance? The EPOC reviews suggest that there could be a positive risk difference with educational meetings of 6%, with the use of local opinion leaders of 9% and with educational outreach visits, 5.6%. Audit is a component of clinical governance in the NationalHealth Service here in the UK as it is seen as part of the drive to improve care quality 7 . This review suggests that its effect in such a process may be small but given the large number of patients treated even small changes can result in large improvements in patient care.

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Effectiveness of strategies to disseminate and implement clinical guidelines for the management of impacted and unerupted third molars in primary dental care, a cluster randomised controlled trial

Cited by 50 publications

References 25 publications

Impact of Guideline Implementation on Patient Care: a Cluster RCT

Impact of Guideline Implementation on Patient Care: a Cluster RCT

Knowledge May Not Be the Best Target for Strategies to Influence Evidence-Based Practice: Using Psychological Models to Understand RCT Effects

Audit and feedback had small but potentially important improvements in professional practice

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