title: Impact of microbiological consultation on clinical decision making: a case-control study of clinical management of recurrent periodontitis.
abstract: Data obtained from diagnostic tests may influence the clinician's perception of the patient's state and in some instances may alter subsequent choices of therapeutic interventions. To determine if microbiological consultation influences the clinical management of patients with recurrent periodontitis, an observational, case-control study was conducted to measure the amount and type of periodontal treatment provided by periodontists (n = 13) who had referred patients with recurrent periodontitis for microbiological consultation. The control group consisted of periodontists (n = 10) who had not referred recurrent periodontitis patients for testing. Patients (n = 31; 20 females, 11 males; mean age 49.8 +/- 10.0 years) treated by the case group of periodontists were matched for age and sex to patients (n = 48; 22 females, 26 males; mean age 49.9 +/- 8.5 years) treated by the control group of periodontists. Questionnaires were administered to quantitatively assess the amount and type of treatment before and after receiving the microbiological report. Specific analyses were performed as a function of the time of receipt of the microbiology report. Case-control differences prior to the receipt of the report indicated that the amount of surgery/year was 43% greater for controls (P < 0.04), in spite of control patients exhibiting fewer deep pockets than case patients (P < 0.05). Case-control differences after the receipt of the report indicated that case patients were provided with 45% greater number of appointments/year (P < 0.005), 46% greater scaling/year (P < 0.02), and 79% greater antibiotics/year (P < 0.01) compared with controls. The report influenced 9 (69%) case periodontists to change treatment. Case patients who received a change in treatment (n = 21) exhibited greater number of deep pockets at the time of entry into the study (P < 0.05) as compared with case patients who did not receive a change in treatment. Paired t-tests of differences within groups before and after the report demonstrated that case patients had a significant increase in treatment after the report as shown by 22% greater number of visits/year (P < 0.05) and 54% greater number of antibiotic prescriptions/year (P < 0.01). In contrast, controls demonstrated no significant change in treatment. Further, contrasts of change in treatment before and after the report again indicated that case patients exhibited a significantly higher number of visits/year (P < 0.04) and number of antibiotic prescriptions/year (P < 0.02) compared with control patients.(ABSTRACT TRUNCATED AT 400 WORDS)
authors.affiliation: Department of Periodontics, Faculty of Dentistry, University of Toronto, ON.
authors.forename: D
authors.initials: D
authors.lastname: Levy
authors.forename: A
authors.initials: A
authors.lastname: Csima
authors.forename: P
authors.initials: P
authors.lastname: Birek
authors.forename: R P
authors.initials: RP
authors.lastname: Ellen
authors.forename: C A
authors.initials: CA
authors.lastname: McCulloch
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001431:Bacteriological Techniques / Q000706:statistics & numerical data; D016022:Case-Control Studies; D015169:Colony Count, Microbial; D003657:Decision Making; D003773:Dental Plaque / Q000382:microbiology; D005260:Female; D016905:Gram-Negative Bacterial Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010514:Periodontal Pocket / Q000382:microbiology; D010518:Periodontitis / Q000175:diagnosis* / Q000382:microbiology / Q000628:therapy; D012008:Recurrence
chemical_list: D000900:Anti-Bacterial Agents