Impact of guideline implementation on patient care: a cluster RCT.
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.
Mettes
T G
TG
Department of Preventive and Restorative Dentistry, College of Oral Sciences, Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands. d.mettes@dent.umcn.nl
van der Sanden
W J M
WJ
Bronkhorst
E
E
Grol
R P T M
RP
Wensing
M
M
Plasschaert
A J M
AJ
D000293:Adolescent; D001071:Appointments and Schedules; D002648:Child; D016000:Cluster Analysis; D003663:Decision Trees; D003729:Dental Care / Q000592:standards*; D005792:General Practice, Dental / Q000592:standards*; D019983:Guideline Adherence; D006801:Humans; D008334:Mandible; D008875:Middle Aged; D010380:Peer Review; D017410:Practice Guidelines as Topic; D015397:Program Evaluation; D011446:Prospective Studies; D016300:Radiography, Bitewing / Q000592:standards; D012308:Risk Management; D014095:Tooth, Impacted / Q000175:diagnosis / Q000628:therapy*; D016896:Treatment Outcome