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

M Bahrami, C Deery, J E Clarkson, N B Pitts, Marie Johnston, I Ricketts, G MacLennan, Z J Nugent, C Tilley, D Bonetti, C Ramsay

Research output: Contribution to journalArticle

29 Citations (Scopus)

Abstract

Objective To investigate the effectiveness and cost-effectiveness of different guideline implementation strategies, using the Scottish Intercollegiate Guidelines Network (SIGN) Guideline 42 'Management of unerupted and impacted third molar teeth' (published 2000) as a model.

Design A pragmatic, cluster RCT (2x2 factorial design).

Subjects Sixty-three dental practices across Scotland. Clinical records of all 16-24-year-old patients over two, four-month periods in 1999 (pre-intervention) and 2000 (post-intervention) were searched by a clinical researcher blind to the intervention group. Data were also gathered on the costs of the interventions.

Interventions Group 1 received a copy of SIGN 42 Guideline and had an opportunity to attend a postgraduate education course (PBEC). In addition to this, group 2 received audit and feedback (A and F). Group 3 received a computer aided learning (CAL) package. Group 4 received A and F and CAL.

Principal outcome measurement The proportion of patients whose treatment complied with the guideline.

Results The weighted t-test for A and F versus no A and F (P=0.62) and CAL versus no CAL (P=0.76) were not statistically significant. Given the effectiveness results (no difference) the cost effectiveness calculation became a cost-minimisation calculation. The minimum cost intervention in the trial consisted of providing general dental practitioners (GDPs) with guidelines and the option of attending PGEC courses. Routine data which subsequently became available showed a Scotland-wide fall in extractions prior to data collection.

Conclusion In an environment in which pre-intervention compliance was unexpectedly high, neither CAL nor A and F increased the dentists' compliance with the SIGN guideline compared with mailing of the guideline and the opportunity to attend a postgraduate course. The cost of the CAL arm of the trial was greater than the A and Farm. Further work is required to understand dental professionals' behaviour in response to guideline implementation strategies.

Original languageEnglish
Pages (from-to)691-696
Number of pages6
JournalBritish Dental Journal
Volume197
Early online date11 Dec 2004
DOIs
Publication statusPublished - 2004

Keywords

  • EVIDENCE-BASED DENTISTRY
  • 3RD MOLAR REMOVAL
  • PROFESSIONAL PRACTICE
  • ORAL-SURGERY
  • INTERVENTIONS
  • REVIEWS
  • AUDIT
  • GAP

Cite this

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, M ; Deery, C ; Clarkson, J E ; Pitts, N B ; Johnston, Marie; Ricketts, I ; MacLennan, G ; Nugent, Z J ; Tilley, C ; Bonetti, D ; Ramsay, C .

In: British Dental Journal, Vol. 197, 2004, p. 691-696.

Research output: Contribution to journalArticle

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abstract = "Objective To investigate the effectiveness and cost-effectiveness of different guideline implementation strategies, using the Scottish Intercollegiate Guidelines Network (SIGN) Guideline 42 'Management of unerupted and impacted third molar teeth' (published 2000) as a model.Design A pragmatic, cluster RCT (2x2 factorial design).Subjects Sixty-three dental practices across Scotland. Clinical records of all 16-24-year-old patients over two, four-month periods in 1999 (pre-intervention) and 2000 (post-intervention) were searched by a clinical researcher blind to the intervention group. Data were also gathered on the costs of the interventions.Interventions Group 1 received a copy of SIGN 42 Guideline and had an opportunity to attend a postgraduate education course (PBEC). In addition to this, group 2 received audit and feedback (A and F). Group 3 received a computer aided learning (CAL) package. Group 4 received A and F and CAL.Principal outcome measurement The proportion of patients whose treatment complied with the guideline.Results The weighted t-test for A and F versus no A and F (P=0.62) and CAL versus no CAL (P=0.76) were not statistically significant. Given the effectiveness results (no difference) the cost effectiveness calculation became a cost-minimisation calculation. The minimum cost intervention in the trial consisted of providing general dental practitioners (GDPs) with guidelines and the option of attending PGEC courses. Routine data which subsequently became available showed a Scotland-wide fall in extractions prior to data collection.Conclusion In an environment in which pre-intervention compliance was unexpectedly high, neither CAL nor A and F increased the dentists' compliance with the SIGN guideline compared with mailing of the guideline and the opportunity to attend a postgraduate course. The cost of the CAL arm of the trial was greater than the A and Farm. Further work is required to understand dental professionals' behaviour in response to guideline implementation strategies.",
keywords = "EVIDENCE-BASED DENTISTRY, 3RD MOLAR REMOVAL, PROFESSIONAL PRACTICE, ORAL-SURGERY, INTERVENTIONS, REVIEWS, AUDIT, GAP",
author = "M Bahrami and C Deery and Clarkson, {J E} and Pitts, {N B} and Marie Johnston and I Ricketts and G MacLennan and Nugent, {Z J} and C Tilley and D Bonetti and C Ramsay",
note = "This project was supported by Scottish Executive's Chief Scientists Office and NHS R&D Programme (Trial R2-64). The Dental Health Services Research Unit is core funded by the Chief Scientist Office of the Scottish Executive Health Department. The views expressed are those of the authors. Received 10 July 2003; Accepted 3 December 2003; Published online 11 December 2004.",
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TY - JOUR

T1 - 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

AU - Bahrami, M

AU - Deery, C

AU - Clarkson, J E

AU - Pitts, N B

AU - Johnston, Marie

AU - Ricketts, I

AU - MacLennan, G

AU - Nugent, Z J

AU - Tilley, C

AU - Bonetti, D

AU - Ramsay, C

N1 - This project was supported by Scottish Executive's Chief Scientists Office and NHS R&D Programme (Trial R2-64). The Dental Health Services Research Unit is core funded by the Chief Scientist Office of the Scottish Executive Health Department. The views expressed are those of the authors. Received 10 July 2003; Accepted 3 December 2003; Published online 11 December 2004.

PY - 2004

Y1 - 2004

N2 - Objective To investigate the effectiveness and cost-effectiveness of different guideline implementation strategies, using the Scottish Intercollegiate Guidelines Network (SIGN) Guideline 42 'Management of unerupted and impacted third molar teeth' (published 2000) as a model.Design A pragmatic, cluster RCT (2x2 factorial design).Subjects Sixty-three dental practices across Scotland. Clinical records of all 16-24-year-old patients over two, four-month periods in 1999 (pre-intervention) and 2000 (post-intervention) were searched by a clinical researcher blind to the intervention group. Data were also gathered on the costs of the interventions.Interventions Group 1 received a copy of SIGN 42 Guideline and had an opportunity to attend a postgraduate education course (PBEC). In addition to this, group 2 received audit and feedback (A and F). Group 3 received a computer aided learning (CAL) package. Group 4 received A and F and CAL.Principal outcome measurement The proportion of patients whose treatment complied with the guideline.Results The weighted t-test for A and F versus no A and F (P=0.62) and CAL versus no CAL (P=0.76) were not statistically significant. Given the effectiveness results (no difference) the cost effectiveness calculation became a cost-minimisation calculation. The minimum cost intervention in the trial consisted of providing general dental practitioners (GDPs) with guidelines and the option of attending PGEC courses. Routine data which subsequently became available showed a Scotland-wide fall in extractions prior to data collection.Conclusion In an environment in which pre-intervention compliance was unexpectedly high, neither CAL nor A and F increased the dentists' compliance with the SIGN guideline compared with mailing of the guideline and the opportunity to attend a postgraduate course. The cost of the CAL arm of the trial was greater than the A and Farm. Further work is required to understand dental professionals' behaviour in response to guideline implementation strategies.

AB - Objective To investigate the effectiveness and cost-effectiveness of different guideline implementation strategies, using the Scottish Intercollegiate Guidelines Network (SIGN) Guideline 42 'Management of unerupted and impacted third molar teeth' (published 2000) as a model.Design A pragmatic, cluster RCT (2x2 factorial design).Subjects Sixty-three dental practices across Scotland. Clinical records of all 16-24-year-old patients over two, four-month periods in 1999 (pre-intervention) and 2000 (post-intervention) were searched by a clinical researcher blind to the intervention group. Data were also gathered on the costs of the interventions.Interventions Group 1 received a copy of SIGN 42 Guideline and had an opportunity to attend a postgraduate education course (PBEC). In addition to this, group 2 received audit and feedback (A and F). Group 3 received a computer aided learning (CAL) package. Group 4 received A and F and CAL.Principal outcome measurement The proportion of patients whose treatment complied with the guideline.Results The weighted t-test for A and F versus no A and F (P=0.62) and CAL versus no CAL (P=0.76) were not statistically significant. Given the effectiveness results (no difference) the cost effectiveness calculation became a cost-minimisation calculation. The minimum cost intervention in the trial consisted of providing general dental practitioners (GDPs) with guidelines and the option of attending PGEC courses. Routine data which subsequently became available showed a Scotland-wide fall in extractions prior to data collection.Conclusion In an environment in which pre-intervention compliance was unexpectedly high, neither CAL nor A and F increased the dentists' compliance with the SIGN guideline compared with mailing of the guideline and the opportunity to attend a postgraduate course. The cost of the CAL arm of the trial was greater than the A and Farm. Further work is required to understand dental professionals' behaviour in response to guideline implementation strategies.

KW - EVIDENCE-BASED DENTISTRY

KW - 3RD MOLAR REMOVAL

KW - PROFESSIONAL PRACTICE

KW - ORAL-SURGERY

KW - INTERVENTIONS

KW - REVIEWS

KW - AUDIT

KW - GAP

U2 - 10.1038/sj.bdj.4811858

DO - 10.1038/sj.bdj.4811858

M3 - Article

VL - 197

SP - 691

EP - 696

JO - British Dental Journal

JF - British Dental Journal

SN - 0007-0610

ER -