Abstract
Design This study utilised a two-arm cluster randomized controlled trial, with pre- and post-test assessments.
Intervention General dental practitioners were randomly allocated to intervention and control groups using a random number table. The intervention was multifaceted and consisted of:
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Initial dissemination of a clinical practice guideline (CPG) by mail, and instruction for use of the CPG.
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At 1 month, general information and feedback on 36 simulated patient cases; Second month: individual feedback on 36 simulated patient cases, partially handwritten.
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Third month: interactive meeting with discussion on the CPG.
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Fourth month: reminder (laminated card with overview of CPG recommendations).
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Fifth month: reminder (overview of general recommendations).
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Sixth month: reminder (postcard with overview of CPG recommendations).
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Eleventh month: repeat questionnaire and 36 simulated patient cases.
Outcome measure Outcomes evaluated were the answers given on pre- and postintervention questionnaires and the number of patients in the simulated cases who were referred for removal of their asymptomatic impacted mandibular third molars.
Results There was a decrease in the number of patients referred for third molar extraction (see Table 1) and also a significant reduction in the mean number of treatment decisions made by the participants in the intervention group that were not in agreement with the CPG (False Positives and False Negatives) (10.5 in the pretest assessment vs 5.7 in the post-test assessment; mean decrease, 4.8; 95% confidence interval, 3.2–6.4). No significant decrease was observed in the control group (mean decrease, 2.4; 95% confidence interval, 0.7–4.2). There was no difference in the proportion of CPG-consistent, true, positive decisions, however.
Conclusions The study demonstrated that the method employed for dissemination and implementation of a CPG on asymptomatic, impacted mandibular third molars improved the knowledge of dentists on this topic, but did not improve their clinical decision-making skills.
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Address for correspondence: Dr Wil JM van der Sanden, Radboud University Nijmegen Medical Centre, College of Dental Sciences, PO Box 9101, 6500 HB Nijmegen, The Netherlands. E-mail: w.vandersanden@dent.umcn.nl
van der Sanden WJM, Mettes DG, Plasschaert AJM, Grol RPTM, Mulder J, Verdonschot EH. Effectiveness of clinical practice guideline implementation on lower third molar management in improving clinical decision-making: a randomized controlled trial. Eur J Oral Sci 2005; 113:349–354
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Bonetti, D. Guideline improved dentists' knowledge but not their clinical decision-making skills. Evid Based Dent 7, 8 (2006). https://doi.org/10.1038/sj.ebd.6400386
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DOI: https://doi.org/10.1038/sj.ebd.6400386
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