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      The effectiveness of guideline implementation strategies in the dental setting: a systematic review

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          Abstract

          Background

          Guideline implementation has been an ongoing challenge in the dental practice setting. Despite this, there are no reviews summarising the existing evidence regarding effective guideline implementation strategies in this setting. In order to address this, this systematic review examines the effectiveness of guideline implementation strategies in the dental practice setting.

          Methods

          A systematic search was undertaken according to the PRISMA statement across nine electronic databases, targeting randomised controlled trials and quasi-experimental studies which evaluated the effectiveness of guideline implementation strategies in improving guideline adherence in the dental setting. All records were independently examined for relevance and appraised for study quality by two authors, with consensus achieved by a third author. Data were extracted from included studies using a standardised data extraction pro forma.

          Results

          A total of 15 records were eligible for inclusion in this review, which focused on the effects of audit and feedback, reminders, education, patient-mediated interventions, pay for performance and multifaceted interventions. Although there were some conflicting evidence, studies within each category of implementation strategy indicated a positive effect on guideline adherence.

          Conclusions

          This study has identified education, reminders and multifaceted interventions as effective implementation strategies for the dental practice setting. Although this is similar to research findings from other health sectors, there is some evidence to suggest patient-mediated interventions may be less effective and pay for performance may be more effective in the dental setting. These findings can inform policy makers, professional associations, colleges and organisations in the future adoption of clinical guidelines in the dental practice setting.

          Trial registration

          This systematic review was registered with the International Prospective Register of Systematic Reviews (PROSPERO), registration ID CRD42018093023.

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          Most cited references33

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          The effect of electronic prescribing on medication errors and adverse drug events: a systematic review.

          Elske Ammenwerth, Petra Schnell-Inderst, Christof Machan … (2008)
          The objective of this systematic review is to analyse the relative risk reduction on medication error and adverse drug events (ADE) by computerized physician order entry systems (CPOE). We included controlled field studies and pretest-posttest studies, evaluating all types of CPOE systems, drugs and clinical settings. We present the results in evidence tables, calculate the risk ratio with 95% confidence interval and perform subgroup analyses for categorical factors, such as the level of care, patient group, type of drug, type of system, functionality of the system, comparison group type, study design, and the method for detecting errors. Of the 25 studies that analysed the effects on the medication error rate, 23 showed a significant relative risk reduction of 13% to 99%. Six of the nine studies that analysed the effects on potential ADEs showed a significant relative risk reduction of 35% to 98%. Four of the seven studies that analysed the effect on ADEs showed a significant relative risk reduction of 30% to 84%. Reporting quality and study quality was often insufficient to exclude major sources of bias. Studies on home-grown systems, studies comparing electronic prescribing to handwriting prescribing, and studies using manual chart review to detect errors seem to show a higher relative risk reduction than other studies. Concluding, it seems that electronic prescribing can reduce the risk for medication errors and ADE. However, studies differ substantially in their setting, design, quality, and results. To further improve the evidence-base of health informatics, more randomized controlled trials (RCTs) are needed, especially to cover a wider range of clinical and geographic settings. In addition, reporting quality of health informatics evaluation studies has to be substantially improved.
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            Evaluating the message: the relationship between compliance rate and the subject of a practice guideline.

            R Grilli, J Lomas (1994)
            To explore the relationship between providers' compliance and some key aspects of the clinical messages in practice guidelines, studies published in the English language medical literature between 1980 and 1991 were retrieved through MEDLINE and through relevant review articles in the field. All published studies providing compliance rates with practice guidelines and endorsed by official organizations were eligible for the study. The clinical content and the reported compliance rate were gathered for each recommendation in the 23 studies selected. The medical and surgical procedures addressed by 143 recommendations were identified according to specialty area, type of procedure (diagnostic, surgical, etc.) and were independently classified by the authors as being high or low on characteristics thought to influence diffusion:complexity, trialability and observability. The mean compliance rate with the 143 clinical recommendations was 54.5% (95% CI: 50.2%-58.9%), with those in the specialty areas of cardiology and oncology showing the highest compliance (mean 63.6% and 62.2%, respectively). Recommendations concerning procedures with high complexity had lower compliance rates than those low on complexity (41.9% vs. 55.9%; P = 0.05), and those judged to be high on trialability had higher compliance rates than those low on trialability (55.6% vs 36.8%; P = 0.03). Overall, all the characteristics of the clinical recommendations considered in the practice guidelines could account for no more than 47% of the observed variability in compliance rates. The target area of practice and the complexity and trialability of the recommended procedure appear to be useful, if partial, predictors of the level of compliance with a practice guideline.
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              Advancing the literature on designing audit and feedback interventions: identifying theory-informed hypotheses

              Heather Colquhoun, Kelly Carroll, Kevin Eva … (2017)
              Background Audit and feedback (A&F) is a common strategy for helping health providers to implement evidence into practice. Despite being extensively studied, health care A&F interventions remain variably effective, with overall effect sizes that have not improved since 2003. Contributing to this stagnation is the fact that most health care A&F interventions have largely been designed without being informed by theoretical understanding from the behavioral and social sciences. To determine if the trend can be improved, the objective of this study was to develop a list of testable, theory-informed hypotheses about how to design more effective A&F interventions. Methods Using purposive sampling, semi-structured 60–90-min telephone interviews were conducted with experts in theories related to A&F from a range of fields (e.g., cognitive, health and organizational psychology, medical decision-making, economics). Guided by detailed descriptions of A&F interventions from the health care literature, interviewees described how they would approach the problem of designing improved A&F interventions. Specific, theory-informed hypotheses about the conditions for effective design and delivery of A&F interventions were elicited from the interviews. The resulting hypotheses were assigned by three coders working independently into themes, and categories of themes, in an iterative process. Results We conducted 28 interviews and identified 313 theory-informed hypotheses, which were placed into 30 themes. The 30 themes included hypotheses related to the following five categories: A&F recipient (seven themes), content of the A&F (ten themes), process of delivery of the A&F (six themes), behavior that was the focus of the A&F (three themes), and other (four themes). Conclusions We have identified a set of testable, theory-informed hypotheses from a broad range of behavioral and social science that suggest conditions for more effective A&F interventions. This work demonstrates the breadth of perspectives about A&F from non-healthcare-specific disciplines in a way that yields testable hypotheses for healthcare A&F interventions. These results will serve as the foundation for further work seeking to set research priorities among the A&F research community. Electronic supplementary material The online version of this article (10.1186/s13012-017-0646-0) contains supplementary material, which is available to authorized users.
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                Author and article information

                Contributors
                Amy R. Villarosa:
                ORCID: http://orcid.org/0000-0003-3198-472X
                amy.villarosa@westernsydney.edu.au
                Della Maneze: della.maneze@health.nsw.gov.au
                Lucie M. Ramjan: l.ramjan@westernsydney.edu.au
                Ravi Srinivas: ravi.srinivas@health.nsw.gov.au
                Michelle Camilleri: michelle.camilleri@health.nsw.gov.au
                Ajesh George: a.george@westernsydney.edu.au
                Journal
                Journal ID (nlm-ta): Implement Sci
                Journal ID (iso-abbrev): Implement Sci
                Title: Implementation Science : IS
                Publisher: BioMed Central (London )
                ISSN (Electronic): 1748-5908
                Publication date (Electronic): 17 December 2019
                Publication date PMC-release: 17 December 2019
                Publication date Collection: 2019
                Volume: 14
                Electronic Location Identifier: 106
                Affiliations
                [1 ]Centre for Oral Health Outcomes and Research Translation (COHORT), Liverpool, 1871 Australia
                [2 ]ISNI 0000 0000 9939 5719, GRID grid.1029.a, Western Sydney University, ; Penrith, 2751 Australia
                [3 ]ISNI 0000 0001 2105 7653, GRID grid.410692.8, South Western Sydney Local Health District, ; Locked Bag 7103, Liverpool BC, NSW 1871 Australia
                [4 ]GRID grid.429098.e, Ingham Institute for Applied Medical Research, ; Liverpool, 1871 Australia
                [5 ]ISNI 0000 0000 9939 5719, GRID grid.1029.a, Translational Health Research Institute, , Western Sydney University, ; Penrith, 2751 Australia
                [6 ]ISNI 0000 0004 1936 834X, GRID grid.1013.3, University of Sydney, ; Camperdown, 2050 Australia
                Author information
                http://orcid.org/0000-0003-3198-472X
                Article
                Publisher ID: 954
                DOI: 10.1186/s13012-019-0954-7
                PMC ID: 6918615
                PubMed ID: 31847876
                SO-VID: a5da057f-ecd8-4f56-8077-e82605bf2c40
                Copyright © © The Author(s). 2019
                License:

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                Date received : 8 May 2019
                Date accepted : 25 November 2019
                Funding
                Funded by: South Western Sydney Local Health District
                Award ID: P00025002
                Award Recipient :
                Funded by: National Health and Medical Research Council
                Award ID: APP1168119
                Award Recipient :
                Categories
                Subject: Systematic Review
                Custom metadata
                issue-copyright-statement © The Author(s) 2019

                ScienceOpen disciplines: Medicine
                Keywords: dentistry,implementation,clinical guidelines
                Data availability:
                ScienceOpen disciplines: Medicine
                Keywords: dentistry, implementation, clinical guidelines

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