Measuring Adherence to Evidence-Based Clinical Practice Guidelines

Richard Clark; Utsana Tonmukayakul; Yvonne Mangan; Michael Smith; Mark Gussy; David Manton; Denise Bailey; Hanny Calache

doi:10.1016/j.jebdp.2017.05.001

Measuring Adherence to Evidence-Based Clinical Practice Guidelines

J Evid Based Dent Pract. 2017 Dec;17(4):301-309. doi: 10.1016/j.jebdp.2017.05.001. Epub 2017 May 12.

Authors

Richard Clark¹, Utsana Tonmukayakul², Yvonne Mangan³, Michael Smith⁴, Mark Gussy⁵, David Manton⁶, Denise Bailey⁶, Hanny Calache⁷

Affiliations

¹ Dental Health Services Victoria, Melbourne, Victoria, Australia; Health f(x), Melbourne, Victoria, Australia.
² Deakin Health Economics, School of Health and Social development; Deakin University, Geelong, Victoria, Australia.
³ Torres and Cape Hospital and Health Service, Queensland Government, Brisbane, Australia.
⁴ Barwon Health, Geelong, Victoria, Australia.
⁵ Department of Dentistry and Oral Health, La Trobe Rural Health School, La Trobe University, Bendigo, Victoria, Australia.
⁶ Melbourne Dental School, University of Melbourne, Melbourne, Victoria, Australia.
⁷ Dental Health Services Victoria, Melbourne, Victoria, Australia; Deakin Health Economics, School of Health and Social development; Deakin University, Geelong, Victoria, Australia; Department of Dentistry and Oral Health, La Trobe Rural Health School, La Trobe University, Bendigo, Victoria, Australia; Melbourne Dental School, University of Melbourne, Melbourne, Victoria, Australia. Electronic address: hanny.calache@deakin.edu.au.

PMID: 29197431
DOI: 10.1016/j.jebdp.2017.05.001

Abstract

Objectives: Dental Health Services Victoria publishes evidence-based clinical practice guidelines (CPGs) to assist public oral health practitioners to provide high-quality dental care. How well these CPGs are implemented into practice is unknown. The aim of this study was to assess adherence to selected CPGs.

Methods: An electronic auditing tool was developed using clinical indicators derived for "stainless steel crown (SSC)," "restorative care for children under general anesthetic (GA)," and "direct restorative materials" CPG. Six trained dentists audited a random sample of 204 dental records of children aged 3-12 years from 2 major public dental agencies.

Results: In total, 319 material-based treatments were audited, comprising 170 resin composite, 81 glass ionomer cement, 64 SSC, and 4 amalgam restorations. Adherence to the current guidelines varied from 94% of the SSC to none of the amalgam treatments audited. Almost half (47%) of the resin composite restorations and 5% of glass ionomer cement restorations were nonadherent to the relevant guideline.

Conclusions: Average adherence was up to 72% of cases. Clinicians need to consider recording the rationale upon which their professional judgment is based when they decide not to follow an appropriate CPG.

Keywords: Adherence; Children; Clinical audit; Clinical practice guidelines; Dental caries.

MeSH terms

Child
Child, Preschool
Composite Resins
Dental Amalgam
Dental Caries*
Dental Materials
Dental Restoration, Permanent*
Glass Ionomer Cements
Humans

Substances

Composite Resins
Dental Materials
Glass Ionomer Cements
Dental Amalgam