Impact of peer group education to improve routine oral examination

Objectives:

In most Western countries a decreasing prevalence of oral diseases underpins the need for an individualised approach in assigning recall intervals. The present trial was conducted to evaluate whether a multifaceted implementation strategy can improve individual recall assignment in general dental practice according to evidence-based recommendations in clinical practice guidelines (CPGs).

Methods:

This study was a cluster randomised controlled trial with incomplete block design in which groups of general dental practitioners (GDPs) were the unit of randomisation. The aim was to determine the effectiveness of multifaceted peer group education on decision-making of GDPs in daily practice. Patients who visited dental practice for routine oral examination (ROE) during September 2006 and May 2007 were prospectively enrolled in the trial. All patient data were collected using registration forms to be completed by GDPs and patient records. Seven peer groups of GDPs were randomised either to the intervention arm or control arm. GDPs in both trial arms received actual evidence-based clinical practice guidelines (CPG) focussed on the subject of the allocated trial arm. Recall interval assignment was defined as primary outcome measure. The interventions comprised successively online training using risk-based patient vignettes, dissemination of a CPG by mail, an interactive peer group meeting for continuing professional development (CPD) with group feedback. Reminders (flow charts) were sent by mail four weeks after the meeting. GDPs were given access to the online vignettes for further individual training.

Results:

Recall assignment: The rate of guideline adherence in high-risk patients showed a small increase in the control group (+2,7%) and a decrease in the intervention group (-0.8%), a difference that was not significant (p=0.18). For low risk patients, guideline adherence increased in the intervention group with +8%, which differed significantly from the control group (-6.1%), (p=0.00).

Conclusions:

The results of this trial showed small to moderate effects in primary outcome measures in low-risk patients. Further research in barriers for performance change in dental practice is recommended.