Academic detailing in oral healthcare - results of the ADVOCATE Field Studies

Background: Academic detailing (AD) is a defined form of educational outreach that can be used to influence decision making and reduce unwarranted variation in healthcare delivery. This paper describes the results of the proof of concept phase of the ADVOCATE Field Studies. This study evaluated the feasibility, acceptability and usefulness of AD reinforced with feedback data, to promote prevention-oriented, patient-centred and evidence-based oral healthcare delivery by general dental practitioners (GDPs). Methods: In the Field Studies, six groups of GDPs (n = 39) were recruited in The Netherlands, Germany and Denmark. Each group had four meetings reinforced with feedback data for open discussions on dental practice and healthcare delivery. Conventional and directed content analysis was used to analyze the qualitative data collected from focus group interviews, debriefing interviews, field notes and evaluation forms. Results: A total of nine themes were identified. Seven themes related to the process of the Field Studies and covered experiences, barriers and facilitators to AD group meetings, data collection and the use of an electronic dashboard for data presentation and storage. Two themes related to the outcomes of the study, describing how GDPs perceived they made changes to their clinical practice as a result of the Field Studies. Conclusions: The ADVOCATE Field Studies approach offers a novel way of collecting and providing feedback to care providers which has the potential to reduce variation oral healthcare delivery. AD plus feedback data is a useful, feasible approach which creates awareness and gives insight into care delivery processes. Some logistic and technical barriers to adoption were identified, which if resolved would further improve the approach and likely increase the acceptability amongst GDPs

Perspectives of general dental practitioners on preventive, patient-centred, and evidence-based oral healthcare

Objective In the last 30 years, innovations in oral healthcare (OHC), such as advanced restorative techniques, shifts towards preventive and evidence-based care and changes in patients’ expectations, have increased the complexity of clinical decision-making in OHC. Little is known about the perspectives of general dental practitioners (GDPs) on the value of providing preventive, patient-centred and evidence-based OHC. This study aimed to explore the range of perspectives present amongst GDPs on OHC. Method Q-methodology was used to explore perspectives among 78 GDPs working in the Netherlands. Participants were asked to sort 50 statements representing three central domains in OHC: i.) restorative versus preventative OHC, ii.) disease-centred versus patient-centred OHC and iii.) expertise-based versus evidence-based OHC. Opinion statements about delivering OHC were formulated on the basis of published literat

Making decisions better : an evaluation of an educational intervention

Rationale, aims and objectives Despite the widespread inclusion of consultation skills in undergraduate healthcare curricula, patient–doctor interactions are often an imparting of evidence or information rather than an exchange. Evidence-based practice may be further enhanced by increasing explicit understanding of decision-making processes used by healthcare professionals and patients. This exploratory investigation evaluated the impact of an educational intervention on understanding of decision-making processes and practice. The effect of session schedule was assessed to inform the future delivery strategy of such approaches. Methods Three groups of primary care health professionals (n = 85) completed questionnaires using Likert scales to assess strength of agreement with decision-making statements exploring four themes – Theory, Applied Theory, Practice and Joint Practice – pre-intervention and post-intervention. Responses were analysed, firstly to assess the impact of the intervention on understanding of decision-making processes and practice across all participants and then by group to determine the effect of session schedules on outcome measures. Results Overall agreement with the decision-making statements significantly increased after the learning set (Mean = −0.162, SD = 0.355); t(64) = −3.666, p < 0.001). Multivariate analysis on effect of session schedule only found significant interactions for the theme ‘Joint Practice’ with group (p < 0.025) and 3-way interaction of Group and Main role. (p < 0.048). No consistent positive impact of longer session schedule was found. Conclusion Participation in the learning sessions significantly improved self-reported understanding of decision-making processes and application to clinical practice. The extended learning sessions did not provide additional benefits over and above 2 half days or 1 whole day learning sessions

Improving Oral Health care Using Academic Detailing - Reproducibility and Scalability of the Added Value for Oral Care Field Studies Approach

Objectives: A proof-of-concept study has shown that the Added Value for Oral Care (ADVOCATE) Field Studies approach (academic detailing with feedback data) is considered a feasible, useful, and acceptable way to motivate general dental practitioners (GDPs) to reflect on and, if required, change their oral health-care delivery. The aims of this proof-of-principle study were to test whether such results were reproducible and to reach consensus among stakeholders on recommendations for wider implementation. Methods: Eleven groups of GDPs were recruited in 6 countries (Denmark, England Germany, Hungary, Ireland, and The Netherlands). Each group had 3 academic detailing meetings, being stimulated by feedback data. Focus group interviews were held to evaluate the reproducibility of the Field Studies approach. A World Café session explored suggestions for the wider implementation of the approach. Results: Replicable results on feasibility, acceptability, and usefulness of the Field Studies approach were seen; 7 out of 9 themes identified in the proof-of-concept study were validated. Directed content analyses identified that adjustments to procedures to collect and present feedback data were desirable. Overall, the approach can stimulate GDPs to reflect on and change aspects of their oral health-care delivery. Conclusions: The Field Studies approach, after some adjustments to data collection procedures, is ready for further testing in larger studies

Correction: Perspectives of general dental practitioners on preventive, patient-centred, and evidence-based oral healthcare-A Q-methodology study.

[This corrects the article DOI: 10.1371/journal.pone.0219931.]

Prostate cancer screening: well intentioned initiatives may use up resources but not improve health outcomes

No abstract available