Applying psychological theory to evidence-based clinical practice : identifying factors predictive of managing upper respiratory tract infections without antibiotics

Background: Psychological models can be used to understand and predict behaviour in a wide range of settings. However, they have not been consistently applied to health professional behaviours, and the contribution of differing theories is not clear. The aim of this study was to explore the usefulness of a range of psychological theories to predict health professional behaviour relating to management of upper respiratory tract infections (URTIs) without antibiotics. Methods: Psychological measures were collected by postal questionnaire survey from a random sample of general practitioners (GPs) in Scotland. The outcome measures were clinical behaviour (using antibiotic prescription rates as a proxy indicator), behavioural simulation (scenario-based decisions to managing URTI with or without antibiotics) and behavioural intention (general intention to managing URTI without antibiotics). Explanatory variables were the constructs within the following theories: Theory of Planned Behaviour (TPB), Social Cognitive Theory (SCT), Common Sense Self-Regulation Model (CS-SRM), Operant Learning Theory (OLT), Implementation Intention (II), Stage Model (SM), and knowledge (a non-theoretical construct). For each outcome measure, multiple regression analysis was used to examine the predictive value of each theoretical model individually. Following this 'theory level' analysis, a 'cross theory' analysis was conducted to investigate the combined predictive value of all significant individual constructs across theories. Results: All theories were tested, but only significant results are presented. When predicting behaviour, at the theory level, OLT explained 6% of the variance and, in a cross theory analysis, OLT 'evidence of habitual behaviour' also explained 6%. When predicting behavioural simulation, at the theory level, the proportion of variance explained was: TPB, 31%; SCT, 26%; II, 6%; OLT, 24%. GPs who reported having already decided to change their management to try to avoid the use of antibiotics made significantly fewer scenario-based decisions to prescribe. In the cross theory analysis, perceived behavioural control (TPB), evidence of habitual behaviour (OLT), CS-SRM cause (chance/bad luck), and intention entered the equation, together explaining 36% of the variance. When predicting intention, at the theory level, the proportion of variance explained was: TPB, 30%; SCT, 29%; CS-SRM 27%; OLT, 43%. GPs who reported that they had already decided to change their management to try to avoid the use of antibiotics had a significantly higher intention to manage URTIs without prescribing antibiotics. In the cross theory analysis, OLT evidence of habitual behaviour, TPB attitudes, risk perception, CS-SRM control by doctor, TPB perceived behavioural control and CS-SRM control by treatment entered the equation, together explaining 49% of the variance in intention. Cnclusion: The study provides evidence that psychological models can be useful in understanding and predicting clinical behaviour. Taking a theory-based approach enables the reation of a replicable methodology for identifying factors that predict clinical behaviour. Hwever, a number of conceptual and methodological challenges remain

Caries classification and management in the context of the CariesCare International (CCI™) consensus:a clinical case study

The objective of this clinical case study is to illustrate the caries management four-step structured process, leading to personalised interventions specifc for each individual patient’s risks and needs, according to CariesCare International, derived from the International Caries Classifcation and Management System (ICCMS) for clinical practice. An 18-year-old female was diagnosed with higher caries risk at the individual level, and with several caries lesions at different severity stages, some likely active and others likely inactive. A care plan was co-created with the patient and delivered to obtain optimal health outcomes. Several issues pertinent to patient-centred care are discussed, including caries management at the individual and the tooth surface level, the preservation of tooth structure, patient’s caries risk management, and prevention and control of caries lesions. The patient’s perspective is taken into account and the health outcome focus of the system is highlighted

Inequalities in oral health:The economic burden of dental caries

Aim or Purpose: This study aimed to: determine the lifetime costs of preventing and managing of dental caries in five countries (Brazil, Germany, Indonesia, Italy, UK), and assess the impact on these costs from levelling up prevention and management across socioeconomic groups in the five study countries. We comment on plausible actions for stakeholders to better manage the burden presented by dental caries. Materials and Methods: We conducted an evidence review, expert engagement via a group meeting and one-on-one expert interviews, alongside an economic evaluation. A cohort simulation model was developed, estimating the projected lifetime costs for a cohort aged 12 years old today, using national-level DMFT data and progression rates of dental caries through an individual's lifetime. Results: Base on the preliminary analysis, the lifetime costs of dental caries represent a significant burden on individuals and health systems. The lowest socioeconomic groups in each country face the greatest health and economic burden from the disease. By targeting preventative interventions to reduce the incidence of dental caries, there is considerable potential for individual countries to improve oral health across their population. Conclusions: This unique analysis of the economic costs of preventing and managing dental caries across socioeconomic groups in five countries supports policymakers in raising awareness of this important issue amongst their stakeholders. Prioritising the prevention of dental caries can be justified based on these data that quantify the benefit in economic terms and provides a broad agenda for action. This study was commissioned by the EFP. This research was funded by a grant from Haleon

Do incentives, reminders or reduced burden improve healthcare professional response rates in postal questionnaires?:Two randomized controlled trials

BACKGROUND: Healthcare professional response rates to postal questionnaires are declining and this may threaten the validity and generalisability of their findings. Methods to improve response rates do incur costs (resources) and increase the cost of research projects. The aim of these randomised controlled trials (RCTs) was to assess whether 1) incentives, 2) type of reminder and/or 3) reduced response burden improve response rates; and to assess the cost implications of such additional effective interventions. METHODS: Two RCTs were conducted. In RCT A general dental practitioners (dentists) in Scotland were randomised to receive either an incentive; an abridged questionnaire or a full length questionnaire. In RCT B non-responders to a postal questionnaire sent to general medical practitioners (GPs) in the UK were firstly randomised to receive a second full length questionnaire as a reminder or a postcard reminder. Continued non-responders from RCT B were then randomised within their first randomisation to receive a third full length or an abridged questionnaire reminder. The cost-effectiveness of interventions that effectively increased response rates was assessed as a secondary outcome. RESULTS: There was no evidence that an incentive (52% versus 43%, Risk Difference (RD) -8.8 (95%CI −22.5, 4.8); or abridged questionnaire (46% versus 43%, RD −2.9 (95%CI −16.5, 10.7); statistically significantly improved dentist response rates compared to a full length questionnaire in RCT A. In RCT B there was no evidence that a full questionnaire reminder statistically significantly improved response rates compared to a postcard reminder (10.4% versus 7.3%, RD 3 (95%CI −0.1, 6.8). At a second reminder stage, GPs sent the abridged questionnaire responded more often (14.8% versus 7.2%, RD −7.7 (95%CI −12.8, -2.6). GPs who received a postcard reminder followed by an abridged questionnaire were most likely to respond (19.8% versus 6.3%, RD 8.1%, and 9.1% for full/postcard/full, three full or full/full/abridged questionnaire respectively). An abridged questionnaire containing fewer questions following a postcard reminder was the only cost-effective strategy for increasing the response rate (£15.99 per response). CONCLUSIONS: When expecting or facing a low response rate to postal questionnaires, researchers should carefully identify the most efficient way to boost their response rate. In these studies, an abridged questionnaire containing fewer questions following a postcard reminder was the only cost-effective strategy. An increase in response rates may be explained by a combination of the number and type of contacts. Increasing the sampling frame may be more cost-effective than interventions to prompt non-responders. However, this may not strengthen the validity and generalisability of the survey findings and affect the representativeness of the sample

Caries OUT: Caries management in children with CariesCare International adapted to the pandemic

Fil: Carletto-Körber, Fabiana. Universidad Nacional de Córdoba. Facultad de Odontología. Cátedra de Integral Niños y Adolescentes; Argentina.Fil: Vázquez, Fernando Rafael. Universidad Nacional de Córdoba. Facultad de Odontología. Cátedra de Integral Niños y Adolescentes; Argentina.Fil: Oña, Jennifer Ann. Universidad Nacional de Córdoba. Facultad de Odontología. Cátedra de Integral Niños y Adolescentes; Argentina.Fil: Martin, Anabella. Universidad Nacional de Córdoba. Facultad de Odontología. Cátedra de Integral Niños y Adolescentes; Argentina.Fil: Martinez Cortes, Angie Carolina. Universidad El Bosque. Vicerrectoría de Investigaciones; Colombia.Fil: Douglas, Gail. University of Leeds. Dental Public Health. Leeds Dental Institute; United Kindom.Fil: Newton, Tim. King’s College London. Dental Innovation and Impact. Faculty of Dentistry, Oral and Craniofacial Sciences; United Kindom.Fil: Pitts, Nigel. King’s College London. Dental Innovation and Impact. Faculty of Dentistry, Oral and Craniofacial Sciences; United Kindom.Fil: Deery, Chris. University of Sheffield. School of Clinical Dentistry; United Kindom.Fil: Martignon, Stefania. University of Sheffield. School of Clinical Dentistry; United Kindom.OBJECTIVES: To describe caries risk status, caries lesions and management decisions for both, using the CariesCare International (CCI) approach in children aged 3 to 8 years from Córdoba, as part of the multicenter interventional trial of a Caries OUT group, without aerosol generating procedures (AGP) and reducing face-to-face consultation. METHODS: Under informed consent (parents) and assent (children) and, with ethical approval (FO-UNC-4275/2021), 28 children participated (males n = 9; females n = 19), in a public institution and a private one (2020). The clinical history was applied using the framework project software, including the four dimensions (D) of the adapted CCI system: 1D-Determination of caries risk, including diet and tooth brushing practices; 2D-Detection and assessment of severity and activity of caries lesions (ICDAS epi-combined); 3D-Management decisions at individual and dental levels; 4D-Development (plan) of caries management (individual and dental levels) without AGP. RESULTS: 1D: 92.9% presented high risk; 2D: 2709 tooth surfaces were evaluated, finding caries lesions: Initial Active (n = 134), Inactive (n = 6); Moderate-Microcavity Active (n = 34), Shadow-underlying Active (n = 34); Severe Active (n = 52), Inactive (n = 2). 3D and 4D: Individual on-site/remote risk management (92.9%); dental: active monitoring (n = 25); non-operative management (Naf, SDF) (n = 154); operative management with dental preservation (ART) (n = 52); extraction/referral (n = 50). CONCLUSIONS: With CCI, a high risk and burden of caries was found, with according individual and dental management needs, without AGP and less consultation time, representing an alternative for children's dental care during the pandemic.OBJETIVO: Describir el estado de riesgo de caries, lesiones de caries y decisiones de manejo de ambas, mediante el abordaje con CariesCare International (CCI), en niños de 3 a 8 años de Córdoba, como parte del ensayo multicéntrico intervencional de un grupo Caries OUT, sin procedimientos generadores de aerosoles (PGA) y disminuyendo consulta presencial. MATERIALES Y MÉTODOS: Bajo consentimiento (padres) y asentimiento (niños) informado y, con aprobación ética (FO-UNC-4275/2021), participaron 28 niños (varones: n=9; mujeres: n=19), en una institución pública y una privada (2020).Se aplicó la historia clínica utilizando el software del proyecto marco, incluyendo las cuatro dimensiones (D) del sistema CCI adaptado:1D-Determinación del riesgo de caries, incluyendo prácticas de dieta y de cepillado dental; 2D-Detección y valoración de severidad y actividad de lesiones de caries (ICDAS epi-combinado); 3D-Decisiones de manejo a niveles individual y dental; 4D: Desarrollo (plan) de manejo de caries (niveles individual y dental) sin procedimientos generadores de aerosoles (PGA). RESULTADOS: 1D:92.9% presentó riesgo alto; 2D: se valoraron 2709 superficies dentarias, encontrándose lesiones de caries: Iniciales Activas (n=134), Inactivas (n=6); Moderadas-Microcavidad Activas (n=34), Sombra-subyacente Activas (n=34); Severas Activas (n=52), Inactivas (n=2). 3D y 4D: Manejo individual de riesgo presencial/remoto (92.9%); dental: monitoreo activo (n=25); manejo no operatorio (Naf, SDF) (n=154); manejo operatorio con preservación dental (TRA) (n=52); exodoncia/derivación (n=50). CONCLUSIÓN: Con CCI se encontró alto riesgo y carga de caries, con necesidades de manejo individual y dental acordes, sin PGA y menor tiempo de consulta, representando una alternativa de atención de niños durante la pandemia.Fil: Carletto-Körber, Fabiana. Universidad Nacional de Córdoba. Facultad de Odontología. Cátedra de Integral Niños y Adolescentes; Argentina.Fil: Vázquez, Fernando Rafael. Universidad Nacional de Córdoba. Facultad de Odontología. Cátedra de Integral Niños y Adolescentes; Argentina.Fil: Oña, Jennifer Ann. Universidad Nacional de Córdoba. Facultad de Odontología. Cátedra de Integral Niños y Adolescentes; Argentina.Fil: Martin, Anabella. Universidad Nacional de Córdoba. Facultad de Odontología. Cátedra de Integral Niños y Adolescentes; Argentina.Fil: Martinez Cortes, Angie Carolina. Universidad El Bosque. Vicerrectoría de Investigaciones; Colombia.Fil: Douglas, Gail. University of Leeds. Dental Public Health. Leeds Dental Institute; United Kindom.Fil: Newton, Tim. King’s College London. Dental Innovation and Impact. Faculty of Dentistry, Oral and Craniofacial Sciences; United Kindom.Fil: Pitts, Nigel. King’s College London. Dental Innovation and Impact. Faculty of Dentistry, Oral and Craniofacial Sciences; United Kindom.Fil: Deery, Chris. University of Sheffield. School of Clinical Dentistry; United Kindom.Fil: Martignon, Stefania. University of Sheffield. School of Clinical Dentistry; United Kindom.Otras Ciencias de la Salu