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Table 2 Summaries of included studies

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

First author, year, countryAimsStudy designStudy populationEPOC categories [intervention(s)]Comparator groupOutcome
Afuakwah, C., 2015, ScotlandImprove documentation of caries risk assessments (CRA)Pretest-posttest quasi-experimental studyFour dentists working at a general dental practice in a Scottish Index of Multiple Deprivation One areaMultifaceted intervention:
Reminders [CRA pro forma, aide memoire]
Education (NFS) [staff training]
N/AAdherence improved from 52.5% pre-intervention to 100% post-intervention
Amemori, M., 2013, FinlandDevelop and evaluate two interventions intended to increase the implementation of tobacco use prevention and cessation counsellingCluster randomised controlled trial75 dentists and dental hygienists employed at 34 clinics within two municipal health care regions in Finland Education (meetings) [lectures, interactive sessions, multimedia demonstrations and role play session (n = 21)]
Multifaceted intervention (n = 27):
 o Education (meetings) [as above]
 o Pay for performance [fee for service]
No intervention (n = 25) No effect on prevention counselling for any group
Cessation counselling 6 months post-intervention was higher for intervention groups (effect size = 0.52, p = 0.007), despite a relapse after 2 months
Bahrami, M., 2004, ScotlandEvaluate the effectiveness of different implementation strategies for clinical guidelines relating to the management of impacted and unerupted third molar teethPragmatic, 2 × 2 factorial cluster randomised controlled trial51 general dental practices in Scotland who had been given the opportunity to attend a postgraduate course regarding the guidelines Reminders [computer-aided learning with decision support (n = 13)]
Audit and feedback [audit and feedback (n = 13)]
Multifaceted intervention (n = 13):
 o Reminders [as above]
Audit and feedback [as above]
No intervention (n = 12)No significant difference in guideline adherence was seen between intervention and control groups
Chopra, R., 2014, UKTo audit dentists’ antimicrobial prescription and evaluate the effectiveness of education on their adherence to antimicrobial prescribing guidelinesPretest-posttest quasi-experimental studyTwo audit cycles each including 60 patients in the dental department of a hospital in LondonEducation (meetings) [extensive training and education of staff and students]N/AA 50% increase in appropriate prescriptions was seen post intervention, as was a 38% increase in practitioners recording a diagnosis
Elouafkaoui, P., 2016, ScotlandCompare the impact of individualised audit and feedback interventions on dentists’ antibiotic prescribing ratesCluster randomised controlled trial2566 dentists from 795 general dental practices Audit and feedback [audit and feedback (n = 1999)]Current practice (n = 567) A 5.7% greater decrease in antibiotic prescription (p = 0.01) was seen among the intervention groups
Defined daily dose rate reduced by 6.6% more in the intervention group (p = 0.03)
Friction, J., 2011, USACompare the impact of two reminder approaches on access of guidelines for patients with medically complex conditionsRandomised clinical trial109 dentists from 15 dental clinics Reminders [computer alerts to providers (n = 32)]
Patient-mediated interventions [notifications to patients (n = 38)]
Usual care (n = 39)Both interventions increased guideline website use by 19% for the first 6 months (p < 0.05); however, this was not sustained to 12 months
Gnich, W., 2018, ScotlandExplore the effect of a financial incentive on frequency of fluoride varnish application(FVA) and underlying mechanismsNon-equivalent groups quasi-experimental study709 dentists who had submitted payment claims for dental services to the NHS primary care dental contractPay for performance [novel fee-for-service (n = 343)]Continuous fee-for-service (n = 350)FVA rates increased among both groups; however, a greater increase was seen among the intervention group (β = 0.82, 95% CI = 0.72–0.92)
Isaacson Tilliss, T., 2006, USATo determine the effect of a multifaceted implementation strategy on oral cancer screening examinations and discussions of tobacco useCluster randomised controlled trial31 dental care providers at 6 dental practices in ColoradoMultifaceted intervention (n = 18):
Local consensus process [local consensus process]
Reminders [multi-modal reminders for practitioners]
Patient-mediated interventions [multi-modal reminders for patients]
Education (meetings) [interactive educational workshop]
Usual care (n = 12)No significant change was seen in patient reports of dental provider practice following the intervention, except a 22.1% (p = 0.015) increase in reporting “the dentist/hygienist told me that I was being screened for oral cancer”
Montini T., 2013, USATo test the feasibility of using web-based computer-mediated clinical decision support system to improve dentists’ adherence to the Treating Tobacco Use and Dependence Clinical Practice GuidelinesPretest-posttest quasi-experimental studyOne general dental clinic located at the New York College of DentistryReminders [computer decision support system]N/A Screening patients for tobacco use increased by 33.1% (p < 0.001)
Rates of advising, referring and prescribing nicotine replacement therapy for tobacco users increased by 58.9% (p < 0.001), 15.2% (p < 0.001) and 14.3% (p = 0.035) respectively
Rindal, D. B., 2013, USATo determine the effect of a computer-assisted tobacco intervention tool on frequency of dentists’ adherence to tobacco guidelinesCluster randomised controlled trial548 patients from 15 HealthPartners Dental Group clinics in metropolitan MinnesotaReminders [practitioners provided with computer decision support system]Usual careRates of assessing interest in quitting (17%, p = 0.0006), discussing strategies (21%, p = 0.003) and referral (20%, p = 0.007) were significantly higher in the intervention group
Rosseel, J. P., 2012, The NetherlandsTo examine the effect of patient-mediated feedback on adherence of dental practitioners to tobacco cessation guidelinesPretest-posttest quasi-experimental study23 primary care dental practices in the Netherlands, their professional personnel and patientsPatient-mediated interventions [patient-mediated feedback]N/AMore patients reported receiving assessment of smoking status (25.3% increase, p < 0.01), information on smoking (21.3% increase, p < 0.01) and advice and support (26.5%, p < 0.01) 12 months post-intervention despite a 6.1% drop in reported provision of advice after 6 months
Shelley, D., 2011, USATo evaluate the effect of a multicomponent intervention to implement tobacco use treatment guidelines in public health dental clinicsPretest-posttest quasi-experimental study14 comprehensive care general dentistry clinics at the New York College of DentistryMultifaceted intervention:
Reminders [chart system]
Education (meetings) [faculty and student training]
Environment [nicotine replacement therapy]
Referral systems [referral protocol]
Audit and feedback [referral feedback]
N/A No significant difference in rates of screening for tobacco use
Rates of advising, assessing and referring or prescribing nicotine replacement therapy for tobacco users increased by 20.6% (p < 0.001), 12.1% (p = 0.01) and 9.1% (p = 0.01) respectively
Simons, D., 2013, UKTo determine the effects of an audit on the process and outcomes of clinical endodontic carePretest-posttest quasi-experimental study20 clinicians within the Community Dental Service of the National Health ServiceAudit and feedback [audit and feedback]N/AIn general, there was increased adherence to various endodontic guidelines (0.7–42.9% increase), although this was not seen in all guidelines
Walsh, M. M., 2006, USATo compare the effects of workshop training and mailed self-study training with and without reimbursement on tobacco-use-related attitudes and behaviours as reported by dentists and patientsCluster randomised controlled trial with a 2 × 2 factorial design265 dentists who participated in Delta Dental plans serving state employees in California, Pennsylvania and West Virginia Education (materials) [self-study (n = 100)]
Education (meetings) [workshop (n = 99)]
No intervention (n = 66)Although patient and self-reported adherence to tobacco guidelines was higher among both intervention groups, more dentists in the workshop group reported adherence than in the self-study group.
Due to a low claim rate, reimbursement had no further effect on this
Zahabiyoun, S., 2015, UKTo determine whether clinical audit can improve use of antibiotics in the dental servicePretest-posttest quasi-experimental studyTwo dental clinics in the northeast of EnglandAudit and feedback [clinical audit]N/A Compliance with metronidazole prescription guidelines increased by 15.3% (p = 0.012)
Compliance with amoxicillin prescription guidelines increased by 35.2% (p = 0.041)