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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, country Aims Study design Study population EPOC categories [intervention(s)] Comparator group Outcome
Afuakwah, C., 2015, Scotland Improve documentation of caries risk assessments (CRA) Pretest-posttest quasi-experimental study Four dentists working at a general dental practice in a Scottish Index of Multiple Deprivation One area Multifaceted intervention:
Reminders [CRA pro forma, aide memoire]
Education (NFS) [staff training]
N/A Adherence improved from 52.5% pre-intervention to 100% post-intervention
Amemori, M., 2013, Finland Develop and evaluate two interventions intended to increase the implementation of tobacco use prevention and cessation counselling Cluster randomised controlled trial 75 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, Scotland Evaluate the effectiveness of different implementation strategies for clinical guidelines relating to the management of impacted and unerupted third molar teeth Pragmatic, 2 × 2 factorial cluster randomised controlled trial 51 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, UK To audit dentists’ antimicrobial prescription and evaluate the effectiveness of education on their adherence to antimicrobial prescribing guidelines Pretest-posttest quasi-experimental study Two audit cycles each including 60 patients in the dental department of a hospital in London Education (meetings) [extensive training and education of staff and students] N/A A 50% increase in appropriate prescriptions was seen post intervention, as was a 38% increase in practitioners recording a diagnosis
Elouafkaoui, P., 2016, Scotland Compare the impact of individualised audit and feedback interventions on dentists’ antibiotic prescribing rates Cluster randomised controlled trial 2566 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, USA Compare the impact of two reminder approaches on access of guidelines for patients with medically complex conditions Randomised clinical trial 109 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, Scotland Explore the effect of a financial incentive on frequency of fluoride varnish application(FVA) and underlying mechanisms Non-equivalent groups quasi-experimental study 709 dentists who had submitted payment claims for dental services to the NHS primary care dental contract Pay 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, USA To determine the effect of a multifaceted implementation strategy on oral cancer screening examinations and discussions of tobacco use Cluster randomised controlled trial 31 dental care providers at 6 dental practices in Colorado Multifaceted 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, USA To 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 Guidelines Pretest-posttest quasi-experimental study One general dental clinic located at the New York College of Dentistry Reminders [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, USA To determine the effect of a computer-assisted tobacco intervention tool on frequency of dentists’ adherence to tobacco guidelines Cluster randomised controlled trial 548 patients from 15 HealthPartners Dental Group clinics in metropolitan Minnesota Reminders [practitioners provided with computer decision support system] Usual care Rates 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 Netherlands To examine the effect of patient-mediated feedback on adherence of dental practitioners to tobacco cessation guidelines Pretest-posttest quasi-experimental study 23 primary care dental practices in the Netherlands, their professional personnel and patients Patient-mediated interventions [patient-mediated feedback] N/A More 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, USA To evaluate the effect of a multicomponent intervention to implement tobacco use treatment guidelines in public health dental clinics Pretest-posttest quasi-experimental study 14 comprehensive care general dentistry clinics at the New York College of Dentistry Multifaceted 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, UK To determine the effects of an audit on the process and outcomes of clinical endodontic care Pretest-posttest quasi-experimental study 20 clinicians within the Community Dental Service of the National Health Service Audit and feedback [audit and feedback] N/A In 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, USA To 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 patients Cluster randomised controlled trial with a 2 × 2 factorial design 265 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, UK To determine whether clinical audit can improve use of antibiotics in the dental service Pretest-posttest quasi-experimental study Two dental clinics in the northeast of England Audit 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)