van der Sanden W J M, Mettes D G, Plasschaert A J M, van't Hof M A, Grol R P T M, Verdonschot E H
University Medical Centre St Radboud, Department of Cariology and Endodontology, College of Dental Sciences, University of Nijmegen, The Netherlands.
Qual Saf Health Care. 2003 Apr;12(2):107-11. doi: 10.1136/qhc.12.2.107.
To assess the opinions of general dental practitioners regarding the development and importance of clinical practice guidelines and their contribution to the quality of dental care.
A questionnaire was sent to a representative sample of 1656 dentists in the Netherlands. Factor analysis was conducted to identify scales of variables, and a reliability analysis was conducted to verify the reliability of the identified scales. The effect of the independent variables is expressed as odds ratio per scale part (standard deviation, SD). Regression analyses were conducted to study determinants of the opinions on clinical guidelines.
The response rate was 73%; 54% of the respondents supported the development of clinical practice guidelines for dentists. Most respondents indicated that clinical practice guidelines could be used as a checklist, as a support in daily clinical decision making, and as a basis for continuing dental education. The factor analyses yielded four scale factors-contribution of guidelines to effectiveness of care (OR 1.95/SD), contribution of guidelines to professional autonomy (OR 1.70/SD), contribution of guidelines to quality of care (OR 2.52/SD), and contribution of guidelines to collaboration (OR 1.49/SD)-which complied with the criterion of Cronbach's alpha >0.60. Multiple regression analysis with the four scale factors as dependent variables yielded only extremely low correlations for practice and dentist characteristics (R(2)=0.01-0.04).
Only about 50% of dentists support the development and implementation of clinical guidelines. Guidelines are seen as helpful in the provision of continuing dental education and as a support in daily clinical decision making. The most important barrier to successful implementation of clinical practice guidelines is the fear of dental practitioners that guidelines will reduce their professional autonomy. Practice and dentist characteristics are unrelated to dentists' opinions on clinical practice guidelines.
评估普通牙科医生对临床实践指南的制定、重要性及其对牙科护理质量贡献的看法。
向荷兰1656名牙医的代表性样本发放问卷。进行因子分析以识别变量量表，并进行可靠性分析以验证所识别量表的可靠性。自变量的效应表示为每个量表部分的比值比（标准差，SD）。进行回归分析以研究对临床指南看法的决定因素。
回复率为73%；54%的受访者支持为牙医制定临床实践指南。大多数受访者表示，临床实践指南可作为检查表、日常临床决策的支持以及继续牙科教育的基础。因子分析产生了四个量表因子——指南对护理效果的贡献（比值比1.95/标准差）、指南对专业自主权的贡献（比值比1.70/标准差）、指南对护理质量的贡献（比值比2.52/标准差）以及指南对协作的贡献（比值比1.49/标准差）——均符合克朗巴哈系数>0.60的标准。以这四个量表因子为因变量的多元回归分析显示，实践和牙医特征的相关性极低（R² = 0.01 - 0.04）。
只有约50%的牙医支持临床指南的制定和实施。指南被视为有助于提供继续牙科教育以及日常临床决策的支持。临床实践指南成功实施的最重要障碍是牙科医生担心指南会降低他们的专业自主权。实践和牙医特征与牙医对临床实践指南的看法无关。
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