School of Dentistry, University of Dundee, Dundee, Scotland
Health Services Research Unit, University of Aberdeen, Aberdeen, UK.
BMJ Open. 2022 Aug 3;12(8):e059564. doi: 10.1136/bmjopen-2021-059564.
To investigate which organisational characteristics of primary care dental practices influence the implementation of evidence-based guidance.
A multimethod study set within primary care dentistry in Scotland comprising: (1) Semistructured interviews with dental teams to inform development of a self-report questionnaire exploring the translation of guidance in primary care dentistry and (2) A questionnaire-based survey and case studies exploring which organisational characteristics influence knowledge translation.
Interview data identified three themes: leadership, communication and context. Survey data revealed compliance with recommendations from three topics of dental guidance to be variable, with only 41% (emergency dental care), 19% (oral health assessment and review) and 4% (drug prescribing) of respondents reporting full compliance. Analysis revealed no significant relationship between practice characteristics and compliance with emergency dental care or drug prescribing recommendations. Positive associations were observed between compliance with oral health assessment and review recommendations and having a practice manager, as well as with the type of treatment offered, with fully private practices more likely, and fully National Health Service practices less likely to comply, when compared with those offering a mixture of treatment. Synthesis of the data identified leadership and context as key drivers of guidance uptake.
Evidence-based dental recommendations are not routinely translated into practice, with variable leadership and differing practice contexts being central to poor uptake. Guidelines should aim to tailor recommendations and implementation strategies to reflect the complexities and varying contexts that exist in primary care dentistry, thus facilitating the implementation of evidence-based guidance.
调查初级保健牙科实践的哪些组织特征会影响循证指南的实施。
在苏格兰的初级保健牙科中进行的一项多方法研究，包括：（1）对牙科团队进行半结构化访谈，以了解开发自我报告问卷的情况，该问卷旨在探索循证指南在初级保健牙科中的转化；（2）基于问卷调查和案例研究，探索哪些组织特征会影响知识转化。
访谈数据确定了三个主题：领导力、沟通和背景。问卷调查数据显示，对来自三个牙科指南主题的建议的遵守情况存在差异，只有 41%（紧急牙科护理）、19%（口腔健康评估和复查）和 4%（药物处方）的受访者报告完全遵守。分析显示，实践特征与紧急牙科护理或药物处方建议的遵守情况之间没有显著关系。在遵守口腔健康评估和复查建议方面，与拥有一名实践经理以及提供的治疗类型之间存在正相关，与完全私人执业相比，完全国家卫生服务机构更有可能遵守，而提供混合治疗的机构则不太可能遵守。对数据的综合分析确定了领导力和背景是指南采纳的关键驱动因素。
循证牙科建议并未常规转化为实践，领导力的差异和不同的实践背景是采纳不佳的核心原因。指南应旨在针对建议和实施策略进行调整，以反映初级保健牙科中存在的复杂性和不同背景，从而促进循证指南的实施。
