证据-实践差距的原因及其与微创牙科教育对临床医生效果的关联。

Causes of the Evidence-practice Gap and Its Association with the Effects of Minimal Intervention Dentistry Education to Clinicians.

机构信息

Yoko Yokoyama, PhD, MPH, project senior assistant professor, Graduate School of Media and Governance, Keio University, Kanagawa, Japan.

*Naoki Kakudate, DDS, PhD, MPH, professor & division director, Division of Clinical Epidemiology, Kyushu Dental University, Kitakyushu, Fukuoka, Japan; visiting professor, University of Florida College of Dentistry, Gainesville, FL, USA.

出版信息

Oper Dent. 2023 Mar 1;48(2):137-145. doi: 10.2341/22-012-C.

DOI:10.2341/22-012-C

PMID:36745521

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10792988/

Abstract

OBJECTIVES

To identify causes of the evidence-practice gap (EPG) in dentistry in Japan and analyze whether these causes are associated with: (a) improvement of EPG in minimal intervention dentistry (MID) following an educational intervention and (b) specific dentist characteristics.

METHODS

We conducted a mixed-methods questionnaire survey among 197 Japanese dentists that integrated both quantitative and qualitative data. Causative factors for the EPG identified in the quantitative survey were clarified by qualitative analysis. We measured the EPG in a baseline survey using an EPG measurement tool based on MID. To examine how feedback using the latest scientific evidence affected change in the EPG, we measured the EPG again immediately after feedback was provided to participating dentists.

RESULTS

Qualitative analysis classified all dentists into one of four "EPG cause" groups, namely "evidence-", "dentist-", "patient-", and "health insurance system-related" causes. Quantitative analysis confirmed that improvement in the EPG following the feedback intervention was indeed associated with group classification. The highest concordance was found for the "evidence-related" group while the lowest concordance was in the "dentist-related" group (p=0.004). Concordance improved after evidence feedback in all groups but was lowest in the "dentist-related" group. More dentists reported practice busyness in the "dentist-related" group.

CONCLUSIONS

In this study, we identified four groups of causes of EPG among Japanese dentists. The degree of concordance between evidence and clinical practice was the lowest in the "dentist-related" group, and the results of this study are expected to provide useful information for the development of intervention methods for closing the EPG in the future.

摘要

目的

确定日本牙科领域证据实践差距（EPG）的原因，并分析这些原因是否与以下两个方面相关：（a）教育干预后，微创牙科（MID）中 EPG 的改善，以及（b）特定牙医的特征。

方法

我们对 197 名日本牙医进行了一项混合方法问卷调查，该调查综合了定量和定性数据。通过定性分析，明确了定量调查中确定的 EPG 促成因素。我们在基线调查中使用基于 MID 的 EPG 测量工具来测量 EPG。为了研究使用最新科学证据进行反馈如何影响 EPG 的变化，我们在向参与牙医提供反馈后立即再次测量 EPG。

结果

定性分析将所有牙医分为四类“EPG 原因”组，即“证据相关”、“牙医相关”、“患者相关”和“医疗保险制度相关”原因。定量分析证实，反馈干预后 EPG 的改善确实与组分类相关。“证据相关”组的一致性最高，而“牙医相关”组的一致性最低（p=0.004）。在所有组中，在证据反馈后一致性都有所提高，但在“牙医相关”组中最低。“牙医相关”组中有更多的牙医报告说工作繁忙。