Division of Clinical Epidemiology, Kyushu Dental University, 2-6-1, Manazuru, Kokura-kita, Kitakyushu, Fukuoka 803-8580, Japan.
Graduate School of Media and Governance, Keio University, 5322 Endo Fujisawa, Kanagawa 252-0882, Japan.
J Dent. 2024 Oct;149:105255. doi: 10.1016/j.jdent.2024.105255. Epub 2024 Jul 29.
To identify 1) factors of the evidence-practice gap (EPG) in Japan and Brazil as perceived by dentists and compare these factors between two countries, and 2) mechanisms to close this EPG.
The study employed a cross-sectional design by administering a web-based questionnaire to 136 Japanese and 110 Brazilian dentists. The survey queried dentists' reports of which factors possibly cause an EPG, using a newly developed 20-item questionnaire.
An international comparison of 20 items related to factors of the EPG between Japan and Brazil revealed that "Dentists' own experiences are sometimes given priority over evidence" and "Dentists' own thoughts are sometimes given priority over evidence" were common factors to both countries, with over 80 % agreement. In logistic regression, "Insufficient opportunity to learn about evidence in dental education at universities", "Evidence-based treatments are sometimes not covered by the dental insurance system", and "Insufficient evidence which helps dentists choose an appropriate treatment for a patient after careful consideration of his/her own background" were significantly associated with the EPG in Japan (p < 0.05). In Brazil, "Insufficient case reports in which evidence-based dentistry (EBD) is applied to clinical practice" and "Image-based information and devices used for diagnosis vary depending on individual dentists" were significantly associated with the EPG (p < 0.05).
This study suggests that EPG could be improved in Japan: by promoting EBD education at universities, improving the dental insurance system, and accumulating evidence according to patient background; and in Brazil: by promoting EBD case reports and standardizing diagnostic information and devices.
Two factors of EPG common to Japan and Brazil, namely the prioritization of dentists' own "experiences" and "thoughts" over evidence, are urgent issues for improving EPG. In addition, it will be necessary to address the country-specific factors of EPG that were identified in this study.
确定 1）日本和巴西牙医眼中的证据实践差距（EPG）因素，并比较两国之间的这些因素，2）缩小 EPG 的机制。
本研究采用横断面设计，通过向 136 名日本牙医和 110 名巴西牙医发放网络问卷进行。该调查询问了牙医对可能导致 EPG 的因素的报告，使用了新开发的 20 项问卷。
对日本和巴西之间 EPG 20 项相关因素的国际比较表明，“牙医的个人经验有时优先于证据”和“牙医的个人想法有时优先于证据”是两国共同的因素，超过 80%的牙医同意这一观点。在逻辑回归中，“在大学的牙科教育中，学习证据的机会不足”、“循证治疗有时不在牙科保险体系内”和“在仔细考虑患者自身背景后，有助于牙医选择合适治疗方案的证据不足”与日本的 EPG 显著相关（p<0.05）。在巴西，“将循证牙科（EBD）应用于临床实践的病例报告不足”和“用于诊断的基于图像的信息和设备因牙医个体而异”与 EPG 显著相关（p<0.05）。
本研究表明，日本可以通过在大学推广 EBD 教育、改善牙科保险体系、根据患者背景积累证据来改善 EPG；在巴西，可以通过推广 EBD 病例报告和规范诊断信息和设备来改善 EPG。
日本和巴西共同存在的 EPG 两个因素，即牙医自身“经验”和“想法”优先于证据，是改善 EPG 的紧迫问题。此外，还需要解决本研究中确定的 EPG 的特定于国家的因素。
