Measuring Adherence to Evidence-Based Clinical Practice Guidelines.
Richard Clark, Utsana Tonmukayakul, Yvonne Mangan, Michael Smith, Mark Gussy, David Manton, Denise Bailey, Hanny Calache
Author Information
Richard Clark: Dental Health Services Victoria, Melbourne, Victoria, Australia; Health f(x), Melbourne, Victoria, Australia.
Utsana Tonmukayakul: Deakin Health Economics, School of Health and Social development; Deakin University, Geelong, Victoria, Australia.
Yvonne Mangan: Torres and Cape Hospital and Health Service, Queensland Government, Brisbane, Australia.
Michael Smith: Barwon Health, Geelong, Victoria, Australia.
Mark Gussy: Department of Dentistry and Oral Health, La Trobe Rural Health School, La Trobe University, Bendigo, Victoria, Australia.
David Manton: Melbourne Dental School, University of Melbourne, Melbourne, Victoria, Australia.
Denise Bailey: Melbourne Dental School, University of Melbourne, Melbourne, Victoria, Australia.
Hanny Calache: Dental Health Services Victoria, Melbourne, Victoria, Australia; Deakin Health Economics, School of Health and Social development; Deakin University, Geelong, Victoria, Australia; Department of Dentistry and Oral Health, La Trobe Rural Health School, La Trobe University, Bendigo, Victoria, Australia; Melbourne Dental School, University of Melbourne, Melbourne, Victoria, Australia. Electronic address: hanny.calache@deakin.edu.au.
OBJECTIVES: Dental Health Services Victoria publishes evidence-based clinical practice guidelines (CPGs) to assist public oral health practitioners to provide high-quality dental care. How well these CPGs are implemented into practice is unknown. The aim of this study was to assess adherence to selected CPGs. METHODS: An electronic auditing tool was developed using clinical indicators derived for "stainless steel crown (SSC)," "restorative care for children under general anesthetic (GA)," and "direct restorative materials" CPG. Six trained dentists audited a random sample of 204 dental records of children aged 3-12 years from 2 major public dental agencies. RESULTS: In total, 319 material-based treatments were audited, comprising 170 resin composite, 81 glass ionomer cement, 64 SSC, and 4 amalgam restorations. Adherence to the current guidelines varied from 94% of the SSC to none of the amalgam treatments audited. Almost half (47%) of the resin composite restorations and 5% of glass ionomer cement restorations were nonadherent to the relevant guideline. CONCLUSIONS: Average adherence was up to 72% of cases. Clinicians need to consider recording the rationale upon which their professional judgment is based when they decide not to follow an appropriate CPG.
