Changing Clinicians’ Behavior: a Randomized Controlled Trial of Fees and Education

Abstract

The fissure-sealing of newly erupted molars is an effective caries prevention treatment, but remains underutilized. Two plausible reasons are the financial disincentive produced by the dental remuneration system, and dentists' lack of awareness of evidence-based practice. The primary hypothesis was that implementation strategies based on remuneration or training in evidence-based healthcare would produce a higher proportion of children receiving sealed second permanent molars than standard care. The four study arms were: fee per sealant treatment, education in evidence-based practice, fee plus education, and control. A cost-effectiveness analysis was conducted. Analysis was based on 133 dentists and 2833 children. After adjustment for baseline differences, the primary outcome was 9.8% higher when a fee was offered. The education intervention had no statistically significant effect. 'Fee only' was the most cost-effective intervention. The study contributes to the incentives in health care provision debate, and led to the introduction of a direct fee for this treatment.

Interventions Encouraging the Use of Systematic Reviews in Clinical Decision-Making: A Systematic Review

“…19 Clinicians were aware of the treatment of interest and reported their own outcomes. which were not corroborated or assessed for accuracy in the trial conducted by Clarkson et al 20 …”

“…19,20 Concerns for both studies lay in the lack of rigor related to data collection. 19,20 Data collectors were not blinded to whether a hospital was part of the intervention or control group in the study performed by Althabe and colleagues. 19 Clinicians were aware of the treatment of interest and reported their own outcomes.…”

“…All studies reported follow-up of professionals suffi-ciently. [16][17][18][19][20] Allocation concealment was not done for two studies 19,20 and was unclear for one study. 16 For selective reporting, Gülmezoglu et al 17 were not able to report on one practice at follow-up due to the inability to measure.…”

“…Out of 8,104 de-duplicated titles and abstracts, nine studies were deemed relevant in our review. [16][17][18][19][20][21][22][23][24] Review of full text articles led to exclusion of three studies because the intervention was not relevant [22][23][24] and one study because it was a feasibility study. 21 Five relevant randomized controlled trials met the full inclusion criteria (Fig.…”

“…[16][17][18][19][20] Five cluster randomized controlled trials (RCT) examining educational interventions for seeking, appraising, and applying evidence from systematic reviews in decision-making by clinicians were identified (Tables 1). [16][17][18][19][20] A meta-analysis of study outcomes was not possible due to the heterogeneity in the format of the interventions, the settings, and clinical areas being addressed.…”