Do better qualified dentists make fewer hospital referrals?

Lamb, David; Fairclough, Angela L.; Ellis, Bryan

doi:10.1034/j.1600-0579.2000.040105.x

Cited by 1 publication

(1 citation statement)

References 7 publications

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“…This would be recommended for any future studies in this area. Previous studies, through various methodologies, have reported the contributions (to differences in outcome or patient care/management) of: experience of the practitioner (Franks et al, 2000; Lamb et al, 2000), technical skills of the practitioner (Hemminiki, 1982), attentive skills of the practitioner (Rasmussen and Andersen, 2005), and the age (Tsai et al, 1999; Charles et al, 2006) and gender of the practitioner (Franks et al, 2000).…”

Section: Discussionmentioning

confidence: 99%

Measuring practitioner/therapist effects in randomised trials of low back pain and neck pain interventions in primary care settings

Lewis

Morley

Windt

et al. 2010

European Journal of Pain

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In psychological health treatment studies it has been shown that differences between therapists account for some of the non-specific effect of treatment but this phenomenon has not so far systematically been investigated in musculoskeletal disorders. In this study we evaluated and compared the size and potential influence of the 'practitioner effect' (or 'therapist effect') in three randomised treatment trials of low back pain and neck pain patients in primary care. We calculated the proportion of variance in outcomes attributable to differences across practitioners, i.e. the practitioner-variance partition coefficient (p-vpc). As measures of outcome, we focused on self-reported disability as the primary outcome, but we also investigated assessed psychological outcomes. The p-vpc for the disability measures ranged from 2.6% to 7.1% across trials and time points (post treatment and follow up). Estimates differed between treatment subgroups within trials; being highest in treatment subgroups assigned to psychosocial-based interventions. A 'practitioner effect' does exist and is more pronounced in treatments involving greater psychosocial emphasis. This has implications for both practice and research in this clinical area. It highlights the importance of patient-practitioner interactions, and the need to address practitioner effects in designing and analysing outcome studies in low back pain and neck pain in primary care.

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