Report Card-Part II: Professional Organization and Federal Agency Integration of EBD: The Role of Evidence-Based Tools in Developing and Evaluating Practice Guidelines. Is Care Better?

Abstract

Dr. David Turpin, editor of the Journal of Orthodontics and Orthopedic Facial Growth, relates his personal experience as a clinician in the use of evidence in practice. Dr. Barbara Gooch, a Dental Officer with the Centers for Disease Control and Prevention, outlines the role a federal agency plays in the monitoring of oral health, prevention of disease, and evaluating outcomes of their programs. It seems clear that the dental profession is beginning to embrace the concept of evidence-based practice, at least at the organizational level. To effect change in a practitioner’s behavior, however, is a different matter. One of the ways to do this is to start with undergraduate and graduate dental students. As educators we try to teach our students how to search for and appraise Bthe best available evidence[ to incorporate in clinical and public health decisions. On graduation, however, it is unlikely most will continue to search through computer databases and read original research articles. Fortunately, there are several excellent sources of secondary literatureVa synthesis of the evidence in an easy-to-read format. It is more realistic to expect practitioners to use these synopses to apply to clinical practice. A well done systematic review is a state-of-the-art synthesis of current evidence on a given research question. Evidence-based practice guidelines further serve to Btranslate[ evidence from clinical research into language easily understood by clinicians. As with clinical research, not all practice guidelines are created equally. According to Grimshaw and Eccles, 3 important issues underpin the development of valid and usable guidelines. There must be a systematic review of the best available evidence. The expert group assembled to translate the evidence into guidelines should be multidisciplinary. And, finally, developing guidelines requires sufficient resources, such as people with a wide range of skillsVincluding expert clinicians, health services researchers, and group process leadersVand sufficient financial support. The rationale for developing evidence-based clinical practice guidelines is that their use will achieve better health outcomes for patients, or a more efficient use of limited resources, than would have been achieved otherwise. Dissemination and implementation of guidelines are key components to changing practice behavior and health outcomes. Unfortunately, findings from health services research indicates a failure to routinely translate research findings into daily practice. A growing number of studies show that passive approaches, such as unsolicited distribution of consensus recommendations or guidelines are generally ineffective in changing clinical practice. Multifaceted approaches, including provider education, provider feedback, provider reminders, patient education, patient reminders, and patient financial incentives, were associated with improvements in provider adherence to guidelines and patient disease control. We have come a long way in terms of the integration of the evidence-based health care movement over the past 10 years, the question remainsVhave we come far enough?