Sealants and dental caries: insight into dentists' behaviors regarding implementation of clinical practice recommendations.
Sealants and dental caries: insight into dentists' behaviors regarding implementation of clinical practice recommendations.
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密封剂和龋齿：对牙医对实施临床实践建议的行为的洞察力。
DOI：
10.14219/jada.archive.2013.0139
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发表时间：
2013-04
期刊：
影响因子：
--
通讯作者：
Spallek H
中科院分区：
文献类型：
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作者：
O'Donnell JA;Modesto A;Oakley M;Polk DE;Valappil B;Spallek H
作者通过基于小插图的访谈对私人执业牙医进行了一项定性研究，以评估在治疗非空洞性龋齿时使用基于证据的临床建议的障碍。作者招募了 22 名牙医作为方便样本，并向他们展示了两例涉及非空洞性龋损的患者案例。访谈者要求参与者在描述治疗建议时阐明他们的思维过程。参与者将他们的治疗计划与美国牙科协会关于封闭非空洞龋损的建议进行了比较，并描述了在实践中实施这些建议的障碍。作者记录并转录了会议的准确性和主题。个人临床经验成为牙医对非空洞性龋齿治疗决策的决定性因素。其他因素包括缺乏报销和对建议的不信任。作者发现，当建议与牙医的个人经验不一致时，了解这些建议并不会导致他们被采纳。作者发现，基于个人临床经验的根深蒂固的实践行为与基于证据的建议有很大不同，导致这些建议被拒绝。改善循证实践采用的尝试必须不仅仅涉及简单的信息传播，以实现个人临床经验和科学证据之间的平衡。
The authors conducted a qualitative study of private-practice dentists in their offices by using vignette-based interviews to assess barriers to the use of evidence-based clinical recommendations in the treatment of noncavitated carious lesions. The authors recruited 22 dentists as a convenience sample and presented them with two patient vignettes involving noncavitated carious lesions. Interviewers asked participants to articulate their thought processes as they described treatment recommendations. Participants compared their treatment plans with the American Dental Association’s recommendations for sealing noncavitated carious lesions, and they described barriers to implementing these recommendations in their practices. The authors recorded and transcribed the sessions for accuracy and themes. Personal clinical experience emerged as the determining factor in dentists’ treatment decisions regarding noncavitated carious lesions. Additional factors were lack of reimbursement and mistrust of the recommendations. The authors found that knowledge of the recommendations did not lead to their adoption when the recommendation was incongruent with the dentist’s personal experience. The authors found that ingrained practice behavior based on personal clinical experience that differed substantially from evidence-based recommendations resulted in a rejection of these recommendations. Attempts to improve the adoption of evidence-based practice must involve more than simple dissemination of information to achieve a balance between personal clinical experience and scientific evidence.