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Brown LF, Keily PA, Spencer AJ: Evaluation ofa continuing education intervention ... This paper presents an evaluation of a year-long continuing education.

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Coniniiiiiiiv Drill Oval Epidemiol IW4: 22: 441-7 Frinlcd in DcniiKtrk . All rii^liis ri'scrved

..C"'- Munksgaard

1994

Communify Dentistry and Oral Epidemiology ISSN 0301-5661

Evaluation of a continuing education intervention "Periodontics in General Practice'

Louise Frances Brown\ Pamela Anne Keily and Andrew John Spencer^ School of Dental Science. The University of Melbourne. Parkville. Victoria. 'Department of Dentistry. The tjniversity of Adelaide, SA, Australia

Brown LF, Keily PA, Spencer AJ: Evaluation ofa continuing education intervention "Periodontics in General Practice". Community Dent Oral Epidemiol 1994; 22: 441-7. (O Munksgaard, 1994 Abstract - Evidence exists that sotne dentists may be failing to perform adequate periodontal diagnostic and preventive care for their patients. Continuing education (CE) is an avenue that is IVequently employed as a strategy to alter the style of practice. This paper presents an evaluation of a year-long continuing education intervention "Periodontics in General Practice", conducted among randomly selected private general dental practices in Adelaide, South Australia. The CE intervention featured a I-day seminar, bi-tnonthly newsletters, individualised 3-nionthly comparative feedback, and technical assistance. The study employed a longitudinal quasiexperimental design, which allowed for evaluation of the effectiveness of the intervention among practices employing hygienists (;;= 12) and not employing dental bygienists (/;= 12). taking into account the covariates of baseline level of provision of periodontal services, the practice's level of participation in the intervention and attendance at other CE courses in periodontics over the year. A comparison group of practice (/;= 12) did not participate in the intervention over the year. Patient record audits, conducted at baseline and at 12 months, provided data for the evaluation ofthe effect ofthe intervention on the recording of periodontal diagnostic, preventive and treatment item.s. Practices participating in the intervention showed increases in the percentage of records containing at least one periodontal diagnostic notation, and those practices employing hygienists showed an increase in the percentage of records with at least one preventive notation and one treatment item. Using ANCOVA to account for covariation, the main effect ofthe study group was significant in explaining changes in the provision of preventive periodontal services. The results indicate that an extended continuing education intei'vcntion can have significant effect on the provision of periodontal services, and that the magnitude of the effect differs between practices employing and not employing hygienists.

Gii-T (1) has emphasized the need for public health policies in the periodontal area to address not only the education needs of the public but also to ensure that the dental profession has access to up-to-date information on the aetiology, prevention, diagnosis and management of periodontal diseases. Results from studies conducted by SCIIAUB (2) and by M C F A L L and coworkers (3) indicate that the level of periodontal diagnostic activities is inadequate. There is evidence to

suggest that only a stnall proportion of dentists' time is spent on periodontal care (4, 5). The increase of malpractice suits ill this area provides additional indirect evidence that the area is one of growing concern within the dental profession (6). Continuing education is one method which frequently is employed in an attempt to improve dentists' interest, motivation and skills in areas of dentistry. The evidence for the effectiveness of educational interventions in altering the

Key words: chart audit; continuing education: delivery of dental care: dental hygienists: periodontal diseases Dr Louise Brown. School of Dental Science. The University of Melbourne. Grattan Street, Parkville VIC 3052, Australia Accepted for publication 2 January 1994

delivery of dental .services is equivocal (7). A total of seven studies have examined the effectiveness of continuing education progratns in periodontics (8-16). Overall, these studies have demonstrated that participants report positive attitudes towards their participation in the periodontal programs, although measures of actual changes in the provision of periodontal services reveals partial adoption ofthe recommended changes. Reviews of the medical continuina education litera-

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BROWN in

ture provide evidence that some continuing education programs are effective in inducing behaviour change in participants (17-27). Continuing education programs that are successful in modifying practice style usually feature more than the simple transfer of information. Programs structured as moderately intensive interventions featuring the use of individualised feedback, face-to-face assistance, objective setting and the use of esteemed clinical leaders as role models can be both praetical and effective in achieving desired behaviour change. Such programs usually attempt to maintain a provider's participation over the longer term, both with presentations and technical assistance, as well as with additional feedback on their performance. To date, no study in the dental field had presented a comprehensive analysis of the impact of continuing education on the provision of dental services, taking into account covariance due to the baseline level of provision of services, level of involvement in the intervention, and attendance at other continuing education courses over the evaluation period, all of which may infiuence the outcome of the study (17). The interaction of the employment of hygienists and the ability of a practice to alter the provision of periodontal services in response to an educational intervention has not been studied. The employment of dental hygienists has been shown to be associated with increased provision of periodontal and preventive services (25, 26). In Adelaide, South Australia, dental hygienists have been employed in private general dental practices since 1970, and in the late 1980"s, legislation was enacted to enable the employment of dental hygienists in all States and Territories of Australia. The hygienists work under the supervision of a dentist and the nature of their tasks are predominantly preventive periodontal in nature. These tasks range from patient education to root planing. It is reasonable to assume that the effectiveness of interventions designed to alter the provision of periodontal services may differ according to whether or not the practice employed dental hygienists. Therefore, the aim of this study was to evaluate the impact of a year-long continuing education intervention in periodontics on the provision of periodontal services in private general dental practices

groups. One group of practices, a Comparison Group, initially did not participate in the intervention. The practices in this group provided data at baseline and Materials and methods again at 12 months, prior to commencing The study etnployed a prospective, con- the educational intervention in April trolled study design with a cross-over ele- 1989. Two Test Groups of practices partiment. Fig. 1 outlines the structure of the cipated in the intervention for the first study. The study was of 19 months' dura- 12 months, and were followed for a tion, with initial data collection occur- further 6 months after completion of tbe ring 1 month prior to the commencement intervention. The practices in Test Group of a year-long educational intervention, One employed dental hygienists, whereas and final data collection occurring 6 the practices in Test Group Two did noi months after the completion of the inter- employ hygienists at baseline. vention. The intervention was conducted Sampling of practices The satnpling in Adelaide, South Australia, during the of dental practices to participate in the years 1988-89. Three groups of dental study was conducted in two steps. Firstly, practices, all of which were private gen- all private general dental practices within eral dental practices, were randomly se- the Adelaide metropolitan area that emlected for participation in this study. ployed one or more dental hygienists Practices not etnploying dental hygienists (/; = 33) were invited to participate. Of were randomly divided into one of two these, 26 practices consented to partici-

employing and not employing dental hygienists.

Studv Event

Time (month)

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19

Baseline data

Test Groups of Practices

Comparison Groups of Practices

ABC

ABC

No Intervention

12 month data

ABC

ABC seminar'

No Intervention news 18 month data

n e w s '•A'msS

ABC D

DATA COLLECTION A = provider questionnaire B = procedure log C = record audit D = supplementary questionnaire

Fig. I. Overview of study design.

ABC D

INTERVENTION news = newsletter B = feedback based on log data C = feedback teased on audit data availability of technical assisianct:

Evcthtation of a cotttintting edticatioit intctretttion pate (I'&.Wu consent rate). Due to the stnall number of practices employing hygienists, it was not possible to divide this g r o u p into an experitnetital and control group. Henee, all practices employing hygienists at baseline formed Test Group One, T h e sample of practices not employing dental hygienists was randomly drawn from the Dental Board of South Australia Detitists Register, March i9

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