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Changing Clinicians' Behavior : a Randomized Controlled Trial of Fees and Education
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Changing Clinicians' Behavior : a Randomized Controlled Trial of Fees and Education
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Journal Article
Changing Clinicians' Behavior : a Randomized Controlled Trial of Fees and Education
2008
Overview
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.
Publisher
SAGE Publications,SAGE PUBLICATIONS, INC
Subject
/ Child
/ Dental Caries - prevention & control
/ Education, Dental, Continuing
/ Evidence-Based Medicine - economics
/ Evidence-Based Medicine - education
/ General Practice, Dental - economics
/ General Practice, Dental - education
/ General Practice, Dental - methods
/ Humans
/ Molar
/ Outcome and Process Assessment, Health Care
/ Pit and Fissure Sealants - economics
/ Pit and Fissure Sealants - therapeutic use
/ Practice Patterns, Dentists' - economics
/ Practice Patterns, Dentists' - statistics & numerical data
/ Preventive Dentistry - economics
/ Preventive Dentistry - education
/ Preventive Dentistry - statistics & numerical data
/ sealant
