| 1. |
- Koch, Margaretha, et al.
(författare)
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A cost-minimization analysis of root canal treatment before and after education in nickel-titanium rotary technique in general practice
- 2012
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Ingår i: International Endodontic Journal. - : Wiley. - 0143-2885 .- 1365-2591. ; 45:7, s. 633-641
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Tidskriftsartikel (refereegranskat)abstract
- AIM:To compare root canal treatments performed before and after education in a nickel-titanium rotary technique (NiTiR) with respect to costs for instrumentation and number of instrumentation sessions in a County Public Dental Service in Sweden.METHODOLOGY: Following education, 77% of the general dental practitioners adopted completely the NiTiR. The randomly selected sample comprised 850 root canal treatments: 425 performed after the education, mainly using the NiTiR-technique (group A) and 425 performed before, using mainly stainless steel hand instrumentation (SSI) (group B). The number of instrumentation sessions in root canal treatments in group A and B was calculated. A CMA was undertaken on the assumption that treatment outcome was identical in group A and B. Direct costs associated with SSI and NiTiR were estimated and compared. Investment costs required for implementation of NiTiR were calculated, but not included in the CMA.RESULTS:Instrumentation sessions were counted in 418 (98%) root canal treatments performed in group A and 419 (99%) in group B. The number of instrumentation sessions in group A was significantly lower; 2.38, compared with 2.82 in group B (P < 0.001). Thus, on average, for every second root canal treatment performed after the education, one instrumentation session was saved. Root canal treatments in teeth with one canal, and three or more canals, were completed in significantly fewer instrumentation sessions after the education (P < 0.001). Direct costs of instrumentation sessions were SEK 2587 (USD 411) for group A and SEK 2851 (USD 453) for group B, for teeth with one canal, and SEK 2946 (USD 468) for group A and SEK 3510 (USD 558) for group B, for teeth with three or more canals (year 2011). Root canal treatments of teeth with two canals showed no significant difference with respect to number of instrumentation sessions and costs.CONCLUSIONS:Significantly fewer instrumentation sessions were required in group A, and root canal instrumentation therefore costs less than in group B. On the assumption that treatment outcome is identical in group A and B, root canal instrumentation performed after the education was more cost-effective.
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| 2. |
- Koch, Margaretha
(författare)
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On implementation of an endodontic program : change of practice, treatment outcome and cost-effectiveness
- 2013
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- It is widely accepted that the uptake of research findings by practitionersis unpredictable, yet until they are adopted, advances intechnology and clinical research cannot improve health outcomesin patients. Despite extensive research there is limited knowledgeof the processes by which changes occur and ways of measuringthe effectiveness of change of practice. The overall aim of this thesiswas to investigate aspects of an educational intervention in clinicalendodontic routines and new instrumentation techniques in aSwedish County Public Dental Service. Special reference was madeto the establishment of changed behaviour in practice, the process ofchange, and the clinical effects.Although a high level of competence in root canal treatment proceduresis required in general dental practice, a number of Swedishstudies have revealed inadequate root-fillings quality and associatedperiapical inflammation in general populations. It is suggested thatthe adoption of the nickel-titanium rotary instrumentation (NiTiR)technique would improve the cleaning and shaping of root canalsand the quality of the root-filling. However, there is limited knowledgeof the effectiveness of the technique when applied in generaldental practice.In two of four consecutive studies, the subjects were employees of acounty Public Dental Service. The aim was to investigate the rate ofadoption of clinical routines and the NiTiR technique: the output,and the qualitative meaning of successful change in clinical practice.In the other two studies the aim was to investigate treatment effectand the cost-effectiveness of root canal treatment in a general population:the outcome.Four hundred employees (dentists, dental assistants, administrativeassistants and clinical managers) of a Swedish County Public DentalService were mandatorily enrolled in an educational and trainingprogram over two years. Change of practice was investigated in apost-education survey. The NiTiR technique was adopted by significantlymore dentists in the intervention county compared to acontrol county (77% and 6% respectively). Dentists in the interventioncounty completed root canal instrumentation in significantlyfewer sessions than the dentists in the control county.Eight in-depth interviews, two with each participant, (dentist, dentalassistant, receptionist, clinical manager), were strategically selectedfor a phenomenological analysis. Four factors were identified asnecessary for successful change: 1) disclosed motivation, 2) allowancefor individual learning processes, 3) continuous professionalcollaboration, and 4) a facilitating educator.A random sample of 850 performed root canal treatments was usedfor a study of treatment outcome; 425 before and 425 after the educationand adoption of the NiTiR technique. Root-filling quality,periapical status and tooth survival were assessed on radiographstaken at treatment and at follow-up, ≥4 years later. Apical periodontitiswas found in 34% of the teeth root-filled before the educationcompared to 33%, after. After the education, root-filling qualityimproved significantly, tooth survival was significantly higher,however, without a subsequent improvement in success rate posteducation;68% vs. 67%.A micro-costing model was used to calculate the costs of root canalinstrumentation, pre- and post-education, in the same sample usedin the study of treatment outcome. Costs were lower post-education:by SEK 264 for teeth with one canal and SEK 564 for teeth withthree or more canals. A reason for lower costs was that the NiTiRtechnique dominated after the education and required significantlyfewer instrumentation sessions. A cost-minimization analysis disclosedthat root canal treatments undertaken post-education weremore cost-effective.In conclusion, there was only a partial relationship between outputand outcome. Although root-filling quality improved significantly,the study did not show any association between the more frequentuse of NiTiR and an improvement in remaining teeth with normalperiapical status or success rate. However, the use of NiTiR wasmore cost-effective. These results are in accordance with previousfindings of the so called efficacy-effectiveness gap in clinical practice:a high output is not predictive of a high outcome. The overallconclusion to be drawn from these studies is that further researchis warranted to identify factors associated with improvement of thequality of endodontic care.The general interpretation of the findings of these implementationstudies is as important as the effects of the change in endodonticinstrumentation: a clinically relevant and applicable intervention,introduced by experienced expertise under allowing learning and collaboratingcircumstances, disclosed clinicians’ motivation and facilitatedimplementation. The finding of qualitative differences betweenthe questionnaire responses and the in-depth interviews suggestthat a critical approach is warranted when comparing surveys andqualitative methods aimed at investigating qualitative experiences ofchange, due to their different epistemological premises.
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| 3. |
- Koch, Margaretha, et al.
(författare)
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Successful clinical and organisational change in endodontic practice : a qualitative study
- 2014
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Ingår i: European journal of dental education. - : John Wiley & Sons. - 1396-5883 .- 1600-0579. ; 18:3, s. 121-127
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to explicate and describe the qualitative meaning of successful clinical and organizational change in endodontic practice, following a comprehensive implementation program, including the integration of the nickel-titanium-rotary-technique. After an educational intervention in the Public Dental Service in a Swedish county, thematic in-depth interviews were conducted, with special reference to the participants' experience of the successful change. Interviews with four participants, were purposively selected on the basis of occupation (dentist, dental assistant, receptionist, clinical manager), for a phenomenological human scientific analysis. Four constituents were identified as necessary for the invariant, general structure of the phenomenon: 1) disclosed motivation, 2) allowance for individual learning processes, 3) continuous professional collaboration, and 4) a facilitating educator. The perceived requirements for achieving successful clinical and organizational change in endodontic practice were clinical relevance, an atmosphere which facilitated discussion and allowance for individual learning patterns. The qualities required in the educator were acknowledged competence with respect to scientific knowledge and clinical expertise, as well as familiarity with conditions at the dental clinics. The results indicate a complex interelationship among various aspects of the successful change process.
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| 4. |
- Wolf, Eva, et al.
(författare)
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Adoption of change in endodontic practice after an educational program : A qualitative study
- 2022
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Ingår i: Clinical and Experimental Dental Research. - : John Wiley & Sons. - 2057-4347. ; 8:3, s. 781-792
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: The aim was to define the characteristics of successful implementation of new clinical endodontic routines within a public dental health organization, following an educational program. Materials and Methods: Fifteen staff members were strategically selected for the interview. All had completed a theoretical educational intervention including a complementary endodontic treatment strategy and, for the dentists, comprising training in the nickel-titanium-rotary-technique. All experienced the successful acceptance of new clinical routines. Two thematic in-depth audiotaped interviews were conducted, wherein the informants described the implementation process in their own words. The interviews were transcribed verbatim and analyzed according to Qualitative Content Analysis. Results: A theme was identified: A multiple flexible process with governance support and gradual reinforcement of motivation, with the following main categories: Firstly, contextual facilitation, with two subcategories (i) a multifaceted organizational foundation and (ii) a tolerance of flexibility. Secondly, emotional facilitation, with two subcategories (i) an experience of simplification and (ii) an experience of improvement. Conclusion: The results improve the understanding of a multifaceted process underlying the acceptance of changes to clinical endodontic procedures by dentists in a public dental health organization. Important contributing factors identified were governance support, a committed resource person with contextual knowledge, tolerance of flexibility in implementation, and permissive informal communication channels within the local workplace. These findings might be a valuable contribution to an evidence base, facilitating the selection of the most appropriate educational strategy and structure for a specified purpose.
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