The art of distilling information
With upwards of 500 dental journals covering every single aspect of dentistry, and more than 2,000 articles written every month – of which 150 are randomised controlled trials – information overload is a genuine problem for the average dentist in Scotland.
To keep up to date with every single paper and trial of relevance would be more than a full-time job and leave no time for the actual business of dentistry.
So, what is the answer? A quick flick through the journals in a lunch break every month or so, a visit to a conference once or twice a year to hear the latest thinking? If only there was an internationally-renowned organisation on our doorstep that could distil that information into user-friendly guidance documents…
Six years ago the National Dental Advisory Committee (NDAC), which advises the Chief Dental Officer on issues of national importance in Scottish dentistry, identified a need for just such an organisation, and thus the Scottish Dental Clinical Effectiveness Programme (SDCEP) came into being. With Professor Jan Clarkson as Director, SDCEP works within the dental directorate of NHS Education for Scotland (NES).
“It evolved from discussions within the profession about a perceived lack of clarity for people in practice as to where they get advice and guidance about a range of issues, from clinical activity to other aspects of running practices,” said Dr Doug Stirling, SDCEP’s Programme Manager.
“Decontamination is a case in point: there has been a host of information on decontamination out there but it has not been, from a dental team’s point of view, easily accessible. And, even when they could find it, it may not necessarily have been in a form that was readily understood.”
Doug, who was employed at the inception of the programme along with an administrator, was handed seven topics that had been identified by the NDAC and tasked with working out a process of guidance development. As a result, a guidance development group was formed for each topic, consisting of dental professionals with a particular interest or experience in that specific area.
Overseeing all the activities of SDCEP is a steering group, made up of representatives of each guidance group and the major dental institutions. Doug continued: “We have a number of general dentists on the steering group because we realise how vital it is to have end user representation in everything that we do.
“At the end of the day what we profess to do is produce user-friendly guidance and so we have to ask the users how it is working for them. Having them involved at every stage, from scoping through the development of the guidance itself, is crucial.”
For each of the topics the programme development team carry out a consultation whereby a draft copy of the guidance is made available on the website (http://www.SDCEP.org.uk) and sent out to interested individuals and organisations, as well as a random selection of dentists for their comments. “This is really important for all sorts of reasons, not least the credibility of the guidance,” said Doug.
And that credibility is further enhanced through SDCEP’s sister programme TRiaDS (Translational Research in a Dental Setting) which aims to evaluate the impact of guidance within practice. Dr Linda Young, Research and Development Manager, explained: “We have learned from research that guidance alone isn’t always sufficient to change practise if a change is actually needed. The area that I am involved in is the implementation of the guidance and supporting dentists and their teams in translating recommendations into practice.
“Throughout the guidance process we investigate the gap between current practise and what the guidance recommendations are likely to say, and what the barriers are to following the guidance recommendations.
“Where there are barriers, then we can develop interventions to help support dentists implement the guidance and test them in an experimental way to inform decision makers. This is where working within NES is particularly beneficial because of the important role of educational interventions in supporting the implementation of the guidance.”
Doug continued by saying: “I think other bodies who are involved with this kind of thing – and I’m thinking of the likes of SIGN in Scotland and NICE south of the border – are all acutely aware of the implementation aspect of what they do. There’s a recognition that if a change is necessary then it is unlikely to happen – or happen to the extent you would want it to – by just giving out information, there is more to it than that.”
And once the guidance is published and distributed, the onus shifts to keeping it as up-to-date as possible, as Doug explained: “We are committed to updating the guidance because they are living documents, so to speak. They are based on information that changes, so it is important that we do revisit the topic within a reasonable timescale to determine whether it is still current, if there is something new that makes the guidance out of date, or if there is just a minor change that needs to be made.”
What sets SDCEP and TRiaDS apart, not just in the UK, but around Europe and the world, is the fact that they are unique. There is no equivalent body or organisation working in the dental field today and that is something that should be celebrated.
Professor Jan Clarkson, who as well as being the Director of SDCEP and TRiaDS is Programme Director for the Dental Health Services Research Unit at the University of Dundee, paid tribute to her colleagues by saying: “I think it is significant that, on an international stage, we are the only dedicated programme that is developing guidance for the dental profession. It is important because already we are providing guidance that dentists value and are using.
“We have an international best seller in the drug prescribing guidance and the caries guidance for children is being used by many dental schools throughout the UK.
“The research programme of TRiaDS is an exemplar across healthcare in the world, and there is an awful lot of interest in how we are trying to underpin the best use of the guidance that is being produced.
“I genuinely believe dentists think that we are working to provide them with something that is useful, not only for them but for the whole team. And I think that we produce a very high quality product.”
For more information on the Scottish Dental Clinical Effectiveness Programme, and to view all the guidance documents produced to date, visit http://www.SDCEP.org.uk