Wil JM van der Sanden
University Medical Centre St Radboud, University of Nijmegen, The Netherlands

Research on (the methodology for) the development, implementation and evaluation of clinical practice guidelines for dentists in The Netherlands.

In The Netherlands, the government has transferred the responsibility for improving and maintaining the quality of medical (and dental) care to the medical and dental profession. Professional organisations for family medicine and medical specialists in The Netherlands have successfully developed and implemented a significant number of clinical practice guidelines, which were well accepted by the health care professionals.

In Dutch dentistry only a few attempts have yet been made to develop and implement clinical practice guidelines. Some initiatives resulted in the development of general dental practice guidelines pertaining to practice management and patient related aspects of dental treatment, and to appropriate communication between health care professionals. The Dutch Dental Association has developed a quality assurance program. Among the value components of this program are the construction of nation-wide clinical practice guidelines (CPGs) and interprofessional collaboration in dental peer groups, both on a voluntary basis.

In other countries, many efforts have been made to develop and implement CPGs in a more compulsory manner. Unfortunately, there were some failures as the CPGs were not accepted by the general dental practitioners. Most dentists will easily follow an ‘expert view’, and if the expert believes that the CPG doesn’t describe ‘good dentistry’, nobody will use the specific CPG.
In order to prevent any failure in the development and implementation of the CPGs, these guidelines should be based on sound and convincing evidence; the guideline development procedures should be clear and explicit; and the authorisation should be performed by a well-accepted organisation. According to a 1997 survey, most of the existing dental clinical guidelines in The Netherlands did not fulfil these requirements.

Following the implementation methods for CPGs used by other Dutch medical organisations appears unrealistic because (Dutch) dentists tend to differ from other health care professionals in their attitudes to CPGs. This might for example be caused by the environment in which they work: a single practice. According to our 1998 survey, dentists in The Netherlands feel some reluctance for CPGs because they don’t know what the effects are, and fear that CPGs might limit their professional autonomy.

This new research project attempts to influence dentists’ attitudes and thoughts concerning CPGs towards a more positive view. In a nation wide survey, dentists who supported the development of CPGs were invited to propose topics, perceived as a bottleneck in daily practice. It was assumed that these topics had the highest relevance for the development of a CPG from a dentist’s point of view, and this might lower dentists’ reluctance against CPGs. It was expected that this might simplify a successful implementation. At a later stage, topics which are experienced as important by others (e.g., patients, insurance companies, government), might then be accepted too. The single dentist seldom experiences such topics (e.g., great interpractitioner variation in decision-making) as a problem. Although this method differs from other (internationally used) methods, we do expect it to gain better results, specifically better acceptance of CPGs by dentists.

Contact address:

Wil JM van der Sanden
University Medical Centre St Radboud, Dentistry, University of Nijmegen
P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
Email: w.vandersanden@dent.kun.nl