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Supervised versus non-supervised implementation of an oral health care guideline in (residential) care homes: a cluster randomized controlled clinical trial

Gert Jan van der Putten, Luc De Visschere UGent, Jos Schols, Cees de Baat and Jacques Vanobbergen UGent (2010) BMC ORAL HEALTH. 10.
abstract
BACKGROUND: The increase of the proportion of elderly people has implications for health care services. Advances in oral health care and treatment have resulted in a reduced number of edentulous individuals. An increasing number of dentate elderly people have tooth wear, periodontal disease, oral implants, and sophisticated restorations and prostheses. Hence, they are in need of both preventive and curative oral health care continuously. Weakened oral health due to neglect of self care and professional care and due to reduced oral health care utilization is already present when elderly people are still community-dwelling. At the moment of (residential) care home admittance, many elderly people are in need of oral health care urgently. The key factor in realizing and maintaining good oral health is daily oral hygiene care. For proper daily oral hygiene care, many residents are dependent on nurses and nurse aides. In 2007, the Dutch guideline "Oral health care in (residential) care homes for elderly people" was developed. Previous implementation research studies have revealed that implementation of a guideline is very complicated. The overall aim of this study is to compare a supervised versus a non-supervised implementation of the guideline in The Netherlands and Flanders (Belgium). METHODS/DESIGN: The study is a cluster randomized intervention trial with an institution as unit of randomization. A random sample of 12 (residential) care homes accommodating somatic as well as psycho-geriatric residents in The Netherlands as well as in Flanders (Belgium) are randomly allocated to an intervention or control group. Representative samples of 30 residents in each of the 24 (residential) care homes are monitored during a 6-months period. The intervention consists of supervised implementation of the guideline and a daily oral health care protocol. Primary outcome variable is the oral hygiene level of the participating residents. To determine the stimulating or inhibiting factors of the implementation project and the nurses' and nurse aides' compliance and perceived barriers, a process evaluation is carried out. DISCUSSION: The method of cluster randomization may result in a random effect and cluster selection bias, which has to be taken into account when analyzing and interpreting the results. TRIAL REGISTRATION: Current Controlled Trials ISRCTN86156614
Please use this url to cite or link to this publication:
author
organization
year
type
journalArticle (original)
publication status
published
subject
journal title
BMC ORAL HEALTH
BMC Oral Health
volume
10
article_number
17
pages
8 pages
Web of Science type
Article
Web of Science id
000208596700017
ISSN
1472-6831
DOI
10.1186/1472-6831-10-17
language
English
UGent publication?
yes
classification
A1
copyright statement
I have retained and own the full copyright for this publication
id
1066410
handle
http://hdl.handle.net/1854/LU-1066410
date created
2010-10-27 15:47:30
date last changed
2013-05-14 13:46:07
@article{1066410,
  abstract     = {BACKGROUND: The increase of the proportion of elderly people has implications for health care services. Advances in oral health care and treatment have resulted in a reduced number of edentulous individuals. An increasing number of dentate elderly people have tooth wear, periodontal disease, oral implants, and sophisticated restorations and prostheses. Hence, they are in need of both preventive and curative oral health care continuously. Weakened oral health due to neglect of self care and professional care and due to reduced oral health care utilization is already present when elderly people are still community-dwelling. At the moment of (residential) care home admittance, many elderly people are in need of oral health care urgently. The key factor in realizing and maintaining good oral health is daily oral hygiene care. For proper daily oral hygiene care, many residents are dependent on nurses and nurse aides. In 2007, the Dutch guideline {\textacutedbl}Oral health care in (residential) care homes for elderly people{\textacutedbl} was developed. Previous implementation research studies have revealed that implementation of a guideline is very complicated. The overall aim of this study is to compare a supervised versus a non-supervised implementation of the guideline in The Netherlands and Flanders (Belgium).
METHODS/DESIGN: The study is a cluster randomized intervention trial with an institution as unit of randomization. A random sample of 12 (residential) care homes accommodating somatic as well as psycho-geriatric residents in The Netherlands as well as in Flanders (Belgium) are randomly allocated to an intervention or control group. Representative samples of 30 residents in each of the 24 (residential) care homes are monitored during a 6-months period. The intervention consists of supervised implementation of the guideline and a daily oral health care protocol. Primary outcome variable is the oral hygiene level of the participating residents. To determine the stimulating or inhibiting factors of the implementation project and the nurses' and nurse aides' compliance and perceived barriers, a process evaluation is carried out.
DISCUSSION: The method of cluster randomization may result in a random effect and cluster selection bias, which has to be taken into account when analyzing and interpreting the results.
TRIAL REGISTRATION: Current Controlled Trials ISRCTN86156614},
  articleno    = {17},
  author       = {van der Putten, Gert Jan and De Visschere, Luc and Schols, Jos and de Baat, Cees and Vanobbergen, Jacques},
  issn         = {1472-6831},
  journal      = {BMC ORAL HEALTH},
  language     = {eng},
  pages        = {8},
  title        = {Supervised versus non-supervised implementation of an oral health care guideline in (residential) care homes: a cluster randomized controlled clinical trial},
  url          = {http://dx.doi.org/10.1186/1472-6831-10-17},
  volume       = {10},
  year         = {2010},
}

Chicago
van der Putten, Gert Jan, Luc De Visschere, Jos Schols, Cees de Baat, and Jacques Vanobbergen. 2010. “Supervised Versus Non-supervised Implementation of an Oral Health Care Guideline in (residential) Care Homes: a Cluster Randomized Controlled Clinical Trial.” Bmc Oral Health 10.
APA
van der Putten, G. J., De Visschere, L., Schols, J., de Baat, C., & Vanobbergen, J. (2010). Supervised versus non-supervised implementation of an oral health care guideline in (residential) care homes: a cluster randomized controlled clinical trial. BMC ORAL HEALTH, 10.
Vancouver
1.
van der Putten GJ, De Visschere L, Schols J, de Baat C, Vanobbergen J. Supervised versus non-supervised implementation of an oral health care guideline in (residential) care homes: a cluster randomized controlled clinical trial. BMC ORAL HEALTH. 2010;10.
MLA
van der Putten, Gert Jan, Luc De Visschere, Jos Schols, et al. “Supervised Versus Non-supervised Implementation of an Oral Health Care Guideline in (residential) Care Homes: a Cluster Randomized Controlled Clinical Trial.” BMC ORAL HEALTH 10 (2010): n. pag. Print.