Practice-based research networks
Q&A explores opportunities for clinician research with PBRNs
Research directors from each of the three networks spoke with the ADA News about the purpose of practice-based research and why clinicians should consider joining in this innovative part of dentistry. (For a story about PBRNs at annual session, click here.) Representing the PBRNs were:
- Dr. Gregg H. Gilbert, the Dental Practice-Based Research Network (DPBRN) at the University of Alabama at Birmingham;
- Timothy A. DeRouen, Ph.D., Northwest Practice-Based Research Collaborative in Evidence-Based Dentistry (NW PRECEDENT) at the University of Washington and Oregon Health and Sciences University;
- Dr. Ronald G. Craig, Practitioners Engaged in Applied Research and Learning at the New York University College of Dentistry.
ADA News: Why should ADA-member dentists consider joining a PBRN?
Dr. Craig: Few opportunities exist within the dental profession for private practitioners to have direct impact upon the science base of clinical dentistry. Many PEARL practitioner-investigators have reported that participating in the network distinguishes their practice from other practices in the community by demonstrating their active involvement in the improvement of dental care. It's also allowed them to become involved in shaping a dental school's curriculum, and on a national level, in evidence-based dental practice. No other means exists for practitioners to scientifically evaluate their clinical methods compared to those used by their peers.
Dr. Gilbert: Many say that participating helps improve clinical decision-making and gives them increased enthusiasm for clinical practice and feeling less isolated from their colleagues. Our practitioners unanimously report that they find this process very interesting and that this leads to questions about how their clinical techniques differ from others, which then leads to additional research questions.
Are you actively recruiting now?
Dr. DeRouen: Yes. We've recruited through mailings, continuing education courses, study clubs, state dental meetings, direct contacts and word-of-mouth. We continue to actively recruit to spread out participation among members and not overburden any one practice. In addition, we also recruit for specific studies—such as our pulp capping study comparing the outcomes for calcium hydroxide and mineral trioxide aggregate—from community health centers where pulp capping may be more prevalent.
Dr. Gilbert: Yes, but currently our main recruitment interest is to enroll practices which serve populations with greater treatment needs, such as community health centers.
What do you think has been the impact of PBRNs on EBD so far?
Dr. Craig: So far we've been establishing the network's infrastructure, recruiting practitioner-investigators (PIs), and designing and implementing research studies. During the final two years (the NIDCR grant began in 2005 and runs until 2012) we hope we will bring study results and determine the impact of study results on clinical practice. Individually, many PIs have reported an increased appreciation of an evidence base for procedures and diagnostics, increased vigilance in record-keeping and critical assessment of procedures provided in the practice.
Dr. Gilbert: It can take many years before clinically important scientific evidence is incorporated into routine clinical practice. Therefore, determining how best to move current evidence into regular practice is important to ensure that it quickly reaches the patients for whom it is intended. PBRNs offer an opportune method to accomplish this.
How will practitioner engagement in research change the way dentists care for patients?
Dr. Gilbert: A common means of disseminating the latest scientific clinical evidence is to have the full-time academic researcher present a lecture to an audience of practitioners. DPBRN is committed to the notion that information can and should proceed from the practitioner to the academician as well. Our key to success has been identifying topics of interest to private practitioners and others in regular clinical practice and employing staff regional coordinators to help guide the dental office from initial startup of the study to its completion. A change in knowledge about the latest evidence is necessary to improve daily clinical practice, but it is not sufficient. Rather, we suspect that engagement with colleagues in networked research may be even more important in changing and improving clinical practice.
Dr. DeRouen: We've already heard examples from our dentist members of how participation in practice-based research has changed their perspective in treating patients. One commented on how participation in the protocol of our study on cracked teeth had already changed the way she evaluated cracked teeth in her practice, with the additional use of illumination. Others have become motivated to attend the ADA Evidence-Based Dentistry Champions course. It is clear that the experience of contributing to the evidence base for dental practice through PBRNs has heightened the sensitivity of our dentist members to the levels of evidence supporting what they do in practice, which inevitably will result in more evidence-based care on their part.
Dr. Craig: PBRNs offer unique advantages for conducting clinical research. Since studies are conducted by private practitioners in actual private practice settings, the results of PBRN research are directly relevant to clinical practice and should lead to faster dissemination and result in quicker change in clinical care. Indeed, a major role for PBRNs in the future will be to generate a major proportion of the evidence upon which clinical decisions will be based.
Is this a way for clinicians to get published?
Dr. DeRouen: We encourage clinicians who are interested and demonstrate strong participation and interest in specific studies to participate in the writing of abstracts and manuscripts. We also encourage the members to make presentations to their local study clubs and dental societies. To date, nine members have co-authored 15 abstracts and/or publications and 10 have given presentations.
Dr. Gilbert: As of March our practitioner-investigators had participated in 66 percent of DPBRN’s peer-reviewed and non-peer-reviewed publications and 48 percent of our presentations.
What have the three PBRNs accomplished since they began?
Dr. DeRouen: Northwest PRECEDENT has completed five studies and has 10 more under way or in the planning stages.
Dr. Craig: PEARL has more than 200 practitioner-investigators and has completed five studies and has eight more already in progress or in the planning stages using a network of some 4,500 patients.
All of the studies address common questions such as post-restoration tooth sensitivity, the treatment of deep carious lesions, the outcomes of endodontic and implant therapy including restorations, the use and effectiveness of analgesics, noncarious cervical lesion treatment outcomes, and the criteria used to establish a periodontal diagnosis and triage of periodontal patients for care. These studies range from surveys to effectiveness studies to randomized clinical trials.
Dr. Gilbert: Initially we wondered whether it would be possible to recruit a large number of practitioners or establish the necessary regulatory and contractual relationships, but we're happy to report that the community has been very interested in participating. DPBRN already has had more than 500 practitioner-investigators complete one or more of 19 studies. In addition, our practitioners report that their research activities generate enthusiastic participation among their staff and great interest among their patients. In summary, we have significantly exceeded our recruitment expectations.
More information on the NIDCR-funded Dental Practice-based Research Networks and how to join can be obtained at www.nidcr.nih.gov/research/DER/ClinicalResearch/