Tailored action planning improves decontamination practice when providers are hugely variant in implementing guidance recommendations

Abstract

Background: In Scotland, 180 million instruments are decontaminated annually in dental primary care. There was evidence that dentists were unlikely to change current poor compliance with guidance recommendations. Objective: Increase best decontamination practice. Research Question: Can tailored action plans (TAP) improve decontamination best practice in addition to standard support (an education course on the guidance topic). Methods: Pragmatic RCT: Practices randomised to attend the decontamination education course or to attend the course as well as receive one 3 hour in-practice visit by a NES support team member, trained to deliver the action planning intervention in a standardised way: Use the list of 13 key behaviours derived from the decontamination guidance to help practices identify areas for improvement, set goals, identify barriers, if/then plans; prompts and monitoring schedules. Postal questionnaires assessed decontamination practice prior to attending the course and 12 months later. Primary outcome: Best practice (performing all 13 behaviours). Findings: N=103 (Course alone N=56; Course+TAP N=47). Course+TAP increased best practice significantly compared to attending the course alone (31% to 11%: odds ratio 3.5; 95% CI 1.2 to 10.5; p-value 0.02). Discussion: The decontamination guidance recommended many simple and complex behaviours, not necessarily performed by any one member of the dental practice. Tailored action planning proved a successful way to address implementation challenges faced by dental practices of different list sizes, deprivation indexes, staff composition, number, and motivation to comply. This result was fed back at policy level and the intervention is now a routine part of service support and delivery.