TRiaDS, is an international, multi-disciplinary research collaboration that is part of a unique collaborative partnership between NHS Education for Scotland (NES) and the University of Dundee with researchers employed by both organisations. Funded by NES and directed by Professor Jan Clarkson, the TRiaDS collaboration has developed a programme of knowledge translation research embedded within the Scottish Dental Clinical Effectiveness Programme (SDCEP) guidance development process. TRiaDS has public, academic, policy, service and professional members, including external national and international leaders in the area of knowledge translation science.
The TRiaDS collaboration has developed an innovative, evaluative knowledge translation framework to inform, support and influence delivery of evidence based practice in dental primary care. This framework supports NHSScotland achieve the three quality ambitions of safe, effective, person centred care. In dentistry, this process has been successfully employed to inform the development and translation of evidence-based clinical guidance into practice, contributing to the efficient use of educational resources to support the delivery of NHSScotland’s Healthcare Quality commitment to implement evidence-based practice, thus ensuring patients gain the maximum benefit by receiving the most appropriate care at the right time.
Selected Recent and Current TRiaDS Projects
- RAPiD is a national TRiaDS-led trial to evaluate the effectiveness of different audit and feedback strategies for reducing antibiotic prescribing by dentists. This three-arm, cluster randomised trial has allocated all general dental practices in Scotland to receive either current practice or one of two individualised audit and feedback interventions. The interventions have been developed by linking routinely collected dental prescribing data from the PRISMS database and dental treatment data from the MIDAS database. A theoretically informed process evaluation is an integral component of the trial. Results were reported in 2014. (ISRCTN49204710).
- OHAR Audit. An audit to understand and support the implementation of the SDCEP OHAR guidance in practice was completed by over 1000 dentists. The audit supported general dental practitioners meet their terms of service audit requirements and the findings are informing future policy, education and service initiatives for the implementation of the OHAR guidance and national initiatives for the future development of dental audit.
- Prevention and Management of Caries in General Dental Practice: TRiaDS work to support the implementation of SDCEP guidance identified that the barriers to best practice in this area were multifaceted at the system, professional and patient levels. In collaboration with the Childsmile Programme a mixed methods study, funded by the Chief Scientist Office in Scotland (CZH/3/27, Principal Investigator Jan Clarkson) that includes practice observation, patient interviews and stakeholder consensus workshops is being carried out to identify and inform the development of the educational, policy and service interventions with the greatest potential.
- Decontamination: To support the translation of SDCEP guidance for the ‘Cleaning of Dental Instruments’, TRiaDS, in collaboration with the NES National Infection Control and Dental Support team, conducted a randomised controlled trial to investigate the added value of theoretically based, tailored, in-practice training in addition to conventional postgraduate education (ISRCTN56843582). The results identified a significant increase in the translation of the guidance recommendations as a consequence of the in-practice training, thus reducing the risk of healthcare acquired infection. In-practice training, following the TRiaDS intervention design, is now an established component of NES’s Postgraduate Dental Education Programme. Furthermore, all dental practices in Scotland must undertake this training at least once every three years to meet their Health Board’s practice inspection criteria.
Working in partnership with non-dental partners in NES, future priorities for the TRiaDS Programme include an exploration of the generalisability of the TRiaDS framework within primary care Optometry and Pharmacy. In both disciplines TRiaDS is consulting with stakeholders to identify priority areas for practice improvement where it is believed current practice fails to meet recommended practice. In year 2, TRiaDS will review the available evidence and guidance in the prioritised areas, develop and implement tools to measure current practice and the barriers and facilitators to best practice in order to inform the development of theoretically robust educational interventions for change.
For further information about TRiaDS, visit the TRiaDS website.
Professor Jan Clarkson, Co-Director DHSRU
Dr Linda Young, Research Manager (NES), Member DHSRU
Dr Douglas Stirling, Honorary Senior Researcher
Dr. Debbie Bonetti, Research Fellow
Dr Paula Elouafkaoui, Research Fellow
Mrs Heather Cassie, CSO Research Fellow
Ms Patricia Graham, Administrator