Dr. Martin raises several valid points about PBRNs. First, he mentioned the importance of documenting "treatment longevity, long-term effects and costs of care." I agree such information would hold great value to practitioners, and it has been my hope from the initial planning of this initiative that, whenever possible, PBRN protocols will call for these data sets.
Second, Dr. Martin stressed the need to conduct risk-equivalent clinical trials. Agreed. Most, if not all, PBRN protocols will be written with specific inclusion/exclusion criteria that define the myriad risk factors for various conditions and diseases under study.
Finally, Dr. Martin mentioned the "challenging task" of documenting pretreatment and posttreatment conditions, as well as the possible lack of clinically objective standards to diagnose problematic conditions such as periodontal disease. I share his concerns.
However, as a practice-based network with its real-world strengths and limitations, the PBRN protocols generally will involve relatively straightforward outcomes. The network simply cannot afford to overload busy practitioners with time-consuming protocols that require tedious, in-office calibrations to record complex measurements. Thus, it is unlikely that PBRN participants will confront complex diagnostic issues.
As for the pretreatment and posttreatment data, whenever possible, PBRN protocols will gather these data. For example, if a PBRN study protocol is designed to evaluate a specific type of endodontic therapy in individuals with a clearly defined condition, it may be feasible to evaluate whether these patients are symptom-free two years after the procedure’s completion.
Currently, the PBRN initiative is progressing well through its organizational planning phase, and I encourage practitioners like Dr. Martin not only to offer their real-world perspectives, but also to participate in one of its future clinical trials.
