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Sodo PP, Malele-Kolisa Y, Moola A, Yengopal V, Nemutandani S, Jewett S. Exploring reasons why South African dental therapists are leaving their profession: A theory-informed qualitative study. PLoS One 2023; 18:e0293039. [PMID: 37883391 PMCID: PMC10602277 DOI: 10.1371/journal.pone.0293039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 10/04/2023] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND Dental therapy is a category of mid-level oral health professional that was introduced to address inequities in oral health service provision in South Africa within a constrained human resource for health context. However, low numbers of registered dental therapists and attrition threaten this strategy. AIM This study explored reasons for this attrition, building on the Hertzberg Two-Factor Theory. METHODS Through a qualitative exploratory study design, in-depth interviews were conducted with former dental therapists to explore their reasons for leaving the profession. They were recruited using snowball sampling. All interviews were audio recorded, transcribed verbatim, and coded in NVIVO12. A team of researchers applied thematic analysis to agree on themes and sub-themes, guided by Hertzberg's ideas of intrinsic and extrinsic factors. FINDINGS All 14 former dental therapists interviewed expressed their passion for the profession, even though their motivations to join the profession varied. Many of their reasons for leaving aligned with extrinsic and intrinsic factors defined in Hertzberg's Two-Factor Theory. However, they also spoke about a desire for a professional identity that was recognized and respected within the oral health profession, health system, and communities. This is a novel study contribution. CONCLUSION Dental therapist attrition in South Africa is mainly caused by job dissatisfaction and motivation issues resulting from health system level factors. While the Hertzberg Two-Factor Theory helped identify extrinsic and intrinsic factors at an individual level, we used the Human Resources for Health System Development Analytical Framework to identify solutions for dental therapist production, deployment, and retention. Addressing these issues will enhance retention and accessibility to oral health services in the country.
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Affiliation(s)
- Pumla Pamella Sodo
- School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Yolanda Malele-Kolisa
- School of Oral Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Aneesa Moola
- School of Oral Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Veerasamy Yengopal
- Faculty of Dentistry, University of Western Cape, Cape Town, South Africa
| | - Simon Nemutandani
- Research and Innovation Directorate, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Sara Jewett
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
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Sodo PP, Jewett S, Nemutandani MS, Yengopal V. Attrition of dental therapists in South Africa—A 42‐year review. Community Dent Oral Epidemiol 2022; 51:462-468. [DOI: 10.1111/cdoe.12832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 11/25/2022] [Accepted: 12/08/2022] [Indexed: 12/24/2022]
Affiliation(s)
- Pumla Pamella Sodo
- Department of Family Medicine, School of Clinical Medicine University of the Witwatersrand Johannesburg South Africa
| | - Sara Jewett
- School of Public Health University of the Witwatersrand Johannesburg South Africa
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Relationship between Professional Training of Dentists and Outpatient Clinical Production. BIOMED RESEARCH INTERNATIONAL 2022; 2022:5365363. [PMID: 35355824 PMCID: PMC8958072 DOI: 10.1155/2022/5365363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 03/02/2022] [Indexed: 11/18/2022]
Abstract
Background. The aim was to evaluate the association between the professional training of dentists and their outpatient production (OP) of clinical and collective/preventive procedures and the total number of procedures registered in a health information system. Methods. It included all 19,947 primary dental care units participating in the Program for Improvement of Access and Quality of Primary Care (PMAQ-AB 2nd cycle) and the number of clinical procedures (CP), collective/preventive procedures (PP), and total procedures (TP) registered in the ambulatory information system between November 2013 and July 2014 for each participant oral health team. The outcome was being above the national median of procedures. The main variables related to training were the dentists specialising in family health, the level of training, and participation in permanent education. Effect estimates were calculated by multiple logistic regression. Results. In the final model, controlled by contextual factor work process, family health specialists had higher chances (
, 95% CI: 1.00; 1.27) of producing above the national median of CP than nonspecialists,
(0.96; 1.18) for PP and
(1.08; 1.27) for TP. Dentists taking permanent education had higher chances than those not taking it of producing above the national median for CP, PP, and TT, respectively, with
(1.20; 1.62),
(1.09; 1.40), and
(1.18; 1.39). Conclusion. Training in family health performs more procedures in primary care settings than those without training. However, this OP is influenced by variables related to the municipality and the work process, especially for PP. If the highest production observed is a consequence of training, then public health managers can not only encourage training policies such as permanent education policies to expand the use of services.
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Roberts BS, Roberts EP, Brachvogel W, Stein AB. Practice management curricular changes may lead to enhanced preparedness for practice. J Dent Educ 2020; 84:887-894. [PMID: 32124983 DOI: 10.1002/jdd.12136] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 01/30/2020] [Accepted: 02/13/2020] [Indexed: 11/10/2022]
Abstract
PURPOSE The 2018 American Dental Education Association Survey of Dental School Seniors showed that 62.5% of graduates felt prepared in practice administration compared to 49.5% in 2013. The aim of this study was to survey and Internet search U.S. Dental Schools' Practice Management curriculum (PMC) to assess if and what changes, made in the past 5 years, may account for the continued increase in dental graduates' perception of preparedness for practice METHODS: An electronic survey was emailed to 64 dental schools querying factors for changes in PMC, updates in instructors, instructional methods, technology, topics, hours, and content enhancements. In addition, if a dual degree in business administration was developed or planned in the future. RESULTS Twenty-three schools responded for a 36.0% response rate. All participants (100.0%) indicated PMC changes, 73.9% responded that changes were motivated by student interest, and 60.9% planned future PMC improvements. All respondents (100.0%) updated subject matter and 52.2% had added technology, including Web-based business model and simulation courses. Two schools added dual degree MBA programs in 2017 due to student interest in entrepreneurship and administrative goals. CONCLUSION The study showed that upgrades in topics and teaching methods with Web-based technology, dual degrees, and additional focus on PMC hours, sequence, and number of practice administration courses in D1 and D2 years may be contributory factors for the development of enhanced skills and enhanced attitudes of graduates for practice readiness. Future study is needed to assess if these PMC improvements and advanced business courses have been successful in practicing dentists' careers.
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Affiliation(s)
- Bradley S Roberts
- Midwestern University, College of Dental Medicine Arizona, Glendale, Arizona, USA
| | - Eugenia P Roberts
- Midwestern University, College of Dental Medicine Arizona, Glendale, Arizona, USA
| | - William Brachvogel
- Midwestern University, College of Dental Medicine Arizona, Glendale, Arizona, USA
| | - Amy Buros Stein
- Office of Research and Sponsored Programs, Midwestern University, Glendale, Arizona, USA
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Fdi World Dental Federation. Access to oral healthcare for vulnerable and underserved populations: Adopted by the General Assembly: September 2019, San Francisco, United States of America. Int Dent J 2020; 70:15-16. [PMID: 31985816 PMCID: PMC9379149 DOI: 10.1111/idj.12556] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Nguyen TM, Tonmukayakul U, Calache H. A dental workforce strategy to make Australian public dental services more efficient. HUMAN RESOURCES FOR HEALTH 2019; 17:37. [PMID: 31146760 PMCID: PMC6543641 DOI: 10.1186/s12960-019-0370-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 05/02/2019] [Indexed: 05/22/2023]
Abstract
BACKGROUND Dental services can be provided by the oral health therapy (OHT) workforce and dentists. This study aims to quantify the potential cost-savings of increased utilisation of the OHT workforce in providing dental services for children under the Child Dental Benefits Schedule (CDBS). The CDBS is an Australian federal government initiative to increase dental care access for children aged 2-17 years. METHODS Dental services billed under the CDBS for the 2013-2014 financial year were used. Two OHT-to-dentist workforce mix ratios were tested: Model A National Workforce (1:4) and Model B Victorian Workforce (2:3). The 30% average salary difference between the two professions in the public sector was used to adjust the CDBS fee schedule for each type of service. The current 29% utilisation rate of the CDBS and the government target of 80% were modelled. RESULTS The estimated cost-savings under the current CDBS utilisation rate was AUD 26.5M and AUD 61.7M, for Models A and B, respectively. For the government target CDBS utilisation rate, AUD 73.2M for Model A and AUD 170.2M for Model B could be saved. CONCLUSION An increased utilisation of the OHT workforce to provide dental services under the CDBS would save costs on public dental service funding. The potential cost-savings can be reinvested in other dental initiatives such as outreach school-based dental check programmes or resource allocation to eliminate adult dental waiting lists in the public sector.
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Affiliation(s)
- Tan Minh Nguyen
- Deakin University, 75 Pigdons Road, Waurn Ponds, Victoria 3216 Australia
- University of Melbourne, Parkville, Australia
- Peninsula Health, Frankston, Australia
- Coburg Hill Oral Care, Hill, Coburg, Australia
| | | | - Hanny Calache
- Deakin University, 75 Pigdons Road, Waurn Ponds, Victoria 3216 Australia
- University of Melbourne, Parkville, Australia
- La Trobe University, Bendigo, Australia
- North Richmond Community Health, North Richmond, Australia
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Lopes J, Palmier AC, Werneck MAF, Matta-Machado ATGD, Abreu MHNGD. A Survey About Dental Instruments at the Primary Health Care in Brazil. Braz Dent J 2018; 29:500-506. [DOI: 10.1590/0103-6440201801969] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 07/30/2018] [Indexed: 11/22/2022] Open
Abstract
Abstract This study describes the structure of oral health services in primary health care in Brazil and the instruments available for the provision of oral health care and to compare the number of instruments according to organizational characteristics of health services and among the macroregions. Of the 23,251 oral health teams (OHTs) in the Public Health System, 17,513 (75.3%) participated in this study. Trained researchers observed the structures of the health services and determined the presence of and whether a sufficient quantity of 36 dental instruments existed. The score of each oral health service was determined by the sum of the number of dental instruments present in sufficient quantity (0 to 36). Central tendency measures were compared along with the variability in these scores according to the organizational characteristics of the services and according to the Brazilian macroregion. No instrument was found to be present in all evaluated services. Basic, surgical and restorative instruments were the most frequently found. Periodontal, endodontic and prosthetic instruments exhibited the lowest percentages. The mean and median numbers of dental instruments were higher for teams that operated over more shifts, those with an oral health technician and those in the South and Southeast regions. The oral health services were equipped with basic, surgical and restorative instruments. Instruments designed for periodontal diagnosis, emergency care and denture rehabilitation were less frequently found in these services. The worst infrastructure conditions existed in the OHTs with the worst forms of care organization and in regions with greater social issues.
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Affiliation(s)
- Joyce Lopes
- Universidade Federal de Minas Gerais, Brazil
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Hill H, Macey R, Brocklehurst P. A Markov model assessing the impact on primary care practice revenues and patient's health when using mid-level providers, lesson learned from the United Kingdom. J Public Health Dent 2017; 77:334-343. [PMID: 28272806 DOI: 10.1111/jphd.12212] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 01/13/2017] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To evaluate the cost-effectiveness of using mid-level providers for dental "check-up" examinations and the treatment of caries in different NHS settings in the United Kingdom. Mid-level providers are a broad category that describes non-dentist members of dental teams. This study focused on the potential use of Dental Hygiene Therapists undertaking dental "check-up" examinations and simple restorative treatment, instead of dentists. METHODS A Markov model was used to construct the natural history of caries development in adults that visit a dental practice every six months over a five-year period. Three cost perspectives are taken: those borne to dental healthcare providers in England and Wales, Northern Ireland and Scotland. These represent three separate forms of retrospective payment system that are currently in use in the United Kingdom. The cost outcome was the average amount of retained practice earnings required to provide healthcare per patient visit. The health outcome was the average length of time in a cavity-free state and the cost-effectiveness outcome was incremental cost for six months in a cavity-free state. RESULTS No statistical difference was found between dentists and mid-level providers in the length of time in a cavity-free state but the use of the latter saved money in all three NHS health system jurisdictions. This ranged from £7.85 (England and Wales) to £9.16 (Northern Ireland) per patient visit ($10.20 to $11.90, respectively) meaning the incremental cost for six month in a cavity-free state ranged from £261.67 ($339.93) in England and Wales to £305.33 ($369.68) in Northern Ireland. Further, changes in baseline assumptions and parameter values did not change mid-level providers being the dominant service intervention. CONCLUSION In a time of limited funds for dental services, these results suggest that resources in public funded systems could be saved using mid-level providers in dental practices, without any health risk to patients or capital investment.
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Affiliation(s)
- Harry Hill
- School of Dentistry, The University of Manchester, Manchester, UK.,Manchester Centre for Health Economics, The University of Manchester, Manchester, UK
| | - Richard Macey
- Centre for Endrocinology and Diabetes, The University of Manchester, Manchester, UK
| | - Paul Brocklehurst
- North Wales Organisation for Randomised Trials in Health, Bangor University, Bangor, UK
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Corrêa GT, Celeste RK. Associação entre a cobertura de equipes de saúde bucal na saúde da família e o aumento na produção ambulatorial dos municípios brasileiros, 1999 e 2011. CAD SAUDE PUBLICA 2015; 31:2588-98. [DOI: 10.1590/0102-311x00000915] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 06/03/2015] [Indexed: 11/22/2022] Open
Abstract
Resumo Analisar a associação entre a cobertura populacional de equipes de saúde bucal da Estratégia Saúde da Família (ESF) e a diferença nas taxas de uso de serviços odontológicos públicos nos municípios brasileiros em 1999 e 2011. A amostra contou com 5.507 municípios nos 2 anos. Foram utilizados dados de sistemas de informação oficiais e se procedeu à regressão logística para modelar o incremento nas taxas de procedimentos. Observou-se que 85% dos municípios possuíam equipes de saúde bucal da ESF em 2011 e houve aumentos nas taxas de recursos físicos, humanos e financeiros. A produção odontológica aumentou 49,5% no período. Os municípios que incorporaram mais que 3 equipes de saúde bucal/10 mil habitantes tiveram mais chances de aumentar as taxas de procedimentos coletivos (OR = 1,61; IC95%: 1,23-2,11), preventivos (OR = 2,05; IC95%: 1,56-2,69), restaurações (OR = 2,07; IC95%: 1,58-2,71) e extrações (OR = 1,53; IC95%: 1,19-1,97), após controle por fatores sociodemográficos e relacionados à variação de recursos físicos, humanos e financeiros. A incorporação de equipes de saúde bucal à ESF parece mais efetiva para o aumento de indicadores de uso de serviços odontológicos.
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Wanyonyi KL, Radford DR, Gallagher JE. Dental skill mix: a cross-sectional analysis of delegation practices between dental and dental hygiene-therapy students involved in team training in the South of England. HUMAN RESOURCES FOR HEALTH 2014; 12:65. [PMID: 25407478 PMCID: PMC4247654 DOI: 10.1186/1478-4491-12-65] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Accepted: 09/25/2014] [Indexed: 05/23/2023]
Abstract
BACKGROUND Research suggests that health professionals who have trained together have a better understanding of one another's scope of practice and are thus equipped for teamwork during their professional careers. Dental hygiene-therapists (DHTs) are mid-level providers that can deliver routine care working alongside dentists. This study examines patterns of delegation (selected tasks and patients) by dental students to DHT students training together in an integrated team. METHODS A retrospective sample of patient data (n = 2,063) was extracted from a patient management system showing the treatment activities of two student cohorts (dental and DHT) involved in team training in a primary care setting in the South of England over two academic years. The data extracted included key procedures delegated by dental students to DHT students coded by skill-mix of operator (e.g., fissure sealants, restorations, paediatric extractions) and patient demography. χ2 tests were conducted to investigate the relationship between delegation and patient age group, gender, smoking status, payment-exemption status, and social deprivation. RESULTS A total of 2,063 patients managed during this period received treatments that could be undertaken by either student type; in total, they received 14,996 treatment procedures. The treatments most commonly delegated were fissure sealants (90%) and restorations (51%); whilst the least delegated were paediatric extractions (2%). Over half of these patients (55%) had at least one instance of delegation from a dental to a DHT student. Associations were found between delegation and patient age group and smoking status (P <0.001). Children under 18 years old had a higher level of delegation (86%) compared with adults of working age (50%) and patients aged 65 years and over (56%). A higher proportion of smokers had been delegated compared with non-smokers (45% cf. 26%; P <0.001). CONCLUSIONS The findings suggest that delegation of care to DHT students training as a team with dental students, involved significantly greater experience in treating children and adult smokers, and providing preventive rather than invasive care in this integrated educational and primary care setting. The implications for their contribution to dentistry and the dental team are discussed, along with recommendations for primary care data recording.
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Affiliation(s)
- Kristina L Wanyonyi
- />King’s College London Dental Institute, Division of Population and Patient Health, Bessemer Road, London, SE5 9RS UK
| | - David R Radford
- />Teaching Division, King’s College London Dental Institute, Guys Tower, Guys Hospital, St Thomas Street, London, SE1 9RT UK
- />University of Portsmouth Dental Academy, William Beatty Building, Hampshire Terrace, Portsmouth, Hampshire, PO1 2QG UK
| | - Jennifer E Gallagher
- />King’s College London Dental Institute, Division of Population and Patient Health, Bessemer Road, London, SE5 9RS UK
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Bailit HL, Beazoglou TJ, DeVitto J, McGowan T, Myne-Joslin V. Impact of Dental Therapists on Productivity and Finances: III. FQHC-Run, School-Based Dental Care Programs in Connecticut. J Dent Educ 2012. [DOI: 10.1002/j.0022-0337.2012.76.8.tb05361.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Howard L. Bailit
- Department of Community Medicine; School of Medicine; University of Connecticut Health Center
| | - Tryfon J. Beazoglou
- Department of Craniofacial Sciences; School of Dental Medicine; University of Connecticut Health Center
| | - Judy DeVitto
- University of Connecticut Health Center Finance Corporation
| | - Taegen McGowan
- Department of Community Medicine; School of Medicine; University of Connecticut Health Center
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Beazoglou TJ, Bailit HL, DeVitto J, McGowan T, Myne-Joslin V. Impact of Dental Therapists on Productivity and Finances: II. Federally Qualified Health Centers. J Dent Educ 2012. [DOI: 10.1002/j.0022-0337.2012.76.8.tb05360.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Tryfon J. Beazoglou
- Department of Craniofacial Sciences; School of Dental Medicine; University of Connecticut Health Center
| | - Howard L. Bailit
- Department of Community Medicine; School of Medicine; University of Connecticut Health Center
| | - Judy DeVitto
- University of Connecticut Health Center Finance Corporation
| | - Taegen McGowan
- Department of Community Medicine; School of Medicine; University of Connecticut Health Center
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