A general dental practice research network--philosophy, activities and participant views

Willingness of general dental practices in South East London to engage with research

This study assessed the willingness of general dental practices (GDPs) to participate in research. All 263 GDPs in South East London that provide dental care under National Health Service (NHS) contracts were invited. The survey instrument was adapted from previous studies and piloted before administration. Geographical factors and practice characteristics associated with willingness to participate in research were explored in logistic regression models. A total of 77 responses were received (response rate: 29%). Of them, 40 (53%) expressed interest in being involved in primary care research. They saw their main role as collecting data and facilitating access to patients. Time, bureaucracy and lack of energy were the main reasons behind a decision not to engage with research. Those spending more time in NHS services were more likely to be willing to participate in research. Other possible indicators were single-handed GDPs, participation in the dental foundation training programme and location in more affluent areas.

Initiating research in a private dental practice

Research is an intrinsic part of both academia and clinical best practice. Within an academic environment, this can include access to advice and guidance from trained professionals. Similarly, while sometimes overly risk-averse, within the NHS there is a structured and systematic approach to healthcare research. However, in the UK, a large number of specialist dental procedures take place within the private healthcare system, which does not have access to such support and guidance. How, then, can we generate our own dental research from private dental primary care settings? With a number of phrases becoming part of everyday vocabulary in dental primary care, such as practice-based research, patient-centred outcomes, evidence-based dentistry, it is time to consider this. From research ethics to writing papers, via GCP, IRAS, HEIs and MOOCs, this article summarises the experiences of one non-affiliated (non-academic, non-NHS) private dental practice attempting to enter the world of research. The authors discuss their experiences, share the multiple sources of support encountered along the way, and demonstrate the benefits to everyday practice gained by initiating research studies.

Evaluating Restorative Materials and Procedures in Dental Practice

A wide variety of research methods are appropriate to general dental practice, including clinical trials of materials, assessment of materials and techniques, treatment trends, and assessment of behavior and attitudes, of dentists as well as patients. This paper will describe the use of practice-based networks to evaluate the effectiveness of materials and techniques in dental practice. Several practice-based research groups are presently in operation in the UK and the USA, generally carrying out evaluations of the handling of materials, but with increasing emphasis on the clinical evaluation of restorations. Use of the Dental Practice Board (of England and Wales) database has proved to be a fruitful source of data on the long-term outcome of restorations. Dental practice can provide the large pool of patients available for research. To utilize this pool of patients, dental practitioners and their support staff require training in collecting data.

Practical aspects to undertaking research in the primary care setting: experience from two studies

AIMS

To discuss the practical aspects of conducting research in a primary care setting, from the perspectives of the practitioner and the research team.

METHODS

Various issues are discussed, including the relevance of research questions being generated in this setting, the advantages to both parties and the processes involved in conducting a study in specialist practice. This paper describes two recent studies (a randomized clinical trial and a qualitative study) conducted within specialist practice, to illustrate some of the potential difficulties.

CONCLUSIONS

The success of conducting a study in primary care is determined by a variety of factors, including an interested specialist practitioner, motivated staff in a well-organized practice and the close support of an academic-based research team.

A qualitative investigation of the views of primary care dentists on participating in prospective studies in the North-West of England

BACKGROUND

There is a poor understanding of to how to recruit and involve primary care dentists in clinical trials.

AIM

To use a qualitative paradigm to explore the views of primary care dentists towards participating in clinical trials and develop an understanding of the factors that facilitate and prevent their involvement. DESIGN, SETTING, SUBJECTS AND METHODS: An iterative approach was undertaken using a focus group (n = 6) followed by phased semi-structured interviews (n = 18). Data were analysed using thematic analysis and constant comparative analysis.

FINDINGS

The semi-structured interviews generated nine codes which were organised into three themes: technical issues for trials in primary dental care, practical issues for research in primary dental care and primary care dentists as research consumers. Overall, primary care dentists had a poor understanding of research methodology and clinical research. Barriers to participation included loss of clinical freedom and control, practice disruption, patient welfare, staff workload, financial loss and time.

CONCLUSIONS

Barriers to primary dental care research need to be overcome through appropriate protocols, funding, training and support. Joint working of primary dental care teams and academic researchers is essential, along with a constructive and open dialogue, if clinical trials are to be successfully undertaken in a practice environment.

How primary care dentists perceive and are influenced by research

INTRODUCTION

Little is understood as to how primary care dentists alter their clinical practice.

AIM

To develop an understanding of how primary care dentists view and use research to inform their clinical practice.

METHODS

An iterative approach was followed using two methods of data collection. A focus group was undertaken with dentists and researchers who had been involved in primary care dental research. Subsequently phased, qualitative interviews were undertaken with primary care dentists with a range of research experiences. Focus group and interviews were audio-recorded and transcribed verbatim. Six people participated in the focus group. Eighteen dentists participated in the interviews. Interviews were undertaken in four phases until saturation was achieved. Data were analysed using constant comparison.

FINDINGS

Evidence-based dentistry was considered the ideal. However, the research base for primary care dentistry was thought to lag behind clinical services, to focus on incorrect endpoints, to disregard the patients' voice and failed to consider the impact of conducting research on dental practices. Dentists modified their clinical practice based upon research, colleagues' opinions, courses and ad hoc personal evaluation. Uptake of research was affected by the ethos of the practice, which determined whether the dentists were early or late adopters of research and financial viability of new interventions.

CONCLUSION

  Dentists wanted concise, timely evidence-based guidance to aid their management of patients. Further research needs to be undertaken to understand how to develop an evidence-based culture in primary dental care.

The views of dentists on their participation in a primary care-based research trial

AIMS

To determine the attitudes and opinions of dentists undertaking research in primary care dental practices, about the value of research in primary care.

METHOD

The data were collected during a face-to-face interview utilising a schedule of open and closed questions, which were used to guide the interview.

RESULTS

Twenty-seven of the 40 primary care dentists (67.5%) who had participated in a five-year primary care clinical trial completed the interview. All the respondents believed that primary care research was important and should be of relevance to their practice, but only 12 (44%) thought it was important they carried out this research. The majority (96%) of respondents felt it did not pay financially to do research as a primary care practitioner and 12 (44%) thought research in primary care was too time consuming, but 25 (92%) were prepared to get involved in a primary care research group. Five (56%) salaried service (SS) practitioners and 14 (78%) general dental services (GDS) dentists felt they did not have enough experience, skills or knowledge to conduct their own research. Significantly more salaried dentists compared with GDS dentists felt adequately supported to do primary care research.

CONCLUSION

Future research in primary care should be focused on topics primary care practitioners feel of use to their clinical practice. A method of funding practitioners and providing time for them to complete research away from their clinical duties is necessary. There is a need for collaborative working with an academic institution, which can provide training and academic support for practitioners.

Future Opportunities for Research in Primary Dental Care: Developing Research to Support the Commissioning of Care

On 23rd November 2005, there was a first for the Faculty of General Dental Practice (UK) [FGDP(UK)] when it hosted an open, national research study day, funded by the Department of Health. The study day followed on from a national Research and Development in Primary Dental Care meeting, ‘Reflection and Moving Forward’, held in Manchester in March 2004.1

An Investigation into Merseyside General Dental Practitioners’ Interest in Primary Care Research, Their Views on Research and Their Training Needs

Objectives

The aims of this investigation were to evaluate the interests of primary care dental practitioners within the Mersey Postgraduate Deanery in research and their views on research, their experience and research training needs.

Method

A questionnaire was sent to all practitioners in the Mersey Deanery asking for views on dental research, whether they had been involved in any research projects or had any research training, and whether they would be interested in research training and being part of a primary dental care research network.

Results

A total of 192 practitioners from the 1120 in the Mersey Deanery expressed an interest in being involved in primary care research. Most believed that primary care research was very important in providing a stronger evidence-base in dentistry and improved quality of dental care. Over 50% of respondents were interested in collaborative research, provided that their income and time could be protected and it was part of the normal working day. Almost 25% had some research experience and a number had undergone research training, ranging from informal training to part of a degree.

Conclusions

A number of GDPs in the Mersey Deanery are interested in primary care research. With appropriate training, support and recognition within the new Personal Dental Services (PDS) contracts, there is a golden opportunity for more primary care dentists to participate in research. This, in time, will add to the evidence base in dentistry and should improve patient care.

Clinical trials in dental primary care: what research methods have been used to produce reliable evidence?

OBJECTIVE

To identify controlled clinical trials done exclusively in dental primary care and to classify the research according to design. Details of any procedures used to recruit general dental practitioners and any special organisational arrangements were also collected.

DESIGN

A scoping literature review.

SETTING

Dental primary care defined as general dental practice, community and school dental settings.

PARTICIPANTS

Published randomised controlled trials using randomised or quasi randomised approaches and controlled clinical trials were considered for inclusion in the review. Reports were excluded if they did not describe either a randomised controlled trial or a controlled trial. Studies were excluded if the setting was not primary dental care or the intervention was for non-dental conditions. Conference abstracts without a full report and trials published in a language other than English were also excluded.

MAIN OUTCOMES

Experimental and quasi-experimental designs, clinical areas and different kinds of strategies used to recruit dentists, any organisational arrangements made to support research in dental primary care.

RESULTS

The search of the Cochrane Oral Health Group Controlled Trials Register found 174 articles. Forty-three randomised controlled trials met the inclusion criteria. Trials to evaluate the effects of interventions for types of anaesthesia, periodontal diseases, smoking cessation techniques, dental materials, organisational aspects of dental care, patient anxiety, post extraction healing rates, antibiotics were identified. All were done in general dental practice. Trials in school and community settings were also included.

CONCLUSIONS

Practice-based research needs to be encouraged to provide dental primary care with relevant evidence upon which effective treatment can be based. This review shows there are few trials done in dental primary care to inform clinical practice, most of which have been reported since 1997. The range of trial designs shows that this method of evaluation can be used to evaluate dental primary care interventions and this is promising for those with an interest in improving dental patient outcomes. More research on how to recruit dentists into clinical trial research must be done.

The advantages and disadvantages of running a clinical trial in general practices

This paper reviews the experiences encountered in running a clinical trial on the use of a metal reinforced glass-ionomer cement in general dental practices. The practitioners were asked to place both the test material and amalgam in the same patient and to take impressions both at placement and at three recall intervals. Subsequently plaster casts were produced from these impressions. These were then assessed by three independent observers to provide evaluation of the relative wear of the two restoratives under evaluation. A commercial laboratory manufactured the models on which the three independent observers carried out the assessment of wear. Although the practitioners indicated they would be able to provide the number of restorations required in a relatively short period these expected numbers were never achieved. Despite recruitment of additional participants the trial never did achieve the number of restorations required. The performance of the metal reinforced glass ionomer appeared to vary dependent on the practitioner placing the filling. Questioning of the participants found that some participants were finishing the material using a method specifically contraindicated in the protocol for the trial, the directions supplied with the product, and in briefing sessions held prior to the trial. This implies that there can be major problems in undertaking clinical trials of this nature in the general dental service and has serious clinical implications for those contemplating this type of evaluation and for manufacturers introducing new products.

Understanding the jigsaw of evidence-based dentistry. 3. Implementation of research findings in clinical practice

Part one of this three-part series provided an overview of evidence-based dentistry (EBD), provided one definition of EBD and, having introduced the EBD matrix, concentrated on the research synthesis part of the jigsaw puzzle. Part two focused on the middle row of this puzzle, the dissemination of research results. This final article deals with perhaps the most vital but the most often overlooked element of the puzzle: implementation of research findings in clinical practice.

A general dental practice research network: impact of oral health in general dental practice patients

OBJECTIVE

To measure the subjective impact of oral health in a group of patients attending general dental practices in the North West of England and to investigate the attributes of dentists and practices in order to examine how such attributes might relate to patients' subjective perceptions of oral health.

DESIGN

Fifteen general dental practices conducting a simultaneous survey of attending patients and 15 practitioners from these practices providing information about their attitudes to treatment, prevention and various aspects of their surgery.

SETTING

General dental

OUTCOME MEASURES

Patient subjective impact scores. Relationships between practice and practitioner variables and patients' subjectively perceived oral health.

RESULTS

Fifteen practitioners with diverse practice attributes provided data on 718 patients. The mean total oral health impact score was 18.4. Twenty two per cent of patients had experienced pain in the four weeks before the survey and 11% had been unable to chew some foods. Fifty five per cent of the surveyed population had, in the previous year, worried about the appearance of their mouth and 65% had worried about their oral health in general. Dentists' beliefs were related to patient impact scores but practice attributes were not significantly associated with patients' impacts.

CONCLUSIONS

Fourteen percent of the differences in patients' subjectively perceived oral health can be attributed to dentist attitudes and attributes. Further research regarding the influence of dentists personality and professional beliefs on patients well-being needs to be undertaken.