1
|
Doughty J, Tran C, Santella AJ, Fitzgerald R, Burns F, Porter S, Watt RG. Point of care HIV testing in dental settings in high-income countries: A mixed-methods systematic review. Community Dent Oral Epidemiol 2024; 52:648-659. [PMID: 38822596 DOI: 10.1111/cdoe.12963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 03/27/2024] [Accepted: 04/12/2024] [Indexed: 06/03/2024]
Abstract
OBJECTIVES Expanding HIV testing beyond specialized services has been a key strategic approach to eliminating the transmission of HIV. In recent years, dental settings have been identified as offering an opportunity for delivering point of care HIV testing (POCT) interventions. Intervention components and implementation strategies have varied across studies and there is uncertainty about the prevalence of undiagnosed HIV in the dental patient population. Therefore, this systematic review aimed to synthesize the HIV testing outcomes of intervention studies, identify the core components of POCT interventions implemented in dental settings; and understand the barriers and facilitators to intervention implementation. METHODS A mixed-methods systematic review was undertaken. Two authors reviewed abstracts and full papers for inclusion and appraised the studies using the Mixed Methods Appraisal Tool. A convergent integrated mixed methods study design underpinned the synthesis. Outcomes were presented using descriptive statistics. Intervention components were mapped to the Template for Intervention Description and Replication (TIDieR) checklist. Barriers and facilitators were described using a narrative thematic analysis. RESULTS POCT was offered to 22 146 dental patients, 62.5% accepted POCT. Intervention studies that reported higher uptake of testing utilized a dedicated dental or researcher staff member to provide testing, integrated testing and provided results within the routine dental appointment and adopted a provider-initiated universal approach to offering testing. Six themes emerged that were pertinent to the barriers and facilitators to HIV testing in dental setting. CONCLUSIONS POCT uptake in dental settings was comparable with other non-specialized health settings. Key to the operationalization of the intervention were perceptions about its value and relevance to the dental patient population, attitudes toward the intervention, logistical barriers to its implementation, the risk of HIV testing stigma to the patient-practitioner relationship and maximising the fit of the intervention within the constraints of the dental setting.
Collapse
Affiliation(s)
- J Doughty
- Department of Epidemiology & Public Health, Faculty of Pop Health Sciences, University College London, London, UK
- School of Dentistry, University of Liverpool
| | - C Tran
- Oral and Maxillofacial Surgery department, York and Scarborough Teaching Hospitals NHS Foundation Trust, York, UK
| | - A J Santella
- Marion Peckham Egan School of Nursing & Health Studies, Fairfield University, Fairfield, Connecticut, USA
| | - R Fitzgerald
- Department of Special Care Dentistry, Surrey and Sussex Healthcare Trust
| | - F Burns
- Institute for Global Health, University College London, London, UK
| | - Stephen Porter
- Eastman Dental Institute, Faculty of Medical Sciences, University College London, London, UK
| | - Richard G Watt
- Department of Epidemiology & Public Health, Faculty of Pop Health Sciences, University College London, London, UK
| |
Collapse
|
2
|
Richardson M. What are the possible barriers and benefits to the use of dental therapists within the UK Military Dental Service? Br Dent J 2022; 232:232-238. [PMID: 35217744 DOI: 10.1038/s41415-022-3985-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 04/23/2021] [Indexed: 11/09/2022]
Abstract
Introduction All dental service delivery organisations and their workforce need to adopt more efficient and effective delivery models including increased skill-mix.Aim The aim of this study was to investigate the possible barriers/benefits to the utilisation of dental therapists (DTs) in the UK Military Dental Service.Method An explanatory mixed-methods study of sequential design was conducted using purposive sampling of dentists and DTs in the Defence Military Service. Electronic questionnaires (25) were sent to dentists and DTs with an overall response rate of 80% (15/18 dentists and 6/7 DTs). Following analysis of the questionnaires, seven semi-structured interviews (four dentists, three DTs) were thematically analysed.Results All dentists and DTs agreed that DTs could play a positive role within the Defence Military Service, but the barriers and benefits of their use centred on the six main themes of: leadership, delegation, new ways of working, scope of practice, skill-mix and utilisation.Conclusions To address the barriers and maximise the benefits of using DTs, effective leadership at the organisational, dental centre and individual levels is required. This leadership is key to unlocking the benefits of improved teamwork, increased skill-mix and maximised use of all dental care professionals within the Defence Military Service.
Collapse
Affiliation(s)
- Mark Richardson
- Chief Dental Officer (Defence), Defence Primary Healthcare (Dental), DMS Whittington, Lichfield, Staffordshire, WS14 9PY, UK.
| |
Collapse
|
3
|
Collaborative leadership with a focus on stakeholder identification and engagement and ethical leadership: a dental perspective. Br Dent J 2021; 231:355-359. [PMID: 34561590 PMCID: PMC8461145 DOI: 10.1038/s41415-021-3457-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 12/03/2020] [Indexed: 01/18/2023]
Abstract
The dental profession is susceptible to change. In order to cope and adapt, individuals and organisations will need to work together, now more than ever. One approach that may be beneficial in these times, and beyond, is collaborative leadership. This is where a mutually beneficial relationship is established between two or more parties, who work towards common goals by sharing authority, responsibility and accountability for achieving results. When groups of individuals look beyond their personal interests and instead collaborate, they may channel their efforts to successfully achieve shared goals. However, for this to be fruitful, stakeholders (to include different individuals or groups that have a vested interest) will need to be identified and engaged, and ethical values based on the objectives of the organisation and those advocated by professional and regulatory bodies must be upheld. This paper explores how the traditional practices of stakeholder identification and engagement, as well as ethical leadership, may be of relevance in attaining success through the contemporary collaborative leadership approach. In these times and beyond, embracing mutually beneficial relationships based on trust, integrity and empowerment shall be more important than ever; therefore, there is a great need for collaborative leadership within the dental profession. An awareness of, and ability to use, the traditional practices of stakeholder identification and engagement as well as ethical leadership may allow dental organisations and professionals to better exercise collaborative leadership. Alike with clinical knowledge and skills, dental organisations and professionals must self-reflect on their own leadership capabilities, be self-aware of their strengths and weaknesses, and aspire to improve themselves accordingly.
Collapse
|
4
|
Barnes E, Bullock A, Moons K, Cowpe J, Chestnutt IG, Allen M, Warren W. A whole-team approach to optimising general dental practice teamwork: development of the Skills Optimisation Self-Evaluation Toolkit (SOSET). Br Dent J 2020; 228:459-463. [PMID: 32221450 DOI: 10.1038/s41415-020-1367-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Introduction Studies across the health service reveal benefits of teamwork and barriers to its optimal use. Drawing upon the established Maturity Matrix Dentistry method, the Skills Optimisation Self-Evaluation Toolkit (SOSET) was developed to enable the whole dental team to critically review how they address skill-mix in delivery of patient-centred oral healthcare in their practice. This paper outlines the development of the SOSET and explores its usefulness to general dental practice teams.Methods Research literature and interview data from general dental practice teams were coded for high-level factors (positive and negative) influencing teamwork. We used this coding to identify skill-mix domains, and within each, define criteria. The SOSET process was refined following consultations with dental professionals and piloting.Results Eighty-four papers were coded and 38 dental team members were interviewed across six sites. The SOSET matrix was developed containing nine domains reflecting the use of skill-mix, each containing six development-level criteria. The domains addressed factors such as team beliefs on skill-mix and knowledge of team members' scope of practice, patient demand, the business case, staffing and training, and the practice premises. The process was piloted in 11 practices across South Wales, and feedback was received from 92 staff members. Results showed that the SOSET process was straightforward, that the whole team could contribute to discussion and that it would be used to improve practice. Following piloting, four domains were merged into two new domains, and the number of criteria within all domains was reduced and the wording simplified (seven domains, with four criteria each).Conclusion We used a systematic and rigorous process to develop the SOSET to support dental teams to progress their teamwork practices. Its usefulness was demonstrated in the pilot. The SOSET is now being offered to general dental practices across Wales.
Collapse
Affiliation(s)
- Emma Barnes
- Cardiff Unit for Research and Evaluation in Medical and Dental Education (CUREMeDE), Cardiff University, UK.
| | - Alison Bullock
- Cardiff Unit for Research and Evaluation in Medical and Dental Education (CUREMeDE), Cardiff University, UK
| | - Kirstie Moons
- The Dental Postgraduate Section, Health Education and Improvement Wales (HEIW), UK
| | - Jonathan Cowpe
- Cardiff University School of Dentistry, College of Biomedical and Life Sciences, UK
| | - Ivor G Chestnutt
- Cardiff University School of Dentistry, College of Biomedical and Life Sciences, UK
| | - Mick Allen
- , Aneurin Bevan University Health Board, UK
| | | |
Collapse
|
5
|
The changing face of dental practice: emerging models of team care in Australia. Br Dent J 2020; 228:767-772. [DOI: 10.1038/s41415-020-1529-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
6
|
Barnes E, Bullock A, Chestnutt IG, Cowpe J, Moons K, Warren W. Dental therapists in general dental practice. A literature review and case-study analysis to determine what works, why, how and in what circumstances. EUROPEAN JOURNAL OF DENTAL EDUCATION : OFFICIAL JOURNAL OF THE ASSOCIATION FOR DENTAL EDUCATION IN EUROPE 2020; 24:109-120. [PMID: 31618492 DOI: 10.1111/eje.12474] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 10/08/2019] [Accepted: 10/14/2019] [Indexed: 06/10/2023]
Abstract
INTRODUCTION In the United Kingdom, policy and guidance changes regarding the role of dental therapists (DTs) were implemented in recent years with a view to changing dental care to a more preventive-focussed, teamwork approach. However, success in the adoption of this model of working has been varied. AIMS Adopting a realist approach, our aim was, to examine the use of DTs in general dental practices in Wales, exploring what works, why, how and in what circumstances. MATERIALS AND METHODS The research comprised two stages. (a) A structured literature search, dual-coding papers for high-level factors describing the conditions or context(s) under which the mechanisms operated to produce outcomes. From this, we derived theories about how skill-mix operates in the general dental service. (b) Six case studies of general dental practices (three with a dental therapist/three without a dental therapist) employing a range of skill-mix models incorporating semi-structured interviews with all team members. We used the case studies/interviews to explore and refine the theories derived from the literature. RESULTS Eighty-four papers were coded. From this coding, we identified seven theories which reflected factors influencing general dental practices within three broad contexts: the dental practice as a business, as a healthcare provider and as a workplace. We tested these theories in interviews with 38 dental team members across the six care studies. As a result, we amended five of the theories. CONCLUSION Our analysis provides theory about outcomes that DTs may facilitate and the mechanisms that may assist the work of DTs within different contexts of general dental practice.
Collapse
Affiliation(s)
- Emma Barnes
- Cardiff Unit for Research and Evaluation in Medical and Dental Education (CUREMeDE) Cardiff University, Cardiff, UK
| | - Alison Bullock
- Cardiff Unit for Research and Evaluation in Medical and Dental Education (CUREMeDE) Cardiff University, Cardiff, UK
| | - Ivor G Chestnutt
- College of Biomedical and Life Sciences, Cardiff University School of Dentistry, Cardiff, UK
| | - Jonathan Cowpe
- College of Biomedical and Life Sciences, Cardiff University School of Dentistry, Cardiff, UK
| | - Kirstie Moons
- The Dental Postgraduate Section, Health Education and Improvement Wales, Cardiff, UK
| | - Wendy Warren
- Aneurin Bevan University Health Board, Cardiff, UK
| |
Collapse
|
7
|
Barnes E, Bullock A, Cowpe J, Moons K, Warren W, Hannington D, Allen M, Chestnutt IG, Bale S, Negrotti C. General dental practices with and without a dental therapist: a survey of appointment activities and patient satisfaction with their care. Br Dent J 2018; 225:53-58. [DOI: 10.1038/sj.bdj.2018.522] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2018] [Indexed: 11/09/2022]
|
8
|
Contemporary views of dental practitioners' on patient safety. Br Dent J 2017; 219:535-9; discussion 540. [PMID: 26657441 DOI: 10.1038/sj.bdj.2015.920] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2015] [Indexed: 11/08/2022]
Abstract
BACKGROUND There is little known about general dental practitioners' (GDPs) views on patient safety in dentistry; we believe this to be the first paper describing their opinions and ideas for maintaining or improving safe practices. METHODS Focus groups were used to gather the views of 12 GDPs (who also hold university teaching contracts) on the following topics: Defining patient safety, the important issues in patient safety, safeguards and tools for maintaining safe care, never events and research priorities. Thematic analysis was performed on the verbatim transcripts. RESULTS Key themes from the practitioners included: Medical history (polypharmacy and co-morbidities), competence and skill level, the use of safeguards and tools to ensure safety, the importance of effective communication (including working with a chaperone) and the role of reflective practice. Suggestions for improvement included: effective sharing of information with other healthcare professionals, easy access to guidelines and educational tools, adoption of practice protocols, team working and the use of universal charting systems to limit ambiguity. CONCLUSIONS GDPs are well versed in the concept of patient safety and are keen to implement evidence based tools and/or interventions designed to improve safety for their patients.
Collapse
|
9
|
Willcocks SG. Exploring leadership in the context of dentistry in the UK. Leadersh Health Serv (Bradf Engl) 2016; 29:201-16. [PMID: 27198707 DOI: 10.1108/lhs-02-2016-0009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose The purpose of this paper is to explore selective leadership approaches in the context of dentistry in the UK. Design/methodology/approach This is a conceptual paper utilising published sources from relevant literature about leadership theory and practice and the policy background to dentistry in the UK. Findings This paper suggests that there is merit in identifying and applying an eclectic mix of leadership theory to the case of dentistry. It offers insight into individual aspects of the leadership role for dentists and applies this to the dental context. It also contrasts these individual approaches with shared leadership and suggests this may also be relevant to dentistry. It highlights the fact that leadership will be of growing concern for dentistry in the light of recent policy changes. Research limitations/implications This paper points out that there are developmental implications depending on the particular approach taken. It argues that leadership development will become increasingly important in dentistry in the UK. Originality/value This paper addresses a topic that has so far received limited attention in the literature.
Collapse
|
10
|
Hulme C, Robinson P, Douglas G, Baxter P, Gibson B, Godson J, Vinall-Collier K, Saloniki E, Meads D, Brunton P, Pavitt S. The INCENTIVE study: a mixed-methods evaluation of an innovation in commissioning and delivery of primary dental care compared with traditional dental contracting. HEALTH SERVICES AND DELIVERY RESEARCH 2016. [DOI: 10.3310/hsdr04180] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
BackgroundOver the past decade, commissioning of primary care dentistry has seen contract currency evolving from payment for units of dental activity (UDAs) towards blended contracts that include key performance indicators such as access, quality and improved health outcome.ObjectivesThe aim of this study was to evaluate a blended/incentive-driven model of dental service provision. To (1) explore stakeholder perspectives of the new service delivery model; (2) assess the effectiveness of the new service delivery model in reducing the risk of and amount of dental disease and enhancing oral health-related quality of life (OHQoL) in patients; and (3) assess cost-effectiveness of the new service delivery model.MethodsUsing a mixed-methods approach, the study included three dental practices working under the blended/incentive-driven (incentive) contract and three working under the UDAs (traditional) contract. All were based in West Yorkshire. The qualitative study reports on the meaning of key aspects of the model for three stakeholder groups [lay people (patients and individuals without a dentist), commissioners and the primary care dental teams], with framework analysis of focus group and semistructured interview data. A non-randomised study compared clinical effectiveness and cost-effectiveness of treatment under the two contracts. The primary outcome was gingivitis, measured using bleeding on probing. Secondary outcomes included OHQoL and cost-effectiveness.ResultsParticipants in the qualitative study associated the incentive contract with more access, greater use of skill mix and improved health outcomes. In the quantitative analyses, of 550 participants recruited, 291 attended baseline and follow-up. Given missing data and following quality assurance, 188 were included in the bleeding on probing analysis, 187 in the caries assessment and 210 in the economic analysis. The results were mixed. The primary outcome favoured the incentive practices, whereas the assessment of caries favoured the traditional practices. Incentive practices attracted a higher cost for the service commissioner, but were financially attractive for the dental provider at the practice level. Differences in generic health-related quality of life were negligible. Positive changes over time in OHQoL in both groups were statistically significant.LimitationsThe results of the quantitative analysis should be treated with caution given small sample numbers, reservations about the validity of pooling, differential dropout results and data quality issues.ConclusionsA large proportion of people in this study who had access to a dentist did not follow up on oral care. These individuals are more likely to be younger males and have poorer oral health. Although access to dental services was increased, this did not appear to facilitate continued use of services.Future workFurther research is required to understand how best to promote and encourage appropriate dental service attendance, especially among those with a high level of need, to avoid increasing health inequalities, and to assess the financial impact of the contract. For dental practitioners, there are challenges around perceptions about preventative dentistry and use of the risk assessments and care pathways. Changes in skill mix pose further challenges.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
Collapse
Affiliation(s)
- Claire Hulme
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Peter Robinson
- School of Clinical Dentistry, University of Sheffield, Sheffield, UK
| | - Gail Douglas
- School of Dentistry, University of Leeds, Leeds, UK
| | - Paul Baxter
- Division of Biostatistics, University of Leeds, Leeds, UK
| | - Barry Gibson
- School of Clinical Dentistry, University of Sheffield, Sheffield, UK
| | - Jenny Godson
- Division of Population Health and Care, Health and Wellbeing Directorate, Public Health England, London, UK
| | | | - Eirini Saloniki
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - David Meads
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Paul Brunton
- School of Dentistry, University of Leeds, Leeds, UK
| | - Sue Pavitt
- School of Dentistry, University of Leeds, Leeds, UK
| |
Collapse
|
11
|
Blue CM, Kaylor MB. Dental therapy practice patterns in Minnesota: a baseline study. Community Dent Oral Epidemiol 2016; 44:458-66. [DOI: 10.1111/cdoe.12235] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Accepted: 03/31/2016] [Indexed: 11/29/2022]
Affiliation(s)
| | - Mary Beth Kaylor
- College of Graduate Health Sciences; A. T. Still University; Mesa AZ USA
| |
Collapse
|
12
|
Abstract
Skill mix is a term that has drifted effortlessly into the dental vocabulary over the last few years, but what does it mean to you, and perhaps more importantly what bearing might it have on your dental career? This article and the associated session at the 2016 British Dental Conference and Exhibition will explore dental skill mix from a variety of viewpoints. This includes the historical and wider health care context, challenges and opportunities for clinicians, practices and their patients, and what its significance may be in terms of benefitting oral health at a population level.
Collapse
|
13
|
Wanyonyi KL, Radford DR, Harper PR, Gallagher JE. Alternative scenarios: harnessing mid-level providers and evidence-based practice in primary dental care in England through operational research. HUMAN RESOURCES FOR HEALTH 2015; 13:78. [PMID: 26369553 PMCID: PMC4570749 DOI: 10.1186/s12960-015-0072-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Accepted: 08/26/2015] [Indexed: 05/30/2023]
Abstract
BACKGROUND In primary care dentistry, strategies to reconfigure the traditional boundaries of various dental professional groups by task sharing and role substitution have been encouraged in order to meet changing oral health needs. AIM The aim of this research was to investigate the potential for skill mix use in primary dental care in England based on the undergraduate training experience in a primary care team training centre for dentists and mid-level dental providers. METHODS An operational research model and four alternative scenarios to test the potential for skill mix use in primary care in England were developed, informed by the model of care at a primary dental care training centre in the south of England, professional policy including scope of practice and contemporary evidence-based preventative practice. The model was developed in Excel and drew on published national timings and salary costs. The scenarios included the following: "No Skill Mix", "Minimal Direct Access", "More Prevention" and "Maximum Delegation". The scenario outputs comprised clinical time, workforce numbers and salary costs required for state-funded primary dental care in England. RESULTS The operational research model suggested that 73% of clinical time in England's state-funded primary dental care in 2011/12 was spent on tasks that may be delegated to dental care professionals (DCPs), and 45- to 54-year-old patients received the most clinical time overall. Using estimated National Health Service (NHS) clinical working patterns, the model suggested alternative NHS workforce numbers and salary costs to meet the dental demand based on each developed scenario. For scenario 1:"No Skill Mix", the dentist-only scenario, 81% of the dentists currently registered in England would be required to participate. In scenario 2: "Minimal Direct Access", where 70% of examinations were delegated and the primary care training centre delegation patterns for other treatments were practised, 40% of registered dentists and eight times the number of dental therapists currently registered would be required; this would save 38% of current salary costs cf. "No Skill Mix". Scenario 3: "More Prevention", that is, the current model with no direct access and increasing fluoride varnish from 13.1% to 50% and maintaining the same model of delegation as scenario 2 for other care, would require 57% of registered dentists and 4.7 times the number of dental therapists. It would achieve a 1% salary cost saving cf. "No Skill Mix". Scenario 4 "Maximum Delegation" where all care within dental therapists' jurisdiction is delegated at 100%, together with 50% of restorations and radiographs, suggested that only 30% of registered dentists would be required and 10 times the number of dental therapists registered; this scenario would achieve a 52% salary cost saving cf. "No Skill Mix". CONCLUSION Alternative scenarios based on wider expressed treatment need in national primary dental care in England, changing regulations on the scope of practice and increased evidence-based preventive practice suggest that the majority of care in primary dental practice may be delegated to dental therapists, and there is potential time and salary cost saving if the majority of diagnostic tasks and prevention are delegated. However, this would require an increase in trained DCPs, including role enhancement, as part of rebalancing the dental workforce.
Collapse
Affiliation(s)
- Kristina L Wanyonyi
- King's College London Dental Institute, Division of Population and Patient Health, Bessemer Road, London, UK.
| | - David R Radford
- King's College London Dental Institute, Teaching Division, Guys Tower, Guys Hospital, London, UK.
- University of Portsmouth Dental Academy, Hampshire Terrace, Portsmouth, UK.
| | - Paul R Harper
- Cardiff University, School of Mathematics, Cardiff, UK.
| | - Jennifer E Gallagher
- King's College London Dental Institute, Division of Population and Patient Health, Bessemer Road, London, UK.
| |
Collapse
|
14
|
Affiliation(s)
- Jacqui Elsden
- Dental education facilitator at Health Education Kent Surrey Sussex
| |
Collapse
|
15
|
Gnich W, Deas L, Mackenzie S, Burns J, Conway DI. Extending dental nurses' duties: a national survey investigating skill-mix in Scotland's child oral health improvement programme (Childsmile). BMC Oral Health 2014; 14:137. [PMID: 25421225 PMCID: PMC4280710 DOI: 10.1186/1472-6831-14-137] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Accepted: 11/04/2014] [Indexed: 11/23/2022] Open
Abstract
Background Childsmile is Scotland’s national child oral health improvement programme. To support the delivery of prevention in general dental practice in keeping with clinical guidelines, Childsmile sought accreditation for extended duty training for dental nurses to deliver clinical preventive care. This approach has allowed extended duty dental nurses (EDDNs) to take on roles traditionally undertaken by general dental practitioners (GDPs). While skill-mix approaches have been found to work well in general medicine, they have not been formally evaluated in dentistry. Understanding the factors which influence nurses’ ability to fully deliver their extended roles is necessary to ensure nurses’ potential is reached and that children receive preventive care in line with clinical guidance in a cost-effective way. This paper investigates the supplementation of GDPs’ roles by EDDNs, in general dental practice across Scotland. Methods A cross-sectional postal survey aiming to reach all EDDNs practising in general dental practice in Scotland was undertaken. The survey measured nurses’: role satisfaction, perceived utility of training, frequency, and potential behavioural mediators of, preventive delivery. Frequencies, correlations and multi-variable linear regression were used to analyse the data. Results Seventy-three percent of practices responded with 174 eligible nurses returning questionnaires. Respondents reported a very high level of role satisfaction and the majority found their training helpful in preparing them for their extended role. While a high level of preventive delivery was reported, fluoride vanish (FV) was delivered less frequently than dietary advice (DA), or oral hygiene advice (OHA). Delivering FV more frequently was associated with higher role satisfaction (p < 0.001). Those nurses who had been practising longer reported delivering FV less frequently than those more recently qualified (p < 0.001). Perceived difficulty of delivering preventive care (skills) and motivation to do so were most strongly associated with frequency of delivery (p < 0.001 for delivery of FV, DA and OHA). Conclusions This study has provided insight into EDDNs’ experiences and demonstrates that with appropriate training and support, EDDNs can supplement GDPs’ roles in general dental practice in Scotland. However, some barriers to delivery were identified with delivery of FV showing scope for improvement. Electronic supplementary material The online version of this article (doi:10.1186/1472-6831-14-137) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Wendy Gnich
- Community Oral Health Section, Glasgow Dental School, Faculty of Medicine, University of Glasgow, 378 Sauchiehall Street, Glasgow G2 3JZ, UK.
| | | | | | | | | |
Collapse
|
16
|
Supporting newly qualified dental therapists into practice: a longitudinal evaluation of a foundation training scheme for dental therapists (TFT). Br Dent J 2013; 214:E21. [DOI: 10.1038/sj.bdj.2013.425] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2012] [Indexed: 11/09/2022]
|
17
|
|