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PubMed1996

Stress in dental practice: a qualitative comparison of dentists working within the NHS and those working within an independent capitation scheme.

A qualitative research methodology was used to compare the stress experienced by dentists working under two different systems of remuneration. No absolute difference was found in the levels of stress experienced by the two groups, as measured by a questionnaire measure of stress experience. Both groups of dentists identified patient management, time pressures and staff and practice management as sources of stress, though the independent capitation scheme dentists felt that they were under less time pressure and faced considerably less paperwork. Techniques for stress management identified by the dentists were limited and symptom-focused. The results suggest that, for dentists at least, changing from NHS to an independent capitation scheme is of great benefit.

Adaptation, Psychological↗
PubMedDate not supplied

Changes in the referral pattern of child patients from the GDS to the CDS following the introduction of capitation in October 1990. General Dental Services. Community Dental Services.

OBJECTIVE: To observe the changes in the criteria for, rate of, and pattern of, referral of child patients from the General Dental Services (GDS) to the Community Dental Services (CDS) which may have occurred following the introduction of capitation as the method of remuneration for general dental practitioners (GDPs) for the treatment of child patients in The new contract 1990. DESIGN: GDP referral criteria and attitude to capitation were assessed in two districts (North Downs and Weybourne Trusts) using a questionnaire distributed to 179 GDPs. Reasons for referral, and treatment received within the CDS, were collated from the dental records of referred children, before and after the introduction of capitation. RESULTS: The response rate from the GDPs was 87%, of whom 82% had referred child patients to the CDS. The results showed that 65% of GDPs indicated a preference for treatment of children under a fee per item system, whereas only 17% favoured capitation. Although 60% believed that their referral of patients to the CDS had not changed following capitation, an analysis of the referred children's dental records revealed that there had actually been a 57% increase in the number of referrals from GDPs to CDS following the introduction of capitation. The GDPs considered the most important referral criteria were for non cooperation or general anaesthesia. More cooperative children had been referred and more routine restorative procedures, less inhalation sedation and deciduous extractions were carried out following the introduction of capitation. CONCLUSIONS: This study has shown that following the introduction of capitation there had been an increase in the number of referrals from the GDS to the CDS.

Adolescent↗
PubMed2003

The effectiveness of routine dental checks: a systematic review of the evidence base.

AIMS: To systematically review the effectiveness of routine dental checks of different recall frequencies in adults and children. METHODS: Search methods included electronic bibliographic databases up to March 2001, relevant internet sites, citation checking and contact with experts and professional dental bodies. INCLUSION CRITERIA: (1) STUDY DESIGN: any; (2) POPULATION: deciduous, mixed and permanent dentition; (3) INTERVENTION: 'Routine dental check': 'clinical examination, advice, charting (including monitoring of periodontal status) and report' as defined in the NHS Executive General Dental Service Statement of Dental Remuneration; (4) Comparator: no routine dental check or routine dental check(s) of different recall frequency; (5) PRIMARY OUTCOMES: caries, periodontal disease, quality of life, oral cancer. RESULTS: Twenty eight studies were identified for the review. Studies were poorly reported and clinically heterogenous which restricted comparison between studies and limited generalisability to the UK situation. There was no consistency across multiple studies in the direction of effect of different dental check frequencies on measures of caries in deciduous mixed or permanent dentition, periodontal disease or oral cancer in permanent dentition. No studies were identified linking empirical measures of quality of life associated with oral health and dental check frequency. CONCLUSIONS: There is no existing high quality evidence to support or refute the practice of encouraging six-monthly dental checks in adults and children.

Adult↗
PubMed2003

NHS Dentistry: Options for Change in context--a personal overview of a landmark document and what it could mean for the future of dental services.

The aims of this paper are to provide an impartial overview of the proposals and agenda for the future brought together in the NHS Dentistry: Options for Change document in the context of previous dental service delivery in primary care, and to start to explore what Options for Change could mean for the future of NHS dental services. Options has been described as perhaps the most radical and ground breaking opportunity for NHS dentistry to finally move forward after prolonged periods of stagnation and disharmony. The Options agenda has the potential to bring in a new style of NHS practice for dentistry, providing a way to finally get off the current 'treadmill' and to develop new NHS dental services where prevention is a priority and providing high quality dental treatment, tailored to the long term needs of the 21st century patient, is the driving aim. However, the difficulties on all sides of leaving behind decades of disputes and overcoming real access, workforce and funding issues must not be underestimated or dismissed. The report was prepared by a working group comprising representatives from the profession, of patient groups and various sections of the Department of Health in England which was brought together by the then Chief Dental Officer. The key themes and priorities for action identified in Options include: local commissioning and funding, methods of remuneration for general dental practitioners, prevention and an oral health assessment for patients, clinical pathways, information and communication technology, practice structure, development of the dental team and the patient experience. The document also contains comprehensive reports of the three Options for Change task groups making recommendations for: 1) a new deal for patients - national standards, 2) systems of delivery of dental care and 3) education, training and development of the dental team. Ways forward for delivering improved, modern, effective, preventive, patient-centred dental care have been identified. This potential can, however, only be realised if viable and sustainable agreements can be achieved to operationalise the best choices.

Critical Pathways↗
PubMed2004

The role of dental therapists working in four personal dental service pilots: type of patients seen, work undertaken and cost-effectiveness within the context of the dental practice.

OBJECTIVES: To describe the type of patients seen and work undertaken by dental therapists employed in four personal dental service practices and to report on their cost-effectiveness within the context of the dental practice. METHOD: All members of the dental team used a standard day sheet to record all patient contacts and procedures undertaken in that session. Dental therapists recorded data for 30 consecutive sessions and dentists recorded information for 20 sessions. Items were recorded in sufficient detail to allow later matching with the GDS statement of remuneration and a calculation of the average gross fees and patient charges per session. RESULTS: The role of the dental therapist varied between the practices studied. In two practices the therapist saw a high proportion of child patients, and in one of these this was combined with providing care for a high number of adult patients who were exempt from patient charges. In the two practices where the dental team did not include a dental hygienist, the dental therapist had a relatively high workload providing dental hygiene care for adult patients. It appears that the gross fees and patient charges generated by the dental therapist in all four PDS practices fail to cover the cost of the salary of the dental therapist, dental nurse and associated overheads borne by the practice.

Adult↗
PubMed2005

The survival of resin modified glass ionomer and stainless steel crown restorations in primary molars, placed in a specialist paediatric dental practice.

AIMS: To prospectively report on the survival of resin-modified glass ionomer cement (RMGIC), photac-fil and pre-formed stainless steel crown (SSC) restorations in primary molar teeth placed over a seven-year period in a specialist paediatric dental practice under private contract of remuneration. METHOD: All primary molar restorations placed by a specialist paediatric dentist over a seven-year period were reviewed and the outcome results recorded. Data were recorded at review visits until June 30, 2003. Data recorded included Class I restorations, Class II restorations and SSC. The Class II cavities were either mesial or distal, with or without buccal/palatal extensions. If both proximal surfaces were decayed or if after cavity preparation the resultant outline form was significantly larger than the minimal classical form, RMGIC was not used; an SSC was placed instead. Stainless steel crown preparation followed conventional guidelines. The crowns were cemented with reinforced zinc oxide and eugenol (Kalzinol). The status was recorded as satisfactory restoration, tooth exfoliated, tooth extracted for orthodontic reasons with the date of extraction, or needing replacement. If replaced then the reason for replacement was also recorded. RESULTS: A total of 544 Class I RMGICs, 962 Class II RMGICs, and 1,010 SSCs were placed. At the last review of each restoration, 98.3% of Class I, 97.3% of Class II RMGICs and 97.0% of SSCs were either satisfactory or withdrawn intact. CONCLUSION: Under the conditions of private specialist practice-based study SSCs continued to prove very successful for the restoration of larger cavities and for pulp-treated primary molar teeth. For the smaller cavities RMGIC were also very successful.

Adolescent↗
PubMed2005

Educational needs and employment status of Scottish dental technicians.

OBJECTIVE: To investigate the educational needs and employment status of dental technicians in Scotland. SUBJECTS: Two hundred and fifty dental technicians with postal addresses in Scotland. DESIGN: Structured questionnaire. RESULTS: An 83% response rate was achieved following three mailings. The majority of respondents were employed in commercial dental laboratories largely within the 'central belt' of Scotland, with 96% stating they were in full-time employment. Only 33% of these essential health-care workers were voluntarily registered with the Dental Technicians' Association, suggesting that a significant number had not felt it necessary or beneficial to do so. A lack of educational structure was identified, as was poor remuneration and an absence of opportunity for career progression. Although the prospect of continuing professional development was desirable, many respondents reported that they would be penalised financially for undertaking this and, in addition, may not be given the opportunity to pursue education because of lack of co-operation from their employer. Only 47% had attended an educational event within the preceding year, and of those who had not done this, a period of two-32 years had elapsed since any CPD involvement. Of the respondents, only 34% stated that any financial assistance had been available for educational purposes, with access to education being highlighted as problematic by 68%. A total of 64% of subjects felt they were out-of-date with professional education. CONCLUSIONS: This study highlights a number of real and potential problems in the field of education in dental technology. It is apparent that change within the structure of education and professional status, although largely welcomed, may be difficult to implement. The profession, as a whole, must realise that these changes in education and employment are not optional, and should be embraced as a positive step which will hopefully raise the profile and status of dental technicians throughout the UK.

Certification↗
PubMed2005

Teledentistry for screening new patient orthodontic referrals. Part 2: GDP perception of the referral system.

OBJECTIVE: To evaluate GDP opinion about a teledentistry system to screen new patient orthodontic referrals. STUDY DESIGN: Cross-sectional questionnaire. SAMPLE: Two hundred general dental practitioners (GDPs) were approached from Stockport, Rochdale, Oldham, Bury and Bolton in Greater Manchester, and High Peak in Derbyshire. METHOD: A questionnaire about a teledentistry system for new orthodontic patients was developed, following interviews with eight GDPs participating in a teledentistry trial. The questionnaire was posted to another 200 GDPs who were asked questions on issues such as the efficiency of a teledentistry system; the usefulness of a teledentistry system from the patients' point of view; their view of a teledentistry system; and any concerns they had relating to security, confidentiality and consent. RESULTS: Seventy one per cent of GDPs thought teledentistry for orthodontic referrals would be a good idea. At least 90% of responders agreed or neither agreed nor disagreed that patients would benefit from such a system. Over half of GDPs agreed or strongly agreed that there would be implications on their surgery time, expense and equipment security. CONCLUSIONS: GDPs generally supported a teledentistry system for new patient orthodontic referrals. Although perceived patient advantages were agreed, GDPs tended to be less sure about the impact on them in terms of set-up expenses, time in the surgery and appropriate remuneration.

Attitude of Health Personnel↗
PubMed2006

Provision of prevention to adults in NHS dental practices and attitudes to prevention.

AIMS: To identify the number of claims reported by the Dental Practice Board (DPB) for the three adult preventive codes for the year ending October 2002 in Wales. To identify the attitudes of practitioners to the use of these codes. DESIGN: A cross-sectional study using routinely gathered DPB data and data generated by a postal questionnaire. SAMPLE: All DPB claims for the 12 months ending October 2002. A randomised sample of 400 dentists currently practising in Wales for the postal questionnaire. RESULTS: The DPB data showed great variation across Wales for: the number, type and distribution of preventive code claims; the age and payment status of patients prescribed these treatments; and the proportion of male versus female dentists claiming for the codes. The questionnaire response rate was 67% (n = 267). The results showed that most respondents were deterred by the restrictions on the codes, insufficient reimbursement and a perceived unwillingness of patients to pay for preventive care. CONCLUSION: Few dentists provide preventive care to adults under the existing remuneration system. Work is necessary to enable dentists to use effective preventive techniques for adult patients. These results can be considered to show the baseline provision of prevention and could facilitate the evaluation of any changes to the current system.

Adolescent↗
PubMed2006

A dental workforce review for a Midlands Strategic Health Authority.

OBJECTIVE: To explore opportunities for workforce development in NHS general dental services (GDS) in Shropshire and Staffordshire. METHOD: Secondary data sources were supplemented with a primary survey of GDS practices to build up a profile of the existing GDS workforce and its current capacity. Attitudes and perceptions on current workforce issues and potential solutions were gathered using a second survey and explored further through other qualitative techniques including interviews and a focus group discussion. RESULTS: The results confirm that there is a shortage of dentists in the area, fuelled by multiple factors including the move from NHS to private work, the decision to retire early and a growing disillusionment with NHS policies and remuneration. Modelling of alternate approaches to future dental clinical needs highlighted the opportunity for meeting the consequent workforce demands through increased involvement of hygienists and therapists. CONCLUSIONS: This study has provided local evidence to inform dental service development in Shropshire and Staffordshire. It has provided a starting point for exploring new ways of working and will contribute towards a more effective implementation of new and evolving service strategies.

Attitude of Health Personnel↗
PubMed2006

Educational needs and employment status of Scottish dental nurses.

OBJECTIVE: To investigate the educational needs and employment status of dental nurses in Scotland. SUBJECTS: One thousand, seven hundred and thirty dental nurses with postal addresses in Scotland. DESIGN: Structured questionnaire. RESULTS: A 65% response rate was achieved following three mailings. The majority of respondents were employed in the central belt of Scotland although comparatively, substantial numbers were also recorded as being employed in Highland and Grampian regions. A total of 70% of dental nurses stated they were in full-time employment, with 74% of all participants reporting they were qualified. Of those who were unqualified, 17% (n = 191) were not in the process of formal training which may mean they are unable to work in the future, unless they conform to the GDC 'grandparenting' requirements. Induction training had only been received by 34% (n = 377) of this group, and a mere 21% (n = 234) reported regular CPD involvement. Of the 75% (n = 832) who responded to a question on funding for CPD, only 50% (412) received financial assistance. Geographical location for many nurses generated a number of difficulties in accessing education, and the possibility of distance or e-learning was requested by 65% of the sample. CONCLUSIONS: This study demonstrates clearly that there are many well-qualified dental nurses in employment in Scotland. However, unless structured career pathways are developed, access to education is simplified, and the problem of poor remuneration is addressed, then foreseeable problems may arise where there is insufficient enticement to encourage people to join what is an already underpopulated profession.

Dental Assistants↗
PubMed2002

Prevalence of human parvovirus B19 in blood donors as determined by a haemagglutination assay and verified by the polymerase chain reaction.

BACKGROUND AND OBJECTIVES: Transmission of human parvovirus B19 (PV B19) by transfusion of blood and blood products is well documented. Although PV B19 infection is connected with severe complications in some recipients, donor screening is not yet mandatory. In this study the prevalence of PV B19, as detected by a haemagglutination assay (the Human PV B19 Antigen-Test), was assessed. In addition, the persistence of B19 DNA and the serological status of blood donors was also assessed. The specificity and utility of the Human PV B19 Antigen-Test for donor screening was investigated and compared with other screening strategies. MATERIALS AND METHODS: The prevalence of PV B19 viraemia was assessed in 28 972 donations from 15,660 remunerated donors by means of the haemagglutination assay. Reactive results were confirmed by the polymerase chain reaction (PCR). RESULTS: Overall, 255 donations gave reactive or indeterminate results in the screening assay. Four donations/donors detected by the haemagglutination assay were confirmed as positive for B19 DNA by PCR. Therefore, a frequency was detected of 1:7243 B19-positive donations and 1:3915 positive donors. Specificity was determined to be 99.1%. Follow-up showed the persistence of viraemia in low concentrations for prolonged time-periods. CONCLUSION: Blood donations with a high level of human PV B19 viraemia can be detected by the haemagglutination assay, which is rapid and easy to perform. The presence of neutralizing antibody may inhibit specific haemagglutination.

Adolescent↗
PubMed2001

The globalisation of the nursing workforce: barriers confronting overseas qualified nurses in Australia.

Recent decades have coincided with the rapid globalisation of the nursing profession. Within Australia there has been rising dependence on overseas qualified nurses (OQNs) to compensate for chronic nurse shortages related to the continued exodus of Australian nurses overseas and to emerging opportunities in other professions. Between 1983/4 and 1994/5, 30 544 OQNs entered Australia on either a permanent or temporary basis, counter-balancing the departure overseas of 23 613 locally trained and 6519 migrant nurses (producing a net gain of just 412 nurses in all). The period 1995/6--1999/2000 saw an additional 11 757 permanent or long-term OQN arrivals, with nursing currently ranked third target profession in Australia's skill migration program, in the context of continuing attrition among local nurses. This pattern of reliance on OQNs is a phenomenon simultaneously occurring in the UK, the US, Canada and the Middle East --- the globalisation of nursing reflecting not merely Western demand but the growing agency and participation of women in skilled migration, their desire for improved quality of life, enhanced professional opportunity and remuneration, family reunion and adventure.

Attitude of Health Personnel↗
PubMed2003

In vivo recovery and safety of human factor VIII product AAFACT in patients with haemophilia A.

AAFACT, a monoclonal purified, solvent/detergent treated human plasma-derived coagulation factor VIII concentrate obtained from plasma of voluntary, non-remunerated blood donors, is manufactured and marketed in the Netherlands by Sanquin Plasma Products since 1995. In a postmarketing surveillance study, 70 previously treated haemophilia A patients were included (73% severe, 14% moderate and 13% mild haemophilia A). Most of these patients were followed during 4 years for the appearance of adverse events, possible transmissions of blood-borne viruses and the occurrence of antibodies against FVIII. The efficacy of treatment was determined in each patient by the in vivo recovery of FVIII. During this study, only six adverse events, possibly related to the use of AAFACT, were reported. None of these were indicated as serious. Transmissions of HIV, HAV, HBV and HCV in the seronegative patients have not been observed. In none of the patients, inhibitors to FVIII were detected. The in vivo recovery of FVIII during this study was not different from the in vivo recovery observed in eight patients during the preregistration study. There was a correlation of in vivo recovery with age and body weight. From these results, we conclude that the clinical usage of this human plasma-derived FVIII product is efficient and safe.

Adolescent↗
PubMed1999

Implementing best practice guidelines: the influence of personal characteristics.

Clinical practice guidelines (CPGs) have not been widely adopted by general practitioners despite their obvious benefits of improving health care. Personal characteristics have been identified as one factor influencing doctors' attitudes towards guidelines. This study examined the impact of personal characteristics of Australian general practitioners on their attitudes towards guidelines. Favouring a fee-for-service remuneration system is highly associated with a negative view towards guidelines. This finding needs to be taken into account when developing strategies for the implementation of guidelines in the Australian context.

Adult↗
PubMed1999

The role of research evidence in pharmaceutical policy making: evidence when necessary but not necessarily evidence.

The use of research evidence in policy making at the legislative and administrative levels would appear to be very selective. Focusing on pharmaceutical policy, this paper argues that research evidence is only one ingredient leading to a policy decision and that any examination of research transfer into policy must take into account the many other factors which impact on decision making. The paper describes the policy making process, barriers to the uptake of research evidence into policy and ways of improving research uptake into policy making. Examples are given from drug licensing, remuneration policies, post-marketing surveillance and product withdrawal from the market.

Drug and Narcotic Control↗
PubMed2000

Enhancing prevention in primary care: are interventions targeted towards consumers' and providers' perceived needs?

OBJECTIVE: To explore perceived barriers to the implementation of prevention guidelines, with a particular interest to perceived information needs from the point of view of health professionals and consumers. STUDY DESIGN: Focus group. SETTING AND PARTICIPANTS: Eight focus groups were held in three Canadian cities: three with consumer, three with family physician, and two with primary care nurses. ANALYSIS: Inductive analysis based on transcribed interviews. The material was analysed by two of the investigators. Agreement on interpretation was checked independently by three other researchers on 10% of the material. RESULTS: Lack of motivation, discontinuity of care and lack of adequate remuneration were perceived as the strongest barriers to prevention implementation. Computerized information management systems were not perceived by physicians and nurses as strong facilitating factors. Consumers expressed strongly a need for information on non-traditional preventive interventions. Physicians and nurses expressed a need for patient education material more than for practice guidelines. Research evidence was not considered as the first criteria to judge the value of preventive information. CONCLUSIONS: Evidence-based medicine has triggered a massive effort to develop technologies to support the dissemination of evidence-based information on the assumption that poor access to such information is an important barrier to implementation of effective practices. Our results suggest that such an assumption may not be correct. Providing only evidence-based information from the realm of traditional medicine will appear restrictive to most users, particularly to consumers, and may not be as valued as anticipated considering the expressed scepticism toward research evidence.

Journal Article↗
PubMed2002

Knowledge about blood donation among a sample of Thai university students.

BACKGROUND AND OBJECTIVES: Blood banks in Thailand use only a voluntary donation system. Although this has been established for many years, the quantity of blood is still insufficient. Knowledge about blood donation and attitudes toward it are inadequate, especially in rural areas. The registry data of the National Blood Centre, Thai Red Cross Society, indicate that most voluntary blood donors are university students. The present study was therefore conducted among the students of Chulalongkorn University to assess their knowledge of voluntary, non-remunerated blood donation. MATERIALS AND METHODS: Four hundred students participated in this study. A self-administered questionnaire and face-to-face interview on various aspects of blood donation were used for data collection. RESULTS: Although most participants (80%) knew about blood donation, only 11% (44 subjects) had ever donated blood voluntarily. We found no significant correlation between demographic data (gender, age, educational level of subjects studied) and such knowledge or actual blood donation. Among the non-donor respondents, fear (305 cases) was the most common reason for not donating blood. CONCLUSIONS: Greater knowledge about blood donation does not lead to donation. Therefore, specific campaigns are needed to convert this into actual voluntary donation.

Adolescent↗