Direct access: how is it working?

Turner, Stephen; Ross, Michael

doi:10.1038/bdjteam.2017.46

Cited by 7 publications

(30 citation statements)

References 18 publications

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“…In Wales, Welsh Government's Prudent Healthcare approach promotes a teamwork approach, emphasising staff 'only do what only they can do'. (1) Adopting a teamwork approach to prevention and routine care can release the dentist for more complex cases (28,29) with time savings enabling dentists to practice at a higher level of expertise. (28) Reviews from the UK and USA concluded that inclusion of a dental therapist in the dental team improved patient access, (30)(31)(32) particularly to underserved populations (e.g.…”

Section: Discussionmentioning

confidence: 99%

A whole-team approach to optimising general dental practice teamwork: development of the Skills Optimisation Self-Evaluation Toolkit (SOSET)

et al. 2020

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Introduction Studies across the health service reveal benefits of teamwork and barriers to its optimal use. Drawing upon the established Maturity Matrix Dentistry method, 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 9 domains reflecting the use of skill-mix, each containing 6 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 2 new domains and the number of criteria within all domains was reduced and the wording simplified (7 domains, with 4 criteria each). Conclusion We used a systematic and rigorous process to develop 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.

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Section: Discussionmentioning

confidence: 99%

A whole-team approach to optimising general dental practice teamwork: development of the Skills Optimisation Self-Evaluation Toolkit (SOSET)

et al. 2020

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“…In brief, factors identified in the literature in the wider external context (C) included treatment need (an ageing dentate population with complex needs and a parallel younger population with improving oral health requiring less complex care), 3,4,6,12 workforce supply and a demand for dental treatment that exceeds capacity, 6,9,12,37 DTs scope of practice and regulation 2,38-43 and funding systems. 1,23,39,44,45 Context factors internal to the practice (C) included dentists' understanding of DTs' role and scope of practice, 9,[46][47][48] confidence in DTs' work, 42,47 dentists' attitude to delegation, 9,43,44,[47][48][49] surgery space 4,47,48,50,51 and availability of suitable varied cases for DTs within the practice patient demographics.…”

Section: Influencing/cmo Factors Identifiedmentioning

confidence: 99%

“…Mechanisms (M) included an established referral system, 24,37,43 team training, 2,4 a payment system that supports DTs' employment, 1,3,23,44,45,47,48,52 good team communication and a workplace culture that values teamwork. 37,43 We coded outcomes at the practice level (O) which included DTs undertaking diverse work and freeing the dentist to complete more complex cases, 43 and increased practice productivity.…”

Section: Influencing/cmo Factors Identifiedmentioning

confidence: 99%

“…As we have reported, by providing routine care to patients, DTs can release the dentist for more complex cases. 43,53 An additional benefit of delegation is time savings which enable dentists to practice at a higher level of expertise. 43 For DTs, performance of a wide variety of activities has been shown to be a predictor of job satisfaction.…”

Section: The Dental Practice As a Workplacementioning

confidence: 99%

“…43,53 An additional benefit of delegation is time savings which enable dentists to practice at a higher level of expertise. 43 For DTs, performance of a wide variety of activities has been shown to be a predictor of job satisfaction. 20 With-DT practices also reported that ADs or newly qualified dentists were sometimes less willing to delegate tasks reasons included financial or regulatory concerns or new patients ("I do feel like they're my patients, that I have to take responsibility for the work."…”

Section: The Dental Practice As a Workplacementioning

confidence: 99%

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Dental therapists in general dental practice. A literature review and case‐study analysis to determine what works, why, how and in what circumstances

Barnes

Bullock

Chestnutt

et al. 2019

Eur J Dental Education

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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. K E Y W O R D S dental therapists, development, general practice, qualitative, realist evaluation, skill-mix, team-work, workforce development How to cite this article: 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. Eur J Dent Educ. 2020;24:109-120. https ://doi.

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Participation of paediatric patients in primary dental care before and after a dental general anaesthetic

Large¹,

Keightley²,

Busuttil-Naudi³

2021

Eur Arch Paediatr Dent

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Purpose The aim of this retrospective study is to determine children’s attendance and experience of preventative interventions and operative treatment (restorations and extractions) with their primary care dentist (PCD) in the 12 months before and after their caries management under dental general anaesthetic (DGA). Methods A record of all children who had an elective DGA in 2016 across two hospital sites was retrospectively obtained (n = 1308). A representative sample of 300 was randomly selected encompassing 114 dental practices. An online questionnaire to the children’s PCDs collated quantitative and qualitative data regarding participation in the pre- and post-DGA period. Results Data was collated and analysed for 80 children (mean age: 6 years 10 months [SD = 2.49; range: 2 years 1 month – 14 years 3 months]; equal sex distribution) with 43 responding PCDs. Attendance for examination declined significantly from 85% (n = 68) pre-DGA to 57.5% (n = 46) post-DGA (p ≤ 0.001). Attendance at emergency appointments pre-DGA was high (33.75% [n = 27]); a significant reduction post-DGA was recorded (p ≤ 0.001). Over one third of children (37.5% [n = 30]) did not receive any form of preventative intervention over 24 months. A non-significant reduction in the provision of operative treatment was observed post-DGA (p = 0.06 [fill, primary]; p = 0.78 [fill, permanent]; p = 0.66 [ext, primary]). No statistical difference between age and treatment experience was found. Qualitative analysis revealed challenges in providing care included behavioural difficulties and poor attendance. Conclusion Improvements are required in strategies employed to support high caries risk children pre- and post-DGA to facilitate a higher incidence of attendance and preventative intervention with PCDs.

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Direct access: how is it working?

Abstract: conducted a survey of dental hygienists and therapists working in direct access practices in the UK to find out how they were functioning, which treatments were involved, and the barriers they had encountered.

Cited by 7 publications

References 18 publications

A whole-team approach to optimising general dental practice teamwork: development of the Skills Optimisation Self-Evaluation Toolkit (SOSET)

A whole-team approach to optimising general dental practice teamwork: development of the Skills Optimisation Self-Evaluation Toolkit (SOSET)

Dental therapists in general dental practice. A literature review and case‐study analysis to determine what works, why, how and in what circumstances

Participation of paediatric patients in primary dental care before and after a dental general anaesthetic

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