Abstract
Objective: To describe stakeholder perspectives of a new service delivery model in primary care dentistry incorporating incentives for access, quality and health outcomes
Design: Observations, interviews and focus groups
Setting: Six UK primary dental care practices, three working under the incentive-driven contract and three working under the traditional activity based contract
Participants: Observations were made of 30 dental appointments. Eighteen lay people, 15 dental team staff and a member of a commissioning team took part in the interviews and focus groups.
Results: Using a qualitative framework analysis informed by Andersen’s model of access we found oral health assessments influenced patients’ perceptions of need, which led to changes in preventive behaviour. Dentists’ responded to the contract, with greater emphasis on prevention, use of the disease risk ratings in treatment planning, adherence to the pathways and the utilisation of skill-mix. Participants identified increases in the capacity of practices to deliver more care as a result. These changes were seen to improve evaluated and perceived health and patient satisfaction. These outcomes fed back to shape people’s predispositions to visit the dentist.
Conclusion: The incentive driven contract was perceived to increase access to dental care, determine dentists’ and patients’ perceptions of need, their behaviours, health outcomes and patient satisfaction. Dentists face challenges in refocussing care, perceptions of preventive dentistry, deployment of skill mix and use of the risk assessments and care pathways. Dentists may need support in these areas and to recognise the differences between caring for individual patients and the patient-base of a practice.
Design: Observations, interviews and focus groups
Setting: Six UK primary dental care practices, three working under the incentive-driven contract and three working under the traditional activity based contract
Participants: Observations were made of 30 dental appointments. Eighteen lay people, 15 dental team staff and a member of a commissioning team took part in the interviews and focus groups.
Results: Using a qualitative framework analysis informed by Andersen’s model of access we found oral health assessments influenced patients’ perceptions of need, which led to changes in preventive behaviour. Dentists’ responded to the contract, with greater emphasis on prevention, use of the disease risk ratings in treatment planning, adherence to the pathways and the utilisation of skill-mix. Participants identified increases in the capacity of practices to deliver more care as a result. These changes were seen to improve evaluated and perceived health and patient satisfaction. These outcomes fed back to shape people’s predispositions to visit the dentist.
Conclusion: The incentive driven contract was perceived to increase access to dental care, determine dentists’ and patients’ perceptions of need, their behaviours, health outcomes and patient satisfaction. Dentists face challenges in refocussing care, perceptions of preventive dentistry, deployment of skill mix and use of the risk assessments and care pathways. Dentists may need support in these areas and to recognise the differences between caring for individual patients and the patient-base of a practice.
| Original language | English |
|---|---|
| Article number | e031886 |
| Number of pages | 7 |
| Journal | BMJ Open |
| Volume | 9 |
| Issue number | 10 |
| DOIs | |
| Publication status | Published - 3 Oct 2019 |
Keywords
- behaviour change
- commissioning
- contract
- dental
- incentives
- oral health