Provision of prevention in Wales

Key Points

• The data generated provide a useful baseline for the provision of preventive care in Wales at a time of contract change.

• The study findings highlight the barriers to the provision of preventive care under the current system.

• This article provides an insight into the attitudes of general dental practitioners to the provision of health education versus health promotion.

Abstract

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.

Main

Provision of prevention to adults in NHS dental practices and attitudes to prevention P. Tomlinson and E. Treasure Br Dent J 2006; 200: 393–397

Comment

This two-part study which examines the provision of NHS preventive care for adults in Wales is timely, given the increased emphasis on prevention within primary dental care across the UK. This study highlights the benefits of comparing health service claims data with the reported clinical practice of dentists for three items of preventive care: intensive instruction in the prevention of dental disease [code 0601]; application of fissure sealants to third molars [code 0701] and application of topical fluorides [code 0711].

The majority of dentists responding to the questionnaire survey recognised the importance of prevention; however many were unaware of the above codes and fewer still used them to claim for fees. Interestingly, none of these preventive items are listed on the BDA's NHS Fees Guide which may go some way to explaining dentists' lack of awareness.

There was evidence from dentists' claims that the preventive items were targeted appropriately towards the section of the population most likely to have higher disease levels¹ — adults exempt from patient charges. The authors suggest that this may have proved easier for dentists to provide as payment was not a barrier to care. However, the low level of preventive care claimed overall is unlikely to reflect the need for prevention and exclude that provided but not claimed. The main barriers to the use of the preventive codes highlighted by dentists were 'insufficient reimbursement', 'too many restrictions' and the perception that 'patients were unwilling to pay for prevention'.

These important findings support the need for radical changes in the methods of paying dentists and charging patients in support of preventive health care. Restrictions within GDS were designed to prevent the abuse of preventive measures which were more difficult to measure. In any new system of care, we need to ensure that patients at high risk of disease can be offered effective preventive measures in a timely manner. However, in order to monitor preventive care appropriately we need new information systems for health.^2,3 Oral health assessments which identify patients' risks of oral disease will provide the evidence for prevention to patients and commissioners and thus firmly underpin this shift to prevention.^3,4 We need to give patients the opportunity to accept or decline preventive care just as they can elements of clinical treatment. As a profession we need to ensure that our preventive care is contemporary, evidence-based and a core element of the health care provided.