What are the changing areas in the practice of dentistry and by how much?

Key Points

• Little research has been undertaken to assess change in dentistry.

• This study has identified that a considerable amount of reported change has taken place in GDPs work patterns in recent years.

• Younger practitioners, those with postgraduate qualifications and those earning more than 20% of their income from private practice reported higher levels of change.

Abstract

Objective To determine the extent and types of change in seven domains of dental practice in a sample of English general dental practitioners (GDPs).

Methods A postal questionnaire was sent to 561 GDPs on the dental lists of three health authorities in diverse regions of England. Information collected included demographic details on personal and practice characteristics, self-rating of amount of change in the seven domains of practice and factors influencing change.

Results The response rate was 60%. Fifty-six per cent of the sample were under 40 years old. Over a third of respondents reported 'changing a lot or completely' certain clinical activities, practice management arrangements and practice amenities. The highest self-reported level of change was in clinical activities. Of the GDPs who reported changing their clinical activities, 56% reported an increase in preventive care, followed by crown and bridge (44%), periodontics (44%) and endodontics (43%). Practice management rated second in the mean rank scores for self-reported change. The main changes reported were the introduction of computer systems and employment of practice managers. A sizeable percentage (66%) reported increasing the amount of information they provided to patients and the time spent discussing care. Quality assurance activities were the area of practice least likely to have changed over a 5-year period. Over half the sample reported not being involved in any quality assurance activities in the previous 5 years. Those respondents who were younger, had a postgraduate qualification and earned more than 20% of their income from private practice reported higher levels of change.

Conclusions General dental practitioners work patterns are dynamic and appear to be responding to changing needs and demands on their service. The main changes were in the types of clinical procedures being carried out. The low prevalence of changes reported in auditing and peer review activities needs to be investigated further.

Main

The prevalence and nature of recent self-reported changes in general dental practice in a sample of English general dental practitioners R. Watt, P. McGlone, D. Evans, S. Boulton, J. Jacobs, S. Graham, T. Appleton, S. Perry and A. Sheiham Br Dent J 2004; 197: 401–405

Comment

This is the first of two interesting papers investigating reported change in general dental practitioners. In the first part a postal questionnaire was used to ask GDPs to self-report the amount of change they perceived they had made in a number of areas. The questionnaire was sent to all gdps in three English health authorities one in the north, one in the midlands and one in the south. Dentists were asked to identify how much they had changed in a number of domains including practice management, quality assurance, clinical practice and communication with patients over the previous five years. Usable responses were received from 60% of the sample although the response rate varied between geographical areas.

The highest number of dentists reporting change was in the area of clinical practice where 91% said they had changed at least a little. In no other area did more than 80% of dentists report any change. Changes in communication with patients was reported by 75% as was a change in educational activities. In contrast 39% of dentists reported no change in the quality assurance over the previous five years. What was rather surprising was that 58% said that they had not participated in either audit or peer review.

Are these results reliable? It depends on two factors — the accuracy of the self-reporting which can be affected, for example, by recall bias; and how representative the respondents were of the population.

Why is this all important? Over the past 5 years there have been changes in policy particularly in relation to life long learning and clinical governance that might make it likely that the rate of change in practitioners might be very high. Is it a problem that 25% of practitioners have not changed their education activities? Very probably not, as these dentists may well have been more than fulfilling the requirements of life long learning and did not need to. In contrast it seem slightly surprising that change in communication with patients was not nearly universal and that considerable numbers had not changed their quality assurance at a time when clinical governance was being introduced.

This paper shows that the majority of dentists report changing in most areas associated with practice and this is very encouraging given the environmental changes that have occurred over the past five years. Exploring the reasons for change would be very interesting.