Feasibility study: assessing the efficacy and social acceptability of using dental hygienist-therapists as front-line clinicians

Abstract

Background The oral health of the adult population has been improving in the United Kingdom decade upon decade. Over half of dental service activity in the National Health Service (NHS) is limited to a check-up without any further treatment. This raises a question as to whether check-ups could be provided by dental hygienist-therapists, rather than general dental practitioners. The aim of this study was to assess the feasibility of a definitive trial to evaluate the costs and effects of using dental hygienist-therapists to undertake the check-up.Methods/design Adult NHS patients were randomised into three arms in two dental practices: patients who only saw dental hygienist-therapists for a check-up, those that saw the general dental practitioner and dental hygienist-therapist alternatively and a control, where patients only saw the general dental practitioner for their check-up. The study ran for 15 months. The primary outcome measures of the study were patient recruitment, retention and fidelity. A parallel and embedded qualitative study was undertaken which recorded the views of participating patients to determine the social acceptability of the intervention.Results Sixty patients participated in the study. The initial recruitment rate for the study was 33.7%. This figure increased to over 82.1% when telephone calls or face-to-face recruitment was utilised. The retention rates were 60% for both the dental hygienist-therapist only group and the alternate general dental practitioner and dental hygienist-therapist group, compared to 70% for the general dental practitioner only group. Fifteen patients were interviewed in the qualitative study and supported a team approach to the provision of check-ups in the NHS. Conclusion This study demonstrates the feasibility of a definitive trial to evaluate the costs and effects of using dental-hygienist-therapists to undertake the check-up.

A Markov model assessing the impact on primary care practice revenues and patient's health when using mid‐level providers, lesson learned from the United Kingdom

“…However, in a descriptive study which examined the attitudes of new patients to mid-level providers working independently to dentists, they found 98 percent of responding patients were satisfied with their mid-level provider care, and 80 percent attended a dental appointment within the next 12 months (43). This concurs with other studies, which found that patients who have a high degree of satisfaction with their experience with midlevel providers (11,39,(44)(45)(46).…”

“…The trial should be designed to capture all possible health gains from receiving a dental check‐up such as the detection of periodontal disease or changes in the patient's education, motivation, and behavior in oral self‐care and follow patients or extrapolate the health and cost effects into the long term. A feasibility study exploring this has recently been completed in the UK .…”

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“…Increasing population health suggests that demand on primary care for general dental practitioner examinations with little or no further treatment will increase with time. 1 However, improvements in global dental health also means that an elderly population retaining dentition for longer 2 is leading to a parallel population with complex treatment needs. 3 The mix of skills in the dental workforce has been extensively debated for many years.…”

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“…3,4 Improving population health suggests that dental examinations with little or no further treatment need will increase with time. 5 Improvements in oral health and reductions in the prevalence of dental caries and periodontal disease 3 mean that while children and adults may require minimal intervention. However, an increasing population of older patients will retain their dentition for longer 6 and for a number of decades to come, will present with complex treatment needs.…”

“…In developed countries, the majority of dentistry practiced is not complex; much of the work of general dental practitioners (GDPs) relates to routine examinations and simple maintenance . Improving population health suggests that dental examinations with little or no further treatment need will increase with time . Improvements in oral health and reductions in the prevalence of dental caries and periodontal disease mean that while children and adults may require minimal intervention.…”