Dental skill mix: a cross-sectional analysis of delegation practices between dental and dental hygiene-therapy students involved in team training in the South of England.

Kristina L Wanyonyi,David R Radford,Jennifer E Gallagher

doi:10.1186/1478-4491-12-65

Kristina L Wanyonyi, David R Radford + Show 1 more

Open Access

https://doi.org/10.1186/1478-4491-12-65

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Abstract

BackgroundResearch suggests that health professionals who have trained together have a better understanding of one another’s scope of practice and are thus equipped for teamwork during their professional careers. Dental hygiene-therapists (DHTs) are mid-level providers that can deliver routine care working alongside dentists. This study examines patterns of delegation (selected tasks and patients) by dental students to DHT students training together in an integrated team.MethodsA retrospective sample of patient data (n = 2,063) was extracted from a patient management system showing the treatment activities of two student cohorts (dental and DHT) involved in team training in a primary care setting in the South of England over two academic years. The data extracted included key procedures delegated by dental students to DHT students coded by skill-mix of operator (e.g., fissure sealants, restorations, paediatric extractions) and patient demography. χ2 tests were conducted to investigate the relationship between delegation and patient age group, gender, smoking status, payment-exemption status, and social deprivation.ResultsA total of 2,063 patients managed during this period received treatments that could be undertaken by either student type; in total, they received 14,996 treatment procedures. The treatments most commonly delegated were fissure sealants (90%) and restorations (51%); whilst the least delegated were paediatric extractions (2%). Over half of these patients (55%) had at least one instance of delegation from a dental to a DHT student. Associations were found between delegation and patient age group and smoking status (P <0.001). Children under 18 years old had a higher level of delegation (86%) compared with adults of working age (50%) and patients aged 65 years and over (56%). A higher proportion of smokers had been delegated compared with non-smokers (45% cf. 26%; P <0.001).ConclusionsThe findings suggest that delegation of care to DHT students training as a team with dental students, involved significantly greater experience in treating children and adult smokers, and providing preventive rather than invasive care in this integrated educational and primary care setting. The implications for their contribution to dentistry and the dental team are discussed, along with recommendations for primary care data recording.

Highlights

Research suggests that health professionals who have trained together have a better understanding of one another’s scope of practice and are equipped for teamwork during their professional careers
The facility at the centre of this research is the University of Portsmouth Dental Academy (UPDA) in the South of England. It is a primary care dental training centre opened in September 2010 to integrate education and training of dental students on outreach training from King’s College London with dental care professionals (DCPs) training in Portsmouth
The findings presented here form part of a wider body of research that looks into case mix and skill mix at UPDA as well as access to dental care [32]

Summary

Introduction

Research suggests that health professionals who have trained together have a better understanding of one another’s scope of practice and are equipped for teamwork during their professional careers. The current position paper of the World Health Organization on scaling up the health workforce considers inter-professional training as an essential step in the development of a collaborative health workforce [1] In both developed and developing countries, the concept of collaborative practice within the dental team is encouraged, through task sharing and wider use of mid-level dental providers [2,3,4,5]. The equivalent personnel who have training to the level of a dental therapist are referred to differently between countries; for example, dental therapists (New Zealand, Malaysia, and USA) [10]; oral health technicians (Brazil) [14]; oral health therapists (Holland) [10]; and dental hygiene-therapists or dental therapists (UK) [6] The development of their role or scope of practice and the regulation of their practice vary between countries. These personnel commonly provide routine care that includes scaling, filling cavities, preventive care, and extraction of children’s teeth [16]

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