Perspectives of general dental practitioners on preventive, patient-centred, and evidence-based oral healthcare—A Q-methodology study

Fatiha Baâdoudi,Fatima M Ali,Denise Duijster,Job N A Van Exel,Neal Maskrey,Geert J M G Van Der Heijden,Amit Arora

doi:10.1371/journal.pone.0219931

Abstract

ObjectiveIn the last 30 years, innovations in oral healthcare (OHC), such as advanced restorative techniques, shifts towards preventive and evidence-based care and changes in patients’ expectations, have increased the complexity of clinical decision-making in OHC. Little is known about the perspectives of general dental practitioners (GDPs) on the value of providing preventive, patient-centred and evidence-based OHC. This study aimed to explore the range of perspectives present amongst GDPs on OHC.MethodQ-methodology was used to explore perspectives among 78 GDPs working in the Netherlands. Participants were asked to sort 50 statements representing three central domains in OHC: i.) restorative versus preventative OHC, ii.) disease-centred versus patient-centred OHC and iii.) expertise-based versus evidence-based OHC. Opinion statements about delivering OHC were formulated on the basis of published literature and input from OHC professionals. By-person factor analysis was used to reveal clusters of communality in statement rankings, which were interpreted and formed perspectives on OHC.ResultsFour perspectives, explaining 47% of variance, on OHC were identified amongst GDPs: ‘the patient-focused dentist who values prevention’, ‘the outcome-oriented dentist who values learning from colleagues’, ‘the team player with ultimate care responsibility’ and ‘the dentist who considers oral health the responsibility of the patient.’ConclusionQ-methodology can be effectively used to describe the different perspectives that GDPs have on the challenges of preventive, patient-centred and evidence-based OHC. GDPs should not be seen as a homogenous group; rather they have different views and approaches to the care they provide. This has implications for health systems; awareness of the heterogeneity of practitioners’ perspectives can potentially be used to develop bespoke quality of care improvement strategies that constructively engage with each of these different groups.

Highlights

Dentistry has been in a period of rapid change—as reflected in technical developments, higher patient expectations and a shift towards both preventive and evidence-based care [1]
Four perspectives, explaining 47% of variance, on oral healthcare (OHC) were identified amongst general dental practitioners (GDPs): ‘the patient-focused dentist who values prevention’, ‘the outcome-oriented dentist who values learning from colleagues’, ‘the team player with ultimate care responsibility’ and ‘the dentist who considers oral health the responsibility of the patient.’
Q-methodology can be effectively used to describe the different perspectives that GDPs have on the challenges of preventive, patient-centred and evidence-based OHC

Summary

Introduction

Dentistry has been in a period of rapid change—as reflected in technical developments, higher patient expectations and a shift towards both preventive and evidence-based care [1]. Development of advanced restorative materials and techniques have broadened the possibilities and the expectations of oral healthcare (OHC). Due to more availability of aesthetic treatment approaches, patients expectations have increased for functionality and for good-looking teeth [2]. Patients are critical consumers that value explicit demonstration of competence of oral health professionals. Prevention and evidencebased care have become key concepts for improving the quality of oral health and OHC. Variation in the delivery and quality of OHC has become explicit, leading to a growing interest in identifying and reducing unexplained variation in OHC [3]

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Results

Discussion

Conclusion