Enhancing patient-centred care in dentistry: a narrative review (original) (raw)
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Background: Delivering improvements in quality is a key objective within most healthcare systems, and a view which has been widely embraced within the NHS in the United Kingdom. Within the NHS, quality is evaluated across three key dimensions: clinical effectiveness, safety and patient experience, with the latter modelled on the Picker Principles of Patient-Centred Care (PCC). Quality improvement is an important feature of the current dental contract reforms in England, with "patient experience" likely to have a central role in the evaluation of quality. An understanding and appreciation of the evidence underpinning PCC within dentistry is highly relevant if we are to use this as a measure of quality in general dental practice. Methods: A systematic review of the literature was undertaken to identify the features of PCC relevant to dentistry and ascertain the current research evidence base underpinning its use as a measure of quality within general dental practice. Results: Three papers were identified which met the inclusion criteria and demonstrated the use of primary research to provide an understanding of the key features of PCC within dentistry. None of the papers identified were based in general dental practice and none of the three studies sought the views of patients. Some distinct differences were noted between the key features of PCC reported within the dental literature and those developed within the NHS Patient Experience Framework. Conclusions: This systematic review reveals a lack of understanding of PCC within dentistry, and in particular general dental practice. There is currently a poor evidence base to support the use of the current patient reported outcome measures as indicators of patient-centredness. Further research is necessary to understand the important features of PCC in dentistry and patients' views should be central to this research.
Defining patient-centred care in dentistry? A systematic review of the dental literature
British dental journal, 2016
Objective This paper presents the results of a systematic review, designed to explore how patient-centred care (PCC) is defined in the dental literature.Method An electronic search of MEDLINE (1946-2012), Embase (1980-2012) PsycINFO (1806-2012), the Cochrane Library and non-peer reviewed literature was conducted using a standardised search protocol. Definitions of patient centred care were identified and scored on two criteria to evaluate quality of definition and quality/type of evidence.Results Of the 28 papers included in the review the majority provided definitions of PCC synonymous with good quality general care (holistic, humanitarian). Only three mentioned the provision of information and the tools to facilitate informed choice. Less than a third of the papers included in this review were based on empirical evidence, and of those that were, only one was an RCT study.Conclusion The evidence suggests that the concept of PCC is neither clearly understood nor empirically and syst...
Patient-centred care in general dental practice - a systematic review of the literature
2014
Background: Delivering improvements in quality is a key objective within most healthcare systems, and a view which has been widely embraced within the NHS in the United Kingdom. Within the NHS, quality is evaluated across three key dimensions: clinical effectiveness, safety and patient experience, with the latter modelled on the Picker Principles of Patient-Centred Care (PCC). Quality improvement is an important feature of the current dental contract reforms in England, with "patient experience" likely to have a central role in the evaluation of quality. An understanding and appreciation of the evidence underpinning PCC within dentistry is highly relevant if we are to use this as a measure of quality in general dental practice. Methods: A systematic review of the literature was undertaken to identify the features of PCC relevant to dentistry and ascertain the current research evidence base underpinning its use as a measure of quality within general dental practice. Results: Three papers were identified which met the inclusion criteria and demonstrated the use of primary research to provide an understanding of the key features of PCC within dentistry. None of the papers identified were based in general dental practice and none of the three studies sought the views of patients. Some distinct differences were noted between the key features of PCC reported within the dental literature and those developed within the NHS Patient Experience Framework. Conclusions: This systematic review reveals a lack of understanding of PCC within dentistry, and in particular general dental practice. There is currently a poor evidence base to support the use of the current patient reported outcome measures as indicators of patient-centredness. Further research is necessary to understand the important features of PCC in dentistry and patients' views should be central to this research.
Psychology, Health & Medicine, 2019
Adopting a patient-centred approach when engaging with patients has been linked to positive outcomes in medicine. However, in the field of dentistry, patient-centred care (PCC) has been understudied. The aim of this study was to explore dentists' opinions about the usefulness of a theoretical model of PCC and its applicability to a dental setting. Twenty semi-structured interviews were conducted with dentists working at a major university hospital in south London. The interviews were audiotaped and analysed using thematic analysis. The analysis showed that dentists found the PCC model to be useful for practical application but mostly for 'other' dentists. They viewed the lowest and highest levels of PCC that the model advocates as 'out-dated' and 'ideal', respectively. Dentists felt that giving patients full choice and control over their treatment was not applicable to everyday clinical practice. They expressed that a tool developed on the basis of this hierarchy of PCC could be useful for self-assessment purposes, although with some reservations. In conclusion, dentists seemed to embrace the practice of PCC and felt that their provision of PCC was at an acceptable standard. They believed that a moderate level of information and choice was most suitable for patients.
A conceptual construction of patient-centered dental care for primary care dentists in Thailand
The objective of this qualitative study was to develop a conceptual construct of patientcentered dental care for primary care dentists in Thailand. The study was divided into 2 steps, with the first step comprising a review of publications in dentistry as well as related medical and nursing care concerning patient-centered treatment. The second step involved in-depth interviews with participants using a semi-structured, open-ended interview form. The participants comprised 3 groups including 5 experts in patient-centered care, 7 dental practitioners, and 8 dental patients at community hospitals. The participants were recruited by purposive sampling. Interviews were transcribed and extracted conceptual constructs by using the thematic analysis method. Nine common attributes were extracted from 9 relevant articles, which could be used to create a patientcentered dental care model. These common attributes included communication, disease diagnostic and illness, whole person, shared information and decision-making, dentist-patient relationship, empathy, comprehensive care, continuing care, and coordinated care. In the second step, 12 attributes were obtained from the interview transcripts. The results found 3 different attributes including accessibility and the dentist's self-awareness, and pain and anxiety management, and. The 12 attributes can be formed into 2 specific domains covering 1) patient-centered interpersonal care, consisting of 8 attributes, and 2) patient-centered integrated care, consisting of 4 attributes. Additionally, this notion could be expanded to further research focused on creating a measurement to assess the proficiency of patient-centered dental care for primary care dentists.
Person-centred care in dentistry - the patients' perspective
Objectives To develop an understanding of the key features of person-centred care (PCC) in relation to general dental practice from a patient's perspective. Background PCC is acknowledged as an important dimension of quality with 'patient experience' increasingly used as a marker of quality within the NHS. A Dental Quality and Outcomes Framework (DQOF) is currently being piloted in the UK, which includes patient experience as one of the three domains. It is recognised that there is limited understanding of PCC within dentistry, with little evidence published on the subject. Methods This study uses qualitative methods to explore the views of 16 purposively sampled patients living in Southwest England. In-depth semi-structured interviews were recorded, transcribed, coded and analysed thematically. Results PCC was viewed as key in the delivery of high-quality care. Dimensions of PCC were identified and categorised as relational or functional aspects of care. Relational aspects of care were viewed as being central to the delivery of PCC with five components identified and named: connection, attitude, communication, empowerment and feeling valued. Functional aspects of care were identified as healthcare system and physical environment and were noted to influence PCC to a variable degree. Conclusion A model of PCC in dentistry is proposed which has been generated from empirical evidence that represents the views of patients. It is hoped that this may inform and influence development of a tool to measure PCC within any future version of the DQOF.
A model of patient-centred care – turning good care into patient-centred care
British Dental Journal, 2014
six) and experiencing care that is tailored to their needs and personal preferences (principle nine). Although both the academic literature and practical recommendations to clinicians through NICE endorse PCC, the extent to which these ideas have truly transferred into medicine or dentistry remains unknown. The UK General Dental Council (GDC) Standards for the dental team, 5 for instance, set out the principles that the dental team should follow. The principles are fairly prescriptive and the Council's recommendation is that these principles should influence all areas of practice. Within this GDC document, standard two is about 'respecting patients' dignity and choices'. Here, it is explicitly stated that the dental team should 'recognise and promote patients' responsibility for making decisions about their bodies, their priorities and their care…' 5 The above statement, although making explicit the need for dental professionals to be patient-centred in a way that patients are encouraged to have some responsibility about decision-making in a dental consultation, does not clearly identify the details of this process. It further fails to differentiate between different contexts and professionals or give examples of how GDC members might implement this standard in day-today clinical practice. This has implications for a team seeking to provide PCC. Many of the papers published in the dental literature that explicitly talk about PCC use the term to refer to provision of care that is holistic