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Paying for treatments? Influences on negotiating clinical need and decision-making for dental implant treatment

By Catherine E Exley, Nikki S Rousseau, Jimmy Steele, Tracy Finch, James Field, Cam Donaldson, J Mark Thomason, Carl May and Janice S Ellis


Background: the aim of this study is to examine how clinicians and patients negotiate clinical need and treatment decisions within a context of finite resources. Dental implant treatment is an effective treatment for missing teeth, but is only available via the NHS in some specific clinical circumstances. The majority of people who receive this treatment therefore pay privately, often at substantial cost to themselves. People are used to paying towards dental treatment costs. However, dental implant treatment is much more expensive than existing treatments – such as removable dentures. We know very little about how dentists make decisions about whether to offer such treatments, or what patients consider when deciding whether or not to pay for them.<br/><br/>Methods/Design: mixed methods will be employed to provide insight and understanding into how clinical need is determined, and what influences people's decision making processes when deciding whether or not to pursue a dental implant treatment. Phase 1 will use a structured scoping questionnaire with all the General dental practitioners (GDPs) in three Primary Care Trust areas (n = 300) to provide base-line data about existing practice in relation to dental implant treatment, and to provide data to develop a systematic sampling procedure for Phase 2. Phases 2 (GDPs) and 3 (patients) use qualitative focused one to one interviews with a sample of these practitioners (up to 30) and their patients (up to 60) to examine their views and experiences of decision making in relation to dental implant treatment. Purposive sampling for phases 2 and 3 will be carried out to ensure participants represent a range of socio-economic circumstances, and choices made.<br/><br/>Discussion: most dental implant treatment is conducted in primary care. Very little information was available prior to this study about the quantity and type of treatment carried out privately. It became apparent during phase 2 that ISOD treatment was an unusual treatment in primary care. We thus extended our sample criteria for Phase 3 to include people who had had other implant supported restorations, although not single tooth replacement

Year: 2009
OAI identifier: oai:eprints.soton.ac.uk:163597
Provided by: e-Prints Soton

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  1. (2004). ADA Council on Scientific Affairs and Division of Sciences: Evidence-based dentistry in clinical practice.
  2. (2004). AJ: How do age and tooth loss affect oral health impacts and quality of life? A study comparing two national samples. Community Dentistry and Oral Epidemiology doi
  3. (1996). Blinkhorn AS: A qualitative investigation of factors governing dentists' treatment philosophies. doi
  4. (2002). C: Consumer involvement in health research: a review and research agenda. Health Policy doi
  5. (2005). Choosing or refusing oral implants: a prospective study of edentulous volunteers for a clinical trial. doi
  6. (1995). Clinical decision making – an art or a science? Part V: patient preferences and their influence on decision making. doi
  7. Countering consumer moral hazard. In Economics of health care financing: the visible hand 2nd edition. Edited by: Donaldson
  8. (2003). EJ: Exploring dental patients' preferred roles in treatment decision-making – a novel approach. doi
  9. (2001). F: Engaging patients in decisions: a challenge to health care delivery and public health [Editorial]. Quality in Health Care
  10. (1988). Fiset L: Factors influencing dental decision making. doi
  11. (2005). House of Commons: House of Commons Health Committee: The use of new medical technologies within the NHS, Volume 1. London: The Stationery Office;
  12. (2005). House of Commons: House of Commons Health Committee: The use of new medical technologies within the NHS, Volume 2: Oral and Written Evidence. London: The Stationery Office;
  13. (2003). Involving patients and the public in the NHS. Clinical Medicine doi
  14. (2003). JG: The metaphor of patients as customers: implications for measuring satisfaction.
  15. (2002). Murtomaa H: Influence of patient characteristics on Finnish dentists' decision-making in implant therapy. Implant Dentistry doi
  16. (1984). Need and decision-making in dentistry – an economic perspective.
  17. (2001). Organisation: International classification of functioning disability and health Geneva: World Health Organisation; doi
  18. (1998). Patient participation in decision-making. doi
  19. (1982). Professionals' criteria for accepting people as patients. Social Science and Medicine doi
  20. (1987). Qualitative analysis for social scientists Cambridge: doi
  21. (1997). Questioning science: how knowledge is socially constructed. doi
  22. (2004). Securing our future health: taking a long-term view final report. The Stationery Office;
  23. (1979). Sociologic influences on decision-making by clinicians. doi
  24. (1965). The constant comparative method of qualitative analysis. Social Problems doi
  25. (2001). The future patient London: Institute of Public Policy Research;
  26. (2003). The major factors that influence endodontic retreatment decisions. Swedish Dental Journal
  27. (2002). The McGill consensus statement on overdentures: Mandibular two implant overdentures as first choice standard of care for edentulous patients. Gerodontology doi
  28. (1998). Treatment outcomes with implant-supported overdentures: clinical considerations. doi
  29. (2001). Walshaw D: A patient-based assessment of implant-stabilized and conventional complete dentures. doi

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