gms | German Medical Science

Background: National guidance in Scotland recommends that patients receive regular comprehensive oral health assessments (OHAs). The aim is to support dentists move from a restorative to a preventive, risk-based approach to care that better meets the needs of individual patients.

Objectives: To support implementation a diagnostic analysis was conducted to identify 1) current practice; and 2) the barriers and enablers to implementation.

Methods: Methods employed included a questionnaire and semi-structured interviews, an in-practice feasibility study and a national audit with an embedded trial of a theoretically informed communication.

Results: Fifty-seven dentists completed a questionnaire and 12 participated in interviews. None was following the recommendations and all perceived the implementation barriers as: time; remuneration; insufficient clinical knowledge; and patient resistance. Nine dentists participated in the in-practice feasibility study. Each assessed their practice records for guidance compliance and to inform action plans for implementation. OHAs were less onerous and time consuming than anticipated and dentists believed patients had reacted positively. Barriers were remuneration, unsuitability of practice software and lack of training. The audit was completed by 1051 dentists and the theoretically informed communication increased participation by 10%.

Discussion: Policy-makers are using the findings to support discussions about remuneration. New software and national training courses are being developed. The national audit has raised awareness of and support for the guidance within the profession.

Implications for guideline developers/users: Creating an environment for users to experience the implementation of guidance recommendations and generating robust evidence about barriers enables multi-agency decision making.