Osteoporosis risk assessment in primary dental care-The attitudes of Swedish dentists, patients and medical specialists.
osteoporosis
primary dental care
qualitative study
risk assessment
Journal
Gerodontology
ISSN: 1741-2358
Titre abrégé: Gerodontology
Pays: England
ID NLM: 8215850
Informations de publication
Date de publication:
Jun 2020
Jun 2020
Historique:
received:
29
04
2019
revised:
29
11
2019
accepted:
06
01
2020
pubmed:
6
2
2020
medline:
19
5
2020
entrez:
6
2
2020
Statut:
ppublish
Résumé
To explore and identify the attitudes of dentists, patients and medical specialists regarding implementation of osteoporosis risk assessment into Swedish primary dental care. Osteoporosis is a major health problem leading to fragility fractures. As shown in academic-based research, dental radiological examination can be used for osteoporosis risk assessment. A substantial number of patients undergo radiographic examinations in primary dental care each year, but little is known about implementation of osteoporosis risk assessment in this setting. A qualitative research approach using focus group discussions and manifest content analysis was applied. Five focus groups with dentists and representatives from patient support groups and a single individual interview with one medical specialist were included in the sample. From the manifest content analysis, three categories emerged: (a) barriers to change in practice, (b) benefits to change in practice, and (c) needs and requirements prior to change in practice. Most participants felt that there was insufficient knowledge of osteoporosis as well as a heavy existing workload. A concern was expressed about medical practitioners' willingness to take on responsibility for patients referred by dentists. Representatives from patient support groups highlighted a lack of knowledge about osteoporosis among both the general public and the medical professionals. Clear guidelines and improved communication channels between stakeholders would have to be established to ensure a smooth treatment path for patients. Despite interest in osteoporosis risk assessment in primary dental care, there are political, workflow and educational barriers that must be overcome for successful implementation.
Sections du résumé
OBJECTIVE
OBJECTIVE
To explore and identify the attitudes of dentists, patients and medical specialists regarding implementation of osteoporosis risk assessment into Swedish primary dental care.
BACKGROUND
BACKGROUND
Osteoporosis is a major health problem leading to fragility fractures. As shown in academic-based research, dental radiological examination can be used for osteoporosis risk assessment. A substantial number of patients undergo radiographic examinations in primary dental care each year, but little is known about implementation of osteoporosis risk assessment in this setting.
MATERIALS AND METHODS
METHODS
A qualitative research approach using focus group discussions and manifest content analysis was applied. Five focus groups with dentists and representatives from patient support groups and a single individual interview with one medical specialist were included in the sample.
RESULTS
RESULTS
From the manifest content analysis, three categories emerged: (a) barriers to change in practice, (b) benefits to change in practice, and (c) needs and requirements prior to change in practice. Most participants felt that there was insufficient knowledge of osteoporosis as well as a heavy existing workload. A concern was expressed about medical practitioners' willingness to take on responsibility for patients referred by dentists. Representatives from patient support groups highlighted a lack of knowledge about osteoporosis among both the general public and the medical professionals. Clear guidelines and improved communication channels between stakeholders would have to be established to ensure a smooth treatment path for patients.
CONCLUSION
CONCLUSIONS
Despite interest in osteoporosis risk assessment in primary dental care, there are political, workflow and educational barriers that must be overcome for successful implementation.
Types de publication
Journal Article
Langues
eng
Pagination
208-216Subventions
Organisme : C O Henrikson Stiftelse
Informations de copyright
© 2020 The Authors. Gerodontology published by Gerodontology Association and John Wiley & Sons Ltd.
Références
Peck WA, Burckhardt P, Christiansen C, et al. Consensus development conference: diagnosis, prophylaxis, and treatment of osteoporosis. Am J Med. 1993;94(6):646-650.
WHO. Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. Report of a WHO Study Group. World Health Organ Tech Rep Ser. 1994;843:1-129.
Hernlund E, Svedbom A, Ivergard M, et al. Osteoporosis in the European Union: medical management, epidemiology and economic burden. A report prepared in collaboration with the international osteoporosis foundation (IOF) and the European Federation of Pharmaceutical Industry Associations (EFPIA). Arch Osteoporos. 2013;8:136.
Devlin H, Allen P, Graham J, et al. The role of the dental surgeon in detecting osteoporosis: the OSTEODENT study. Br Dent J. 2008;204(10):E16-discussion 560-561.
Calciolari E, Donos N, Park JC, Petrie A, Mardas N. Panoramic measures for oral bone mass in detecting osteoporosis: a systematic review and meta-analysis. J Dent Res. 2015;94(3 Suppl):17S-27S.
Karayianni K, Horner K, Mitsea A, et al. Accuracy in osteoporosis diagnosis of a combination of mandibular cortical width measurement on dental panoramic radiographs and a clinical risk index (OSIRIS): the OSTEODENT project. Bone. 2007;40(1):223-229.
Lindh C, Horner K, Jonasson G, et al. The use of visual assessment of dental radiographs for identifying women at risk of having osteoporosis: the OSTEODENT project. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2008;106(2):285-293.
Jonasson G, Sundh V, Hakeberg M, Hassani-Nejad A, Lissner L, Ahlqwist M. Mandibular bone changes in 24 years and skeletal fracture prediction. Clin Oral Investig. 2013;17(2):565-572.
Tanner R, Wall B, Shrimpton P, Hart D, Bungay D. Frequency of Medical and Dental X-ray Examinations in the UK 1997/98. NRPB-R320:52. London: National Radiological Protection Board; 2000.
Barasch A, Safford MM, Qvist V, Palmore R, Gesko D, Gilbert GH. Random blood glucose testing in dental practice: a community-based feasibility study from the dental practice-based research network. J Am Dent Assoc. 2012;143(3):262-269.
Creanor S, Millward BA, Demaine A, et al. Patients' attitudes towards screening for diabetes and other medical conditions in the dental setting. Br Dent J. 2014;216(1):E2.
Rosedale MT, Strauss SM. Diabetes screening at the periodontal visit: patient and provider experiences with two screening approaches. Int J Dent Hyg. 2012;10(4):250-258.
Prakash P, Belek MG, Grimes B, et al. Dentists' attitudes, behaviors, and barriers related to tobacco-use cessation in the dental setting. J Public Health Dent. 2013;73(2):94-102.
Albert DA, Severson H, Gordon J, Ward A, Andrews J, Sadowsky D. Tobacco attitudes, practices, and behaviors: a survey of dentists participating in managed care. Nicotine Tob Res. 2005;7(Suppl. 1):S9-S18.
Nowlin JP, Lee JGL, Wright WG. Implementation of recommended tobacco cessation systems in dental practices: a qualitative exploration in Northeastern North Carolina. J Dent Educ. 2018;82(5):475-482.
Yahya NA, Saub R, Nor MM, Yusoff N. Dental patient knowledge about the effects of smoking and attitudes about the role of dentists in smoking cessation. Southeast Asian J Trop Med Public Health. 2017;48(2):473-484.
Meyers DC, Durlak JA, Wandersman A. The quality implementation framework: a synthesis of critical steps in the implementation process. Am J Community Psychol. 2012;50(3-4):462-480.
Cochrane LJ, Olson CA, Murray S, Dupuis M, Tooman T, Hayes S. Gaps between knowing and doing: understanding and assessing the barriers to optimal health care. J Contin Educ Health Prof. 2007;27(2):94-102.
Glaser BG, Strauss AL. The Discovery of Grounded Theory: Strategies for Qualitative Research. New York, NY: Routledge; 1967.
Kitzinger J. The methodology of focus groups: the importance of interaction between research participants. Sociol Health Illn. 1994;16(1):103-121.
Khan ME, Manderson L. Focus groups in tropical diseases research. Health Policy Plan. 1992;7(1):56-66.
Morgan DL. The Focus Group Guidebook. Thousand Oaks, CA: SAGE Publications, Inc; 1997.
Hallberg LR. Introduction and aims of the book - health, public health and research on public health. In: Hallberg LR-M, ed. Qualitative Methods in Public Health Research: Theoretical Foundations and Practical Examples. Lund: Studentlitteratur; 2002:13-34.
Graneheim UH, Lundman B. Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness. Nurse Educ Today. 2004;24(2):105-112.
Hsieh HF, Shannon SE. Three approaches to qualitative content analysis. Qual Health Res. 2005;15(9):1277-1288.
Smith JM. Interviewing in Market and Social Research. London: Routledge/Thoemmes Press; 1972.
Krueger RA, Casey MA. Focus Groups: A Practical Guide for Applied Research (5th ed.). California, CA: Sage Publications; 2015.
Brocklehurst P, Price J, Glenny AM, et al. The effect of different methods of remuneration on the behaviour of primary care dentists. Cochrane Database Syst Rev. 2013;11(11):CD009853.
Grytten J. Payment systems and incentives in dentistry. Community Dent Oral Epidemiol. 2017;45(1):1-11.
Christell H, Gullberg J, Nilsson K, Heidari Olofsson S, Lindh C, Davidson T. Willingness to pay for osteoporosis risk assessment in primary dental care. Health Econ Rev. 2019;9(1):14.
Morgan DL. Successful Focus Groups: Advancing the State of the Art. Thousand Oaks, CA: SAGE Publications Ltd; 1993.
Jensen O, Gabre P, Sköld U, Birkhed D, Povlsen L. ‘I take for granted that patients know’-oral health professionals' strategies, considerations and methods when teaching patients how to use fluoride toothpaste. Int J Dental Hygiene. 2014;12(2):81-88.
Gronbeck Linden I, Hagglin C, Gahnberg L, Andersson P. Factors affecting older persons' ability to manage oral hygiene: a qualitative study. JDR Clin Trans Res. 2017;2(3):223-232.
Stalmeijer RE, Mcnaughton N, Van Mook WNKA. Using focus groups in medical education research: AMEE guide no. 91. Med Teach. 2014;36(11):923-939.
Sippli K, Rieger MA, Huettig F. GPs' and dentists' experiences and expectations of interprofessional collaboration: findings from a qualitative study in Germany. BMC Health Serv Res. 2017;17(1):179.