The future of dentistry post-COVID-19: perspectives from Urgent Dental Care centre staff in England.
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ABSTRACT:
SUBMITTER: Witton R
PROVIDER: S-EPMC8456399 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:Introduction Following the World Health Organisation declaration of COVID-19 as a global pandemic, routine dental care in the UK ceased, and Urgent Dental Care centres (UDCs) were established to offer remote and face-to-face urgent dental treatment for those in need.Aim To explore perceptions and psychosocial experiences of frontline staff providing care at UDCs in England during COVID-19.Method A qualitative research study using a phenomenological approach. Semi-structured interviews were conducted remotely. Using line-by-line coding, data were analysed using a hybrid approach that incorporated both a deductive, theoretical process and an inductive, data-driven process.Results Participants included 29 dentists and nine dental nurses from UDCs across England. Twelve themes were identified and grouped into positive and negative experiences. Positive experiences were: role fulfilment and having a sense of purpose; team unity and collective coping strategies; and strategic teamwork and preparedness for effective organisation of care. Negative experiences included: feeling undervalued and frustrated due to fragmented guidance and communication; sense of unfairness generated by relational challenges; patient demand outstripping UDC capacity; complex decision-making; uncertainty over safety; suffocating PPE hindering effective communication; ineffective communication channels across healthcare sectors; lack of commitment to remote video consultations; and variable referral quality.Conclusions Participants reported experiencing a number of emotional challenges that appeared to be exacerbated by an unsupportive environment, often due to lack of leadership. However, positive experiences and coping strategies were also identified. Collective and sustained efforts at system level to improve the resilience and mental wellbeing of the current and future dental workforce and integration of dentistry into wider healthcare infrastructures are needed.
| S-EPMC8420962 | biostudies-literature
Project description:Introduction The COVID-19 pandemic has posed many challenges, including provision of urgent dental care. This paper presents a prospective service evaluation during establishment of urgent dental care in the North East of England over a six-week period.Aim To monitor patient volumes, demographics and outcomes at the North East urgent dental care centre and confirm appropriate care pathways.Main outcome methods Data were collected on key characteristics of patients accessing urgent care from 23 March to 3 May 2020. Analysis was with descriptive statistics.Results There were 1,746 patient triages (1,595 telephone and 151 face-to-face), resulting in 1,322 clinical consultations. The most common diagnoses were symptomatic irreversible pulpitis or apical periodontitis. Sixty-five percent of clinical consultations resulted in extractions and 0.8% in an aerosol generating procedure. Patients travelled 25 km on average to access care; however, this reduced as more urgent care centres were established. The majority of patients were asymptomatic of COVID-19 and, to our knowledge, no staff acquired infection due to occupational exposure.Conclusion The urgent dental care centre effectively managed urgent and emergency dental care, with appropriate patient pathways established over the six-week period. Dental preparedness for future pandemic crises could be improved and informed by this data.
| S-EPMC7294194 | biostudies-literature
Project description:Introduction Advanced NHS restorative dentistry services are an important aspect of patient care. Managed clinical networks (MCNs) have been proposed as a future model of care.Aim To assess general dental practitioners' (GDPs') satisfaction with the current provision of advanced NHS restorative dentistry services and assess their views on MCNs.Methods A self-administered, online survey was distributed by the Northern Dental Practice Based Research Network and was shared on social media.Results In total, 108 responses were received from GDPs working in England; 55% in the North East. GDPs felt current services for periodontics, endodontics, tooth surface loss and temporomandibular disorders were the most important and were most unsatisfied with periodontics, endodontics and tooth surface loss. The most important barriers to current referral practice were previous referral rejections and the return of costly treatment plans. Opinions were favourable towards the proposed MCNs, with one-third of participants feeling they were already suitable to apply to deliver Level 2 services. There was a notable imbalance between sexes, with fewer female dentists (57%) registering interest in joining an MCN compared to their male counterparts (76%) and female dentists also identifying more barriers to join MCNs, including access to suitable training. Recent graduates were least likely to cite a lack of time as a barrier to engaging with MCNs.Conclusions GDPs are currently unsatisfied with advanced NHS restorative dentistry services but appear keen to engage with MCNs. The survey identified important insights which may help healthcare planners develop services.
| S-EPMC8896073 | biostudies-literature
Project description:The routine use of standardized diagnostic terminologies (DxTMs) in dentistry has long been the subject of academic debate. This paper discusses the strategies suggested by a group of dental stakeholders to enhance the uptake of DxTMs. Through unstructured interviewing at the 'Toward a Diagnosis-Driven Profession' National Conference held on 19 March 2016 in Los Angeles, CA, USA participants were asked how enthusiastic they were about implementing and consistently using DxTMs at their work. They also brainstormed on strategies to improve the widespread use of DxTMs. Their responses are summarized by recursive abstraction and presented in themes. Conference participants were very enthusiastic about using a DxTM in their place of work. Participants enumerated several strategies to make DxTMs more appealing including: the use of mandates, a value proposition for providers, communication and education, and integration with EHRs and existing systems. All groups across the dental healthcare delivery spectrum will need to work together for the success of the widespread and consistent use of DxTMs. Understanding the provider perspective is however the most critical step in achieving this goal, as they are the group who will ultimately be saddled with the critical task of ensuring DxTM use at the point of care.
| S-EPMC5551205 | biostudies-other
Project description:ObjectivesWe sought to understand the factors influencing the implementation of a primary care intervention to improve post-discharge care following acute kidney injury (AKI).DesignQualitative study using semi-structured interviews and thematic analysis.SettingGeneral practices in one Clinical Commissioning Group area in England.ParticipantsA total of 18 healthcare staff took part in interviews. Participants were practice pharmacists, general practitioners, practice managers and administrators involved in implementing the intervention.ResultsWe identified three main factors influencing implementation: differentiation of the new intervention from other practice work; development of skill mix and communication across organisations. Overall, post-AKI processes of care were deemed straightforward to embed into existing practice. However, it was also important to separate the intervention from other work in general practice. Dedicating staff time to proactively identify AKI on discharge summaries and to coordinate the provision of care enabled implementation of the intervention. The post-AKI intervention provided an opportunity for practice pharmacists to expand their primary care role. Working in a new setting also brought challenges; time to develop trusting relationships including an understanding of boundaries of clinical expertise influenced pharmacists' roles. Unclear and inconsistent information on discharge summaries contributed to concerns about additional work in primary care.ConclusionsThe research highlights challenges around post-discharge management in the primary care context. Coordination and communication were key factors for improving follow-up care following AKI. Further consideration is required to understand patient experiences of the interface between secondary and primary care. The issues pertaining to discharge care following AKI are relevant to practitioners and commissioners as they work to improve transitions of care for vulnerable patient populations.
| S-EPMC7430404 | biostudies-literature
Project description:BACKGROUND:Theoretical models have sought to comprehend and conceptualise how people seek help from health professionals but it is unclear if such models apply to urgent care. Much previous research does not explain the complex interactions that influence how people make sense of urgent care and how this shapes service use. This paper aims to conceptualise the complexity of sense-making and help-seeking behaviour in peoples' everyday evaluations of when and how to access modern urgent care provision. METHODS:This study comprised longitudinal semi-structured interviews undertaken in the South of England. We purposively sampled participants 75+, 18-26 years, and from East/Central Europe (sub-sample of 41 received a second interview at + 6-12 months). Framework analysis was thematic and comparative. RESULTS:The amount and nature of the effort (work) undertaken to make sense of urgent care was an overarching theme of the analysis. We distinguished three distinct types of work: illness work, moral work and navigation work. These take place at an individual level but are also shared or delegated across social networks and shaped by social context and time. We have developed a conceptual model that shows how people make sense of urgent care through work which then influences help-seeking decisions and action. CONCLUSIONS:There are important intersections between individual work and their social networks, further shaped by social context and time, to influence help-seeking. Recognising different, hidden or additional work for some groups may help design and configure services to support patient work in understanding and navigating urgent care.
| S-EPMC6624886 | biostudies-other
Project description:This paper examines issues related to the future supply of registered nursing staff, midwives and health visitors in the National Health Service (NHS) in England at a time when there are major public sector funding constraints and as more of these staff are reaching retirement age. Based on available workforce data, the paper reviews different possible scenarios for the supply of NHS nurses over a ten year period, assessing the impact of different numbers of new staff being trained and of varying retirement patterns from the ageing profession.The government in England has more policy levers available than is the case in many other countries. It determines the number of pre-registration training places that are commissioned and funded, it is the major employer, and it also controls the inflow of nurses from other countries through migration policies. Scenario models provide a picture of what the future might look like under various assumptions. These outcomes can be quantified and the results used to assess the risks and opportunities of alternate policy decisions. The approach used in this paper is that of the aggregate deterministic supply model.As part of this exercise, eight scenarios were selected and modelled. These were:A. "No change"- current inflows and outflowsB. "Redundancies" - current inflow with higher outflowC. "Improved retention" - current inflow with lower outflowD. "Reduced training intakes A" - lower inflows with lower outflowE. "Reduced training intakes B" - lower inflow with higher outflowsF. "Pension time-bomb"- current inflow with a higher rate of retirementG. "Pension delayed"- current inflow with a lower rate of retirementH. "Worst case" - lower inflow and higher outflow including higher retirementMost of the scenarios indicate that a reduction in the supply of nursing staff to NHS England is possible over the next ten years. Small changes in assumptions can make a substantial difference to outcomes and therefore emphasize the point that it is unwise to base policy decisions on a single projection. It is important that different scenarios are considered that may be regarded as possible futures, based on a realistic assessment of the available workforce data, policies and broader labour market and funding outlook.
| S-EPMC3459709 | biostudies-literature
Project description:Introduction An urgent dental care centre (UDCC) was set up at Queen Mary's Hospital in Sidcup, in response to the COVID-19 pandemic. Alongside the reporting of clinical outcomes, it is important to determine the success of a service from a patient’s perspective. The aim of this study was to ascertain patient reported outcome measures (PROMs) and patient reported experienced measures (PREMs) of our service. Method The Oral Health Impact Profile 14 (OHIP-14) tool was used to assess the Oral Health-Related Quality of Life (OHRQoL) of patients, and completed before and after attending our UDCC for treatment. Patients were also asked to complete a patient satisfaction questionnaire. Results 146 patients were recruited for our study, with 95 patients completing the OHIP-14 questionnaires pre- and post intervention at our UDCC and 136 patients completing a patient satisfaction questionnaire. A statistically significant reduction in OHIP score when comparing pre- and post-intervention was found across all OHIP-14 domains. The mean positive response rate (strongly agree or agree) for the patient satisfaction questionnaire was 97.1%. Conclusion A significant improvement in OHRQoL was found after treatment at our UDCC, with the majority of patients reporting a positive experience. We conclude that PROMs and PREMs are vital tools to assess service efficacy, help with the planning of service provision and should remain at the forefront even during a crisis such as the COVID-19 pandemic.
| S-EPMC7881283 | biostudies-literature
Project description:BackgroundThere is an increasing tendency to reconfigure acute hospital care towards a more centralised and specialised model, particularly for complex care conditions. Although centralisation is presented as "evidence-based", the relevant studies are often challenged by groups which hold perspectives and values beyond those implicit in the literature. This study investigated stakeholder perspectives on the rationale for the reconfiguration of urgent and emergency care in Ireland. Specifically, it considered the hypothesis that individuals from different stakeholder groups would endorse different positions in relation to the motivation for, and goals of, reconfiguration.MethodsDocumentary analysis of policy documents was used to identify official justifications for change. Semi-structured interviews with 175 purposively sampled stakeholders explored their perspectives on the rationale for reconfiguration.ResultsWhile there was some within-group variation, internal and external stakeholders generally vocalised different lines of argument. Clinicians and management in the internal stakeholder group proposed arguments in favour of reconfiguration based on efficiency and safety claims. External stakeholders, including hospital campaigners and local political representatives expressed arguments that focused on access to care. A "voter" argument, focused on the role of local politicians in determining the outcome of reconfiguration planning, was mentioned by both internal and external stakeholders, often in a critical fashion.ConclusionOur study adds to an emerging literature on the interaction between a technocratic approach to health system planning advocated by clinicians and health service managers, and the experiential "non-expert" claims of the public and patients.
| S-EPMC6032929 | biostudies-literature
Project description:Histone H1 is the most variable histone and its role at the epigenetic level is less characterized than that of core histones. In vertebrates, H1 is a multigene family, which can encode up to 11 subtypes. The H1 subtype composition is different among cell types during the cell cycle and differentiation. Mass spectrometry-based proteomics has added a new layer of complexity with the identification of a large number of post-translational modifications (PTMs) in H1. In this review, we summarize histone H1 PTMs from lower eukaryotes to humans, with a particular focus on mammalian PTMs. Special emphasis is made on PTMs, whose molecular function has been described. Post-translational modifications in H1 have been associated with the regulation of chromatin structure during the cell cycle as well as transcriptional activation, DNA damage response, and cellular differentiation. Additionally, PTMs in histone H1 that have been linked to diseases such as cancer, autoimmune disorders, and viral infection are examined. Future perspectives and challenges in the profiling of histone H1 PTMs are also discussed.
| S-EPMC7460583 | biostudies-literature