Choosing Wisely: Reducing unnecessary care in dental primary care

Objectives:
Healthcare systems globally are subject to demand pressures. Policymakers must make difficult choices about what to fund within limited budgets, therefore interventions provided must offer good value. One means of promoting high-quality care is by taking a ‘Choosing Wisely’ approach. Choosing Wisely encourages a dialogue between healthcare professionals and patients, involving both in a shared decision-making (SDM) process. The routine provision of six-monthly dental check-ups and scale and polishes (S&P) for adults are treatments with no evidence of clinical benefit. Using these two treatments as exemplar behaviours, this study explored the barriers and enablers to reducing unnecessary care in primary care dentistry.

Methods:
Semi-structured theoretically underpinned interviews and focus groups.

Results:
Interviews were conducted with patients (N=14, UK-wide), professionals (N=20, Scotland) and systems-level stakeholders (N=34, UK-wide).

Dentists fear change, are frustrated by funding models, and have ‘fallen out of love’ with NHS dentistry. Patients value information about clinical evidence, what their care options are, and the opportunity to discuss these. Mapping the interview findings identified potential strategies to reduce the provision of unnecessary care. Focus groups with patients and professionals facilitated co-designed interventions for feasibility testing.

Conclusions:
Multiple factors and complexities influence the reduction of the routine provision of six-monthly check-ups and S&Ps. Whilst similar factors influence both patients and professionals, subtle difference exists in how they view the reduction of these treatments. There is an opportunity to positively improve the system through increased communication, SDM and higher-quality conversations between professionals and patients, to reduce unnecessary treatment and promote high-quality clinically effective care.