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Open Access Study protocol

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

Catherine E Exley1*, Nikki S Rousseau1, Jimmy Steele2, Tracy Finch1, James Field2, Cam Donaldson1, J Mark Thomason2, Carl R May1 and Janice S Ellis2

Author Affiliations

1 Institute of Health and Society, 21 Claremont Place, Newcastle University, Newcastle upon Tyne, NE2 4AA, UK

2 School of Dental Sciences, Framlington Place, Newcastle University, Newcastle upon Tyne, NE2 4BW, UK

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BMC Health Services Research 2009, 9:7  doi:10.1186/1472-6963-9-7

Published: 12 January 2009

Abstract

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.

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.

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 replacements.