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Introducing high-cost health care to patients: dentists' accounts of offering dental implant treatment
OBJECTIVES: The decision-making process within health care has been widely researched, with shared decision-making, where both patients and clinicians share technical and personal information, often being cited as the ideal model. To date, much of this research has focused on systems where patients...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BlackWell Publishing Ltd
2015
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4312916/ https://www.ncbi.nlm.nih.gov/pubmed/25265369 http://dx.doi.org/10.1111/cdoe.12129 |
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author | Vernazza, Christopher R Rousseau, Nikki Steele, Jimmy G Ellis, Janice S Thomason, John Mark Eastham, Jane Exley, Catherine |
author_facet | Vernazza, Christopher R Rousseau, Nikki Steele, Jimmy G Ellis, Janice S Thomason, John Mark Eastham, Jane Exley, Catherine |
author_sort | Vernazza, Christopher R |
collection | PubMed |
description | OBJECTIVES: The decision-making process within health care has been widely researched, with shared decision-making, where both patients and clinicians share technical and personal information, often being cited as the ideal model. To date, much of this research has focused on systems where patients receive their care and treatment free at the point of contact (either in government-funded schemes or in insurance-based schemes). Oral health care often involves patients making direct payments for their care and treatment, and less is known about how this payment affects the decision-making process. It is clear that patient characteristics influence decision-making, but previous evidence suggests that clinicians may assume characteristics rather than eliciting them directly. The aim was to explore the influences on how dentists' engaged in the decision-making process surrounding a high-cost item of health care, dental implant treatments (DITs). METHODS: A qualitative study using semi-structured interviews was undertaken using a purposive sample of primary care dentists (n = 25). Thematic analysis was undertaken to reveal emerging key themes. RESULTS: There were differences in how dentists discussed and offered implants. Dentists made decisions about whether to offer implants based on business factors, professional and legal obligations and whether they perceived the patient to be motivated to have treatment and their ability to pay. There was evidence that assessment of these characteristics was often based on assumptions derived from elements such as the appearance of the patient, the state of the patient's mouth and demographic details. The data suggest that there is a conflict between three elements of acting as a healthcare professional: minimizing provision of unneeded treatment, trying to fully involve patients in shared decisions and acting as a business person with the potential for financial gain. CONCLUSIONS: It might be expected that in the context of a high-cost healthcare intervention for which patients pay the bill themselves, that decision-making would be closer to an informed than a paternalistic model. Our research suggests that paternalistic decision-making is still practised and is influenced by assumptions about patient characteristics. Better tools and training may be required to support clinicians in this area of practice. |
format | Online Article Text |
id | pubmed-4312916 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2015 |
publisher | BlackWell Publishing Ltd |
record_format | MEDLINE/PubMed |
spelling | pubmed-43129162015-02-10 Introducing high-cost health care to patients: dentists' accounts of offering dental implant treatment Vernazza, Christopher R Rousseau, Nikki Steele, Jimmy G Ellis, Janice S Thomason, John Mark Eastham, Jane Exley, Catherine Community Dent Oral Epidemiol Original Articles OBJECTIVES: The decision-making process within health care has been widely researched, with shared decision-making, where both patients and clinicians share technical and personal information, often being cited as the ideal model. To date, much of this research has focused on systems where patients receive their care and treatment free at the point of contact (either in government-funded schemes or in insurance-based schemes). Oral health care often involves patients making direct payments for their care and treatment, and less is known about how this payment affects the decision-making process. It is clear that patient characteristics influence decision-making, but previous evidence suggests that clinicians may assume characteristics rather than eliciting them directly. The aim was to explore the influences on how dentists' engaged in the decision-making process surrounding a high-cost item of health care, dental implant treatments (DITs). METHODS: A qualitative study using semi-structured interviews was undertaken using a purposive sample of primary care dentists (n = 25). Thematic analysis was undertaken to reveal emerging key themes. RESULTS: There were differences in how dentists discussed and offered implants. Dentists made decisions about whether to offer implants based on business factors, professional and legal obligations and whether they perceived the patient to be motivated to have treatment and their ability to pay. There was evidence that assessment of these characteristics was often based on assumptions derived from elements such as the appearance of the patient, the state of the patient's mouth and demographic details. The data suggest that there is a conflict between three elements of acting as a healthcare professional: minimizing provision of unneeded treatment, trying to fully involve patients in shared decisions and acting as a business person with the potential for financial gain. CONCLUSIONS: It might be expected that in the context of a high-cost healthcare intervention for which patients pay the bill themselves, that decision-making would be closer to an informed than a paternalistic model. Our research suggests that paternalistic decision-making is still practised and is influenced by assumptions about patient characteristics. Better tools and training may be required to support clinicians in this area of practice. BlackWell Publishing Ltd 2015-02 2014-09-29 /pmc/articles/PMC4312916/ /pubmed/25265369 http://dx.doi.org/10.1111/cdoe.12129 Text en © 2014 The Authors. Community Dentistry and Oral Epidemiology Published by John Wiley & Sons Ltd http://creativecommons.org/licenses/by/3.0/ This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Original Articles Vernazza, Christopher R Rousseau, Nikki Steele, Jimmy G Ellis, Janice S Thomason, John Mark Eastham, Jane Exley, Catherine Introducing high-cost health care to patients: dentists' accounts of offering dental implant treatment |
title | Introducing high-cost health care to patients: dentists' accounts of offering dental implant treatment |
title_full | Introducing high-cost health care to patients: dentists' accounts of offering dental implant treatment |
title_fullStr | Introducing high-cost health care to patients: dentists' accounts of offering dental implant treatment |
title_full_unstemmed | Introducing high-cost health care to patients: dentists' accounts of offering dental implant treatment |
title_short | Introducing high-cost health care to patients: dentists' accounts of offering dental implant treatment |
title_sort | introducing high-cost health care to patients: dentists' accounts of offering dental implant treatment |
topic | Original Articles |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4312916/ https://www.ncbi.nlm.nih.gov/pubmed/25265369 http://dx.doi.org/10.1111/cdoe.12129 |
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