Perspectives of general dental practitioners on preventive, patient-centred, and evidence-based oral healthcare—A Q-methodology study

OBJECTIVE: In the last 30 years, innovations in oral healthcare (OHC), such as advanced restorative techniques, shifts towards preventive and evidence-based care and changes in patients’ expectations, have increased the complexity of clinical decision-making in OHC. Little is known about the perspectives of general dental practitioners (GDPs) on the value of providing preventive, patient-centred and evidence-based OHC. This study aimed to explore the range of perspectives present amongst GDPs on OHC. METHOD: Q-methodology was used to explore perspectives among 78 GDPs working in the Netherlands. Participants were asked to sort 50 statements representing three central domains in OHC: i.) restorative versus preventative OHC, ii.) disease-centred versus patient-centred OHC and iii.) expertise-based versus evidence-based OHC. Opinion statements about delivering OHC were formulated on the basis of published literature and input from OHC professionals. By-person factor analysis was used to reveal clusters of communality in statement rankings, which were interpreted and formed perspectives on OHC. RESULTS: Four perspectives, explaining 47% of variance, on OHC were identified amongst GDPs: ‘the patient-focused dentist who values prevention’, ‘the outcome-oriented dentist who values learning from colleagues’, ‘the team player with ultimate care responsibility’ and ‘the dentist who considers oral health the responsibility of the patient.’ CONCLUSION: Q-methodology can be effectively used to describe the different perspectives that GDPs have on the challenges of preventive, patient-centred and evidence-based OHC. GDPs should not be seen as a homogenous group; rather they have different views and approaches to the care they provide. This has implications for health systems; awareness of the heterogeneity of practitioners’ perspectives can potentially be used to develop bespoke quality of care improvement strategies that constructively engage with each of these different groups.