Title: The value and cost of different forms of information on oral health status and risk given to patients following a check-up in dental practice
Funder: Department of Health (England)

Abstract: A new contract for NHS dental practice is being piloted. Under this new model all dentists undertake oral health assessments rating each patient according to their oral health and risk of disease. Computer software guides treatment planning to protocols which emphasise preventive care and limit complex treatment (e.g. crowns and bridgework) until patients’ self-care (tooth-brushing and diet) is appropriate. Self-care and prevention are at the heart of the new model which also currently includes patient charges for some preventive treatment. Our study aims to understand a) whether and how patients’ value information on their oral health/ disease risk b) whether presenting information in different forms changes their valuation and c) which way of presenting information presents the greatest estimated value for cost. We will compare three forms of information: 1) verbal communication 2) a paper-based system rating their health/risk as a traffic light and 3) digital images of their mouth generated with a special camera using quantitative light-induced fluorescence (QLF). QLF allows visualisation of tooth mineral loss at a stage before it is visible with the naked eye. It also highlights mature plaque which fluoresces red. Wireless technology allows transmission to the images to devices such as mobile phones. For those with no phones photographs can be printed.Phase 1 will 1) investigate patients’ wants and preferences for information given at their dental check-up; 2) how patients interact with these three different forms of information and 3) whether/how the clinician/patient relationship is influenced by patients having access to different types of information. In this phase we will use interviews and observation and investigate in particular whether different types of patients differ in their approach to different forms of information. Phase 1 ends with piloting and feasibility testing of methods to collect data on patients’ valuation of information and behaviour change. Phase 2 will be an experimental study in 4 NHS dental practices with four objectives: 1)To measure individuals preferences by using the economic preference based valuation methodology Willingness to Pay for the three different methods of giving information; 2)To identify differences in preference for different types of information by differing demographic behavioural and psycho-graphic groups; 3)To assess the patients behaviour change using variables and principles derived from established models of the behaviour change process and any actual change in behaviour after being given information on risk and disease status; 4)To conduct a cost-benefit framework analysis of the three different methods and to explore financial implications for NHS dentistry. In Phase 2 we will also undertake patient interviews to explore reasons for differences in valuations. Our study will lead to a better understanding of what patients’ value; how they interact with different forms of information about their health status and disease risk and whether technological advances in the way we deliver such information are useful or may widen inequalities in health. This improved understanding will not only inform both high level NHS policy regarding new models of NHS dental care aimed at promoting patients’ self-care but wider technology adoption practices related to the giving of information to patients at the level of NHS care providers.


Research activity codes: 7.1 INDIVIDUAL CARE NEEDS
Health categories: ORAL AND GASTROINTESTINAL