Watt R, McGlone P, Evans D, Boulton S, Jacobs J, Graham S, Appleton T, Perry S, Sheiham A
Department of Epidemiology and Public Health, University College London, London WC1E 6BT,UK.
Br Dent J. 2004 Oct 9;197(7):401-5; discussion 395. doi: 10.1038/sj.bdj.4811720.
To determine the extent and types of change in seven domains of dental practice in a sample of English general dental practitioners (GDPs).
A postal questionnaire was sent to 561 GDPs on the dental lists of three health authorities in diverse regions of England. Information collected included demographic details on personal and practice characteristics, self-rating of amount of change in the seven domains of practice and factors influencing change.
The response rate was 60%. Fifty-six per cent of the sample were under 40 years old. Over a third of respondents reported "changing a lot or completely" certain clinical activities, practice management arrangements and practice amenities. The highest self-reported level of change was in clinical activities. Of the GDPs who reported changing their clinical activities, 56% reported an increase in preventive care, followed by crown and bridge (44%), periodontics (44%) and endodontics (43%). Practice management rated second in the mean rank scores for self-reported change. The main changes reported were the introduction of computer systems and employment of practice managers. A sizeable percentage (66%) reported increasing the amount of information they provided to patients and the time spent discussing care. Quality assurance activities were the area of practice least likely to have changed over a 5-year period. Over half the sample reported not being involved in any quality assurance activities in the previous 5 years. Those respondents who were younger, had a postgraduate qualification and earned more than 20% of their income from private practice reported higher levels of change.
General dental practitioners' work patterns are dynamic and appear to be responding to changing needs and demands on their service. The main changes were in the types of clinical procedures being carried out. The low prevalence of changes reported in auditing and peer review activities needs to be investigated further.
确定英格兰普通牙科医生（GDPs）样本中牙科实践七个领域的变化程度和类型。
向英格兰不同地区三个卫生当局牙科名单上的561名GDPs发送了邮政调查问卷。收集的信息包括个人和实践特征的人口统计学细节、对实践七个领域变化量的自我评估以及影响变化的因素。
回复率为60%。样本中有56%年龄在40岁以下。超过三分之一的受访者报告某些临床活动、实践管理安排和实践设施“变化很大或完全改变”。自我报告的最高变化水平出现在临床活动中。在报告改变临床活动的GDPs中，56%报告预防性护理增加，其次是冠桥修复（44%）、牙周病治疗（44%）和牙髓病治疗（43%）。实践管理在自我报告变化的平均排名分数中位列第二。报告的主要变化是引入计算机系统和雇佣实践经理。相当大比例（66%）的人报告增加了向患者提供的信息量以及讨论护理所花费的时间。质量保证活动是5年期间实践中最不可能发生变化的领域。超过一半的样本报告在过去5年中未参与任何质量保证活动。那些年龄较小、拥有研究生学历且私人执业收入超过其总收入20%的受访者报告的变化水平更高。
普通牙科医生的工作模式是动态的，似乎在响应其服务不断变化的需求。主要变化在于所开展的临床程序类型。审计和同行评审活动中报告的变化发生率较低，需要进一步调查。
