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 23;197(8):485-9; discussion 475. doi: 10.1038/sj.bdj.4811748.
The objective of this study was to investigate the barriers and facilitators to change in dental practices among a sample of general dental practitioners (GDPs) from three regions of England.
In-depth face-to-face interviews with 60 GDPs were undertaken. The sample was selected from a group of 317 GDPs who had completed a questionnaire in the first phase of this study. The participants were selected to reflect diversity regarding the number and extent of self-reported changes reported in the questionnaire, and personal and practice characteristics. Of the 92 attempted contacts, 60 (65%) of the interviews were successfully completed. The interview schedule formed the basis of the interview. All the interviews and notes were transferred on to NUD*IST QSR version 4, a qualitative analysis package.
No single factor was identified as being more important than another in facilitating change. The main facilitators for change were: financial factors, regular patient attendance, particularly a core patient group, staff loyalty, having regular staff meetings and open communication and having access to peer support. The main barriers to change were the reverse of the facilitators plus not having a financial stakehold in the practice.
A range of factors were identified as influencing change in general dental practice. These include GDPs' attitudes and experience of change, patient factors, organisational issues, contact with peers and access to appropriate training courses.
本研究的目的是调查来自英格兰三个地区的全科牙医样本在牙科实践中改变的障碍和促进因素。
对60名全科牙医进行了深入的面对面访谈。样本是从在本研究第一阶段完成问卷调查的317名全科牙医中选取的。参与者的选择反映了问卷中自我报告的改变的数量和程度以及个人和实践特征方面的多样性。在92次尝试联系中,成功完成了60次(65%)访谈。访谈提纲构成了访谈的基础。所有访谈和笔记都被录入NUD*IST QSR第4版,这是一个定性分析软件包。
在促进改变方面,没有一个因素被认为比其他因素更重要。改变的主要促进因素有:财务因素、患者定期就诊,尤其是核心患者群体、员工忠诚度、定期召开员工会议及开放沟通以及获得同行支持。改变的主要障碍是促进因素的反面,再加上在实践中没有财务利益。
确定了一系列影响全科牙科实践改变的因素。这些因素包括全科牙医对改变的态度和经验、患者因素、组织问题、与同行的联系以及获得适当培训课程的机会。