Allen Z, Richardson J, Nassar M, Moles D
Faculty of Health: Medicine, Dentistry & Human Sciences, University of Plymouth.
Community Dent Health. 2020 Aug 31;37(3):229-234. doi: 10.1922/CDH_00016Allen06.
To describe dentists' perceptions of their professional roles, including the reasons why they make, accept or decline patient referrals within primary dental care in England.
Qualitative semi-structured interviews, conducted via Skype, telephone or face-to-face. Transcripts were analysed using thematic analysis and typologies were developed.
Ten general dental practitioners (GDPs) and 12 community dentists working in England.
Five main themes were identified: professional independence, the nature of dental care, the business of dentistry, obscure rules and 'no man's land'. This final theme described a notional gap between GDPs' and community dentists' responsibilities towards vulnerable people, who were perceived by participants to include frail older people, anxious and socially marginalised adults and children with high levels of disease. Three typologies of dentists were generated. 'Entrepreneurs' felt no allegiance to the National Health Service and no obligation to treat vulnerable patients. 'Altruistic carers' were committed to caring for exceptionally deserving patients. 'Pragmatic carers' tried to provide relational dental care (time and emotional support) for vulnerable patients but encountered discouraging systemic barriers.
Dentists' perceptions of their roles may influence whether and how they provide access to primary dental care for vulnerable people through referral systems. Access issues may exacerbate the oral health inequalities experienced by vulnerable groups. Based upon the findings, approaches are proposed that may encourage and enable the dental workforce to support vulnerable people actively to receive primary dental care.
描述牙医对其职业角色的认知，包括他们在英格兰初级牙科护理中做出、接受或拒绝患者转诊的原因。
通过Skype、电话或面对面进行定性半结构化访谈。使用主题分析法对访谈记录进行分析，并形成类型学。
在英格兰工作的10名普通牙科医生（GDPs）和12名社区牙医。
确定了五个主要主题：职业独立性、牙科护理的性质、牙科业务、模糊规则和“无人区”。最后一个主题描述了GDPs和社区牙医在对待弱势群体方面责任的概念性差距，参与者认为弱势群体包括体弱的老年人、焦虑和社会边缘化的成年人以及患有严重疾病的儿童。产生了三种类型的牙医。“企业家型”牙医对国民医疗服务体系没有忠诚感，也没有义务治疗弱势患者。“利他型护理者”致力于照顾特别值得照顾的患者。“务实型护理者”试图为弱势患者提供关系性牙科护理（时间和情感支持），但遇到了令人沮丧的系统性障碍。
牙医对其角色的认知可能会影响他们是否以及如何通过转诊系统为弱势群体提供初级牙科护理。获得护理的问题可能会加剧弱势群体所经历的口腔健康不平等。基于这些发现，提出了一些方法，可能会鼓励并使牙科工作人员积极支持弱势群体接受初级牙科护理。
