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Department of Research & Information, Dutch Dental Association (NMT), PO Box 2000, 3430 CA Nieuwegein, The Netherlands
Correspondence: * corresponding author, j.bruers{at}nmt.nl
KEY WORDS: Practice • dental consumption • professional opinions
Within the framework of the research project Data Stations, the Dutch Dental Association (NMT) periodically collects data about the care dentists render to patients, about the way in which they run their practices, and about views and/or wishes of dentists with regard to (current) issues within the dental profession. This paper focuses on the motives underlying the decision of the NMT to undertake the Data Stations Project, and on the way this project is organized. Particular attention will be given to the types of data and the kinds of information this project produces.
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Research and Policy: The Data Stations Project |
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Around each of these questions, a periodic investigation was set up, in which dentists were contacted by mail at least once a year. For these projects, the co-operation of the dental profession itself is indispensable. Therefore, in the NMT research policy, data stations were chosen as the central point of departure—that is, dentists who, for a short or longer period of time and on a regular basis, are prepared to take part in one of the NMT research projects and thus provide concrete data on how they practice their profession. Since 1995, of the present number of about 5800 dentists in general practice, almost 3200 have, at one time or another, participated in one of the Data Stations projects. This is 55% of the population and includes both NMT members and non-members. Moreover, when we look at current participation, at the moment about 1750 dentists—more than 25% of the dentist population in the Netherlands—function as an active Data Station. In all cases, the dentists co-operate voluntarily, without any form of financial reimbursement, and they constitute a representative group, in terms of gender, age, and geographical location.
By way of this structured, permanent, and longitudinal research, the NMT is the only organization within the field of Dutch dentistry that has at its disposal a wide range of objective data. This information is most valuable for achieving policy objectives, and also for developing future policy strategies. At the moment, for exammple, the NMT has at its disposal the annual dental consumption figures for about 650,000 patients, and there is also a longitudinal reservoir of information on the individual teeth of 50,000 patients over a five-year period.
Another important aspect of the Data Stations project is the belief of the NMT that the profession itself, and in particular the participating dentists, benefit directly from the NMT research. That is why dentists sometimes get an individual feedback report, in which their data are compared with the rest of the profession. The purpose of this information is, of course, to stimulate dentists to continue participating.
To maintain the independence and efficiency of the project, collaboration was started with a renowned research bureau. It monitors the confidential collection and processing of the information to ensure that it is not possible for the NMT to relate the data to individual patients and/or dentists.
The outcome of the research has helped to prevent Dutch dentistry being subjected to inappropriate policy decisions. It also ensured that the general strategy was brought more into line with the views of dentists who are active in their profession. Thus, the NMT recently negotiated, with success, adjustments to the dental fee structure, because our case could be validated with data from the Data Stations.
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Results of the Data Stations Project |
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‘Practicing dentistry’
In the first theme, "How do dentists work?", various aspects of the way in which dentists practice their profession are dealt with. ‘Where have they located their practice?’, ‘With whom do they collaborate?’, ‘How do they spend their time?’, and ‘How high are their costs and returns?’ are all examples of questions to be answered via the so-called study on ‘Practicing dentistry’. Within the framework of this research, data are collected periodically, at least once a year, by means of a written questionnaire. The data presented here were collected in the December, 2001, edition and come from over 400 dentists, each of whom runs an independent practice.
Because, in the Dutch situation, the type of practice is important, one of the first items analyzed is collaboration between dentists working in one practice location. Most Dutch dentists (71%) work in a practice where they are the only dentist (solo) (Fig. 1
). This does not mean that they do not work together. It is possible, for example, that they share certain costs with other dentists, get patients referred to them, or that they themselves refer patients to colleagues. But in all these cases, the question concerns collaboration that does not take place within the walls of the individual’s own practice. It does apply, however, to the remaining group, of which 14% work together by employing one or more dentists on a regular basis (employer), and 15% by jointly running a practice with one or more dentists (shared). These two groups of ‘collaborating’ dentists distinguish themselves in particular because, in the latter group, there is shared practice ownership, in which the total practice income and costs are proportionally divided. When these three types of practices are compared with each other with regard to various dentist and practice characteristics, there are considerable differences:
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‘Dental consumption’
The key question, ‘What do dentists do?’, is answered in the study on ‘Dental Consumption’, in which dentists are asked to provide data about the dental procedures they performed (or that colleagues had performed under their supervision) on a random sample of patients from their practice. Initially, this information was collected by hand, requiring a great effort by the data station dentists. However, since the information on procedures completed is collected by the practice administration, and since virtually all dentists in the Netherlands (95%) have automated their administration, the suppliers of the most popular software systems were approached a few years ago and were found to be willing to incorporate into their systems a procedure by which treatment data could be derived automatically from the practice administration. As for the patients, this could be done anonymously. At the moment, these modules are operational within five of the software systems most commonly used, with a total market share of between 80 and 90%. Over 1000 dentists using this software participate in the project.
What actually happens is that, via the automated system, the data of two random samples of patients, taken from the total patient population of a practice, are put on a diskette. These data are comprehensive, including all the treatment provided by a dentist for the random group of patients in a certain period of time, as well as some general demographic information on the patients concerned, such as year of birth, gender, insurance situation, and postal code.
In short, by means of the study on Dental Consumption, data are gathered about the dental care provided and charged for by dentists. This study produces a large amount of information coming from approximately 18% of Dutch dental practices and about 5% of Dutch (dentate) dental patients. These data are unique. It is true that, in the Netherlands, treatment data are also collected by others, especially insurers, but in all cases, this concerns only part of the dental care provided by dentists—for example, only those procedures that are reimbursed by the insurer.
As an illustration of the information that can be obtained from the study on Dental Consumption, Fig. 2 presents the types of dental care provided by dentists to patients in the Netherlands in the year 2000. This information was obtained by studying, for each dentist (through aggregating the data at patient level), the proportion of the procedures they performed that belongs to a specific aspect of dentistry, and, subsequently, how the financial returns have been divided proportionally. It appears that, on average, 49% of the procedures performed by dentists concerned consultation, diagnostics, and/or prevention, and 51% concerned curative or prosthetic dentistry. More than half of these procedures were fillings. At the same time, it emerged that, on average, 38% of the returns dentists generate are from procedures within the fields of consultation, diagnostics, and/or prevention, 51% from curative treatment, and 18% from prosthetic dentistry (fixed and removable prostheses and dental implants). Data on the number of procedures performed on patients who, in the year 2000, had a regular check-up at least once (the majority of dental patients in the Netherlands) are presented in Fig. 3. On average, 20 intra-oral x-rays were taken and 56 sealants were placed per 100 young patients. As for adults, it appears that, on average, 67 intra-oral x-rays were taken and 88 fillings were inserted per 100 patients.
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). Regarding implantology in general practice, it was found that 11% of the dentists inserted dental implants themselves, whereas 60% provide the suprastructures on the implants only. In other words, in the Netherlands, about one in every three dentists (29%) does not carry out any procedures involving dental implants.
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Conclusion |
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