Developing Choosing Wisely (CW) methodology to improve quality and safety in healthcare: An exemplar of reducing low value care in dentistry
Healthcare systems globally are subject to scarce resources, with insufficient resources available to deliver all potential healthcare interventions. Policy-makers require to make difficult choices about what interventions to fund within limited budgets, therefore interventions provided must offer good value for money. This leads to concern about the provision of ‘low-value care’ (LVC). LVC is a test or treatment for which there is no evidence of patient benefit or there is evidence of more harm than benefit.
In dentistry, Covid-19 has resulted in prolonged treatment restrictions, presenting an opportunity to reflect upon the services available and highlighting the importance of reducing treatments with no clinical benefit. The standard provision of 6-monthly scale and polish (S&P) and dental check-ups for adults are treatments with no evidence of clinical benefit.
This study will explore barriers to reducing these areas of LVC from the perspective of dental professionals, patients and other stakeholders, and identify strategies to reduce their use in routine practice. The study will be underpinned by behaviour change theories used to explore the behaviour of healthcare professionals and patients, and explain variation in practice.
This is a multi-method three-stage study underpinned by the Choosing Wisely De-Implementation Framework (CWDIF), the Theoretical Domains Framework (TDF) and Theoretical Framework of Acceptability.
The study will involve:
- Semi-structured interviews with healthcare professionals, patients and other stakeholders to identify barriers and enablers to reducing LVC in relation to the routine provision of S&P and routine 6-monthly recall intervals
- Co-design workshops with healthcare professionals, patients and other stakeholders to develop intervention(s) for further testing
- Multi-method feasibility testing of the proposed intervention(s), within primary care dentistry.