Quality Management in Primary Dental Care: Methods and Challenges

Introduction

In dental care services, the quality is an important factor that affects decision making, the planning of health strategies and policies, the cost of health services and the evaluation of them (Delias et al., 2015; Kitsios et al., 2019; Manolitzas et al., 2018; Sindakis and Kitsios, 2016; Stefanakakis et al., 2017). However, quality in primary dental care often means different things to dental practitioners, policy makers and patients. Nevertheless, the implementation of evaluation processes as well as the improvement of health services is required for the successful implementation of dental interventions (Syngelakis and Kitsios, 2017; Syngelakis et al., 2019; Syngelakis et al., 2013; Syngelakis et al., 2012). According to Campbell et al. (2000), the key dimensions of health care quality are access, effectiveness and efficiency. Following this approach, main dimensions of primary dental care quality include access, effectiveness and efficiency, as well as appropriateness, availability, continuity, patient-centredness, efficacy, respect and caring, safety and timeliness. Key determinants of primary dental care quality include skills of dentists, patient’s satisfaction, patient – dentist interpersonal relationship, dentist’s satisfaction, patient’s safety, trust and accountability of dentist, cost of services, use of modern technology and equipment, referral to a specialist when required, evidence – based decision making, patient’s involvement in decision making and emphasis on prevention (Bader, 2009; Campbell and Tickle, 2013; Chu et al., 2001; Evans et al., 2001; Gonzalez et al., 2006; Tinanoff, 2012).

Therefore, the evaluation of quality in dental services using the assessment methods that are used in other services of primary healthcare is difficult due to the special characteristics of dentistry (Bader, 2009; Dental Quality Alliance, 2019; Tickle et al., 2015). In recent years, researchers have developed some methods in order to evaluate dental quality such as ISO, EFQM, Visitatie, TQM, EPA, benchmarking, Pay for Performance, peer review and Decision Support Systems for clinical services (Lavell et al., 2004; Tinanoff, 2012; Yamalik, 2007a,b; Voinea-Griffin et al 2010a,b). The main goal of these methods is to support patients’ satisfaction and safety, improve healthcare processes and upgrade overall patient’s experience. However, the improvement and the evaluation of primary oral healthcare services is a complicated issue because it involves many factors (e.g. political, legal, economic and social environment) that affect it.

Previous researchers have examined the quality assessment methods in primary dental care and the limitations of these methods. Furthermore, they evaluated the quality indicators in primary healthcare and they discussed the specific aspects of dental services and the dimensions of quality in dentistry focusing on primary dental care (Byrne et al., 2019; Mills et al., 2014; Righolt et al., 2019; Saleh et al., 2015; Samartzis and Talias, 2019; Scambler et al., 2016; Simou et al., 2013). Therefore, the purpose of this chapter is to provide a complete overview of the literature from a different perspective, not implemented in existing analyses and, thus, it is a good starting point for further research. More specifically, this chapter answers the following questions: How many papers are published each year? Which journals have published NSD peer-reviewed publications and which have published the highest number of publications? Which topics have been studied? What areas for future research can be identified?

This chapter provides an overview of the current state of the field and it can help researchers to expand it and to position their study. The evaluation of health quality is an immature field, so it could inspire researchers for empirical investigation. Managers can assist to understand the characteristics of health services, the factors which affect their quality as well as quality in dentistry. It is anticipated that the effective development of health services will be increasingly important in next years as a result of rapid developments in new technologies and changing customer needs or preferences. The usefulness of this chapter is important for researchers who are interested in studying to expand knowledge in this area and they can use this review to position their research. This review may be of interest also to academics who are already studying the evaluation of quality in dental services or health-related scientific areas, or researchers who have been introduced to the field but they are interested in examining more specific insights into where current research topics in this review can be located, and how they may contribute to them.