A Systems Analysis of Fluoride Varnish Application in General Dental Practice in Scotland using the Functional Resonance Analysis Method

摘要

Under Scotland’s child oral health improvement programme\ud(Childsmile) programme dental practices delivering National\udHealth Service (NHS) care are expected to apply sodium fluoride\udvarnish to the teeth of all children at six-monthly intervals from\udthe age of two years. Despite some recognised programme success\udthis key preventive intervention is still variable. Aim: This organisational-level\udproject aimed to study the work system around fluoride\udvarnish application in the practice setting, to identify mechanisms\udand contextual factors likely to come into play in complex\udinterventions to increase application rates. The methodology involved\udapplying the Functional Resonance Analysis Method to\udsynthesise multiple data sources, including: a longitudinal survey\udof GDPs (n = 1,090; 65% follow up rate); in-depth interviews with\udpractitioners and public health experts (n = 43); ‘World Café’ (4)\udworkshop activities with Childsmile staff (n = 56); and NHS rouDownloaded\udby:\udGlasgow Univ.Lib.\ud130.209.6.42 - 11/2/2017 11:15:27 AM\udAbstracts: 64th ORCA Congress Caries Res 2017;51:290–385\udDOI: 10.1159/000471777\ud367\udtine varnish claims data for 2015/16 (n = 86,726 claims at 807 Practices).\udResults Various crosslinked areas affecting varnish application\udwere identified: priorities of care and preventive culture; practice\udmanagement including time, space and use of the dental team;\udparental wishes and child compliance; risk and efficacy evidence;\udand issues with regards to the NHS remuneration system. Conclusion\udThis study identified a number of interlinked organisationlevel\udissues around fluoride varnish application in general dental\udpractice. These have been developed into a randomised pilot and\udfeasibility study which is now underway, involving an enhanced\udaudit and feedback intervention.