Dr Anwen Cope

(she/her)

PhD BDS MPH FDS(DPH) RCPS(Glasg) FHEA

Publication

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Research

Highlighted Projects

PRIDA - Patient Recall Decision Aid Study

Many patients visit their dentist every 6 months for a check-up. However, this may not be the best use of patients’ time and money, or NHS resources. In 2004, the National Institute for Health and Care Excellence (NICE) recommended that the time between dental check-ups should be tailored for each patient, based on how likely they were to develop diseases such as tooth decay, gum disease, or oral cancer. This guidance said that there was no longer a need for many patients to attend every 6 months and that for adult patients who were at low risk of developing dental disease, the time between check-ups could be increased up to a maximum of 24 months. Since the time between check-ups depends on a patients’ risk of developing disease, we call this ‘risk-based recall’.

However, over a decade on from the publication of the NICE guidance, 80% of adult NHS dental patients still go for check-ups every 6-8 months. This is a problem because the resources spent on check-ups for low-risk patients who attend too regularly could be better used to provide care for people who have struggled to get a dentist for a long time or who have toothache. This has been identified as a priority by the Welsh Government, which is one of the reasons why we are undertook this research.

This research involves investigators from Cardiff and Vale University Health Board, Cardiff University (Schools of Dentistry and Medicine), Public Health Wales, dental practices and patient and public involvement representatives. It was funded by a Research for Patient and Public Benefit Grant from Health and Care Research Wales.

AimsThis study aimed:
(1) To explore facilitators and barriers to the implementation of NICE guidelines on dental recall in general dental practice.
(2) To explore NHS dentists’ and patients’ attitudes towards SDM in decisions about recall interval.

MethodsSemi-structured telephone interviews were conducted with 25 NHS general dental practitioners (GDP) in Wales, UK. Transcripts were thematically analysed.

ResultsDentists described integrating information on clinical risk, patients’ social and dental history and professional judgement when making decisions about recall interval. Although most GDPs reported routinely using risk-based recall intervals, a number of barriers exist to recall intervals at the extremes of the NICE recommendations. Many practitioners were unwilling to extend recall intervals to 24 months, even for the lowest-risk patients. Conversely dentists described how it could be challenging to secure the agreement of high-risk patients to 3-month recalls. In addition, time and workload pressures, the need to meet contractual obligations, pressure from contracting organisations, and the fear of litigation also influenced the implementation of risk-based recalls. Whilst many patients would be happy to accept changes to their recall interval, most wanted to be seen at least annually. Most patients were willing to be guided by their dentist in decisions about recall interval, as long as consideration was given to issues such as time, travel and cost. This contrasted with desire to actively participate in decisions about operative treatment. Although dentists’ understanding of SDM varied, practitioners considered it important to involve patients in decisions about their care. However, dentists perceived that time, patient anxiety and concerns about potential adverse outcomes were barriers to the use of SDM.

ConclusionsAlthough awareness of NICE Guideline CG19 was high, there is a need to explore how risk-based recalls may be best supported through contractual mechanisms. Since there is uncertainty about the most clinically and cost-effective dental recall strategy, patient preference may play a role in these decisions.

What are the reasons patients consult a General Medical Practitioner when experiencing a dental problem?

Every year in the UK, approximately 380,000 patients will consult their general medical practitioner (GMP) due to a dental problem. Despite this substantial burden of dental consultations in general medical practice, there has been little investigation of the reasons why patients consult a GMP when experiencing problems with their teeth and gums.

The aim of this study was therefore to explore patients’ reasons for consulting a GMP rather than a dentist when experiencing a dental problem. Thirty nine adult participants who had consulted a UK GMP due to a dental problem in the previous year were recruited to take part in a semi-structured qualitative interview study.

Findings of the study indicate that consultation behaviour is influenced by patients’ interpretation of their symptoms and expectations of care; what they perceive primary care practitioners scope of practice to be; their previous experiences of dental care, including dental anxiety and dissatisfaction with prior treatment; the costs associated with dental care; and the comparative ease of navigating medical and dental care systems. As such, choice of healthcare provider during episodes of dental problems can be considered as arising from an interaction between patients’ personal characteristics, characteristics of the healthcare system in which they are seeking care, and the context in which this process is occurring.

Watch a YouTube video explaining the results of the study

This study was funded by the Royal College of Physicians and Surgeons of Glasgow.

Teaching

I teach Dental Public Health and Evidence Based Dentistry on the Dental Hygiene and Therapy BSc and Dental Surgery BDS programmes.

I am an external examiner for the University of Birmingham BDS course.

Biography

I graduated from Cardiff University with a first-class honours in Bachelor of Dental Surgery in 2009 and subsequently completed a PhD in 2015 and Masters in Public Health (with distinction) in 2018. I entered Dental Public Health specialty training in 2015 and passed the Intercollegiate Specialty Fellowship Examination in 2020 and was awarded the Certificate of Completion of Specialist Training in 2021. I have full registration with the General Dental Council and am named on the specialist list for Dental Public Health. I joined Cardiff University as a Senior Clinical Lecturer and Honorary Consultant in Dental Public Health in September 2021.

Qualifications

• FDS in Dental Public Health. Royal College of Physicians and Surgeons of Glasgow, 2021
• Master of Public Health (Distinction). Cardiff University, 2018
• Doctor of Philosophy (Medicine). Cardiff University, 2015. Thesis Title: Understanding the use of antibiotics for acute dental condition in primary care in the UK.
• Diploma of Membership of the Joint Dental Faculties. Royal College of Surgeons of England, 2013
• Bachelor of Dental Surgery, First Class Honours. Cardiff University, 2009

Honours and awards

• Finalist, Outstanding Contribution to Medical Education, BEST Trainee Awards. Health Education and 
  Improvement Wales (HEIW). 2019
• T C White Lecture Award. Royal College of Physicians and Surgeons of Glasgow. 2017
• Roger Anderson Poster Prize. British Association for the Study of Community Dentistry. 2017
• Roger Anderson Poster Prize. British Association for the Study of Community Dentistry. 2015
• TC White Young Researcher Award. Royal College of Physicians and Surgeons of Glasgow. 2015
• Student Competition Winner. Cochrane UK & Ireland Annual Symposium. 2014

Professional memberships

Full registration with the General Dental Council

Fellow of the Royal College of Physicians and Surgeons of Glasgow

Member of the British Association for the Study of Community Dentistry

Academic positions

2015 – 2021: Specialty Trainee and Hon. Lecturer in Dental Public Health, Cardiff and Vale University Health Board.

2014 – 2015: Post-doctoral Clinical Research Fellow in Dental Public Health, School of Dentistry, Cardiff University

Committees and reviewing

Member, British Dental Association Health and Science Committee

Supervisions

I am interested in supervising MPH, MPhil and PhD students in the areas of:

• Oral epidemiology
• Health services research
• Clinical dentistry