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BMC Oral Health

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Open Access 01-12-2021 | Research

What non-clinical factors influence the general dentist–specialist relationship in Canada?

Authors: Harpinder Kaur, Sonica Singhal, Michael Glogauer, Amir Azarpazhooh, Carlos Quiñonez

Published in: BMC Oral Health | Issue 1/2021

Abstract

Background

The general dentist–specialist relationship is important for effective patient care and the professional environment. This study explores the non-clinical factors that may influence the general dentist–specialist relationship in Canada.

Methods

A cross-sectional web-based survey of a sample of general dentists across Canada was conducted (N ≈ 11,300). The survey collected information on practitioner (e.g., age, gender, years of practice) and practice (e.g., location, ownership) factors. Two outcomes were assessed: not perceiving specialists as completely collegial and perceiving competitive pressure from specialists. Binary and multivariable logistic regression analysis was conducted.

Results

A total of 1328 general dentists responded, yielding a response rate of 11.7%. The strongest associations for perceiving specialists as not completely collegial include being a practice owner (OR = 2.15, 95% CI 1.23, 3.74), working in two or more practices (OR = 1.69, 95% CI 1.07, 2.65), practicing in a small population center (OR = 0.46, 95% CI 0.22, 0.94), and contributing equally to the household income (OR = 0.47, 95% CI 0.26, 0.84). The strongest associations with perceiving medium/large competitive pressure from specialists include having a general practice residency or advanced education in general dentistry (OR = 2.00, 95% CI 1.17, 3.41) and having specialists in close proximity to the practice (OR = 2.52, 95% CI 1.12, 5.69).

Conclusion

Practitioner and practice factors, mostly related to business and dental care market dynamics, are associated with the potential for strained relationships between general dentists and specialists in Canada. This study points to the need for dental professional organizations to openly discuss the current state of the dental care market, as it has important implications for the profession.

D’Amour D, Ferrada-Videla M, San Martin Rodriguez L, Beaulieu M-D. The conceptual basis for interprofessional collaboration: core concepts and theoretical frameworks. J Interprof Care. 2005;19(Suppl 1):116–31. https://doi.org/10.1080/13561820500082529.CrossRefPubMed

Thorsen O, Hartveit M, Johannessen JO, Fosse L, Eide GE, Schulz J, et al. Typologies in GPs’ referral practice. BMC Fam Pract. 2016;18(17):76. https://doi.org/10.1186/s12875-016-0495-y.CrossRef

Morris AJ, Burke FJ. Primary and secondary dental care: the nature of the interface. Br Dent J. 2001;191(12):660–4. https://doi.org/10.1038/sj.bdj.4801262.CrossRefPubMed

Goldenberg AS. The dental referral process. New insights. N Y State Dent J. 1997;63(3):44–7.PubMed

Goldenberg AS. Referral patterns of dentists: analysis and implications of a questionnaire. Int J Psychosom. 1992;39(1–4):76–80.PubMed

Weiner L. The relationship between the specialist and the referring dentist. J Ont Dent Assoc. 1968;45(7):295–6.PubMed

Brustein DD, Rauschart EA. A comparative study on the relationship between the specialist and the referring dentist. J Periodontol. 1971;42(5):306–8. https://doi.org/10.1902/jop.1971.42.5.306.CrossRefPubMed

Kraatz J, Hoang H, Ivanovski S, Crocombe LA. Non-clinical factors associated with referrals to periodontal specialists: a systematic review. J Periodontol. 2017;88(1):89–99. https://doi.org/10.1902/jop.2016.160318.CrossRefPubMed

Schwartz B. The evolving relationship between specialists and general dentists: practical and ethical challenges. J Am Coll Dent. 2007;74(1):22–6.PubMed

10.

Iversen T, Ma CA. Market conditions and general practitioners’ referrals. Int J Health Care Finance Econ. 2011;11(4):245–65. https://doi.org/10.1007/s10754-011-9101-y.CrossRefPubMed

11.

Fang H, Rizzo JA. Competition and physician-enabled demand: the role of managed care. J Econ Behav Organ. 2009;72(1):463–74.CrossRef

12.

Tsai W-C, Kung P-T, Chang W-C. Influences of market competition on dental care utilization under the global budget payment system. Community Dent Oral Epidemiol. 2007;35(6):459–64. https://doi.org/10.1111/j.1600-0528.2006.00355.x.CrossRefPubMed

13.

Landon BE, Reschovsky J, Reed M, Blumenthal D. Personal, organizational, and market level influences on physicians’ practice patterns: results of a national survey of primary care physicians. Med Care. 2001;39(8):889–905. https://doi.org/10.1097/00005650-200108000-00014.CrossRefPubMed

14.

Yu B, Ghoneim A, Lawrence H, Glogauer M, Quiñonez C. Perceived professional roles and implications for clinical decision-making. J Public Health Dent. 2020;80:43–50. https://doi.org/10.1111/jphd.12346.CrossRefPubMed

15.

Ghoneim A, Yu B, Lawrence H, Glogauer M, Shankardass K, Quiñonez C. What influences the clinical decision-making of dentists? A cross-sectional study. PLoS ONE. 2020;15(6):e0233652. https://doi.org/10.1371/journal.pone.0233652.CrossRefPubMedPubMedCentral

16.

Chambers D. The changing relationships between specialists and general dentists [Internet]. Ottawa, ON: Canadian Dental Specialties Association; 2012. Available from: http://conference.capd-acdp.org/wp-content/uploads/2015/09/Changing-Relationship-between-Spec-GPs.pdf.

17.

Cottrell DA, Reebye UN, Blyer SM, Hunter MJ, Mehta N. Referral patterns of general dental practitioners for oral surgical procedures. J Oral Maxillofac Surg. 2007;65(4):686–90. https://doi.org/10.1016/j.joms.2006.11.053.CrossRefPubMed

18.

Zemanovich MR, Bogacki RE, Abbott DM, Maynard JGJ, Lanning SK. Demographic variables affecting patient referrals from general practice dentists to periodontists. J Periodontol. 2006;77(3):341–9. https://doi.org/10.1902/jop.2006.050125.CrossRefPubMed

19.

Schlieve T, Funderburk J, Flick W, Miloro M, Kolokythas A. How do general dentists and orthodontists determine where to refer patients requiring oral and maxillofacial surgical procedures? J Oral Maxillofac Surg. 2015;73(3):509–13. https://doi.org/10.1016/j.joms.2014.08.004.CrossRefPubMed

20.

Dillman DA. Mail and Internet surveys: the tailored design method–2007 Update with new Internet, visual, and mixed-mode guide. Hoboken: Wiley; 2011.

21.

Kaur H. Canadian General Dentists’ Perceptions about their Relationship with Specialists [Internet] [Master Thesis]. Toronto (ON): University of Toronto; 2020 [cited 2021 Apr 12]. Available from: https://tspace.library.utoronto.ca/handle/1807/103425.

22.

Brennan DS, Spencer AJ. The role of dentist, practice and patient factors in the provision of dental services. Community Dent Oral Epidemiol. 2005;33(3):181–95. https://doi.org/10.1111/j.1600-0528.2005.00207.x.CrossRefPubMed

23.

Hazelkorn HM. A comparison of dental treatment plans under different reimbursement systems. J Public Health Policy. 1985;6(2):223–35.CrossRef

24.

Guymon G, Buschang PH, Brown TJ. Criteria used by general dentists to choose an orthodontist. J Clin Orthod. 1999;33(2):87–93.PubMed

25.

Yuen K, Quiñonez C. Competition and financially related misconduct in dental practice: a retrospective descriptive study. J Can Dent Assoc. 2015;81:1488–2159.

26.

Gordan VV, Riley JL, Geraldeli S, Rindal DB, Qvist V, Fellows JL, et al. Repair or replacement of defective restorations by dentists in the dental practice-based research network. J Am Dent Assoc. 2012;143(6):593–601. https://doi.org/10.14219/jada.archive.2012.0238.CrossRefPubMedPubMedCentral

27.

Zadik Y, Levin L. Clinical decision making in restorative dentistry, endodontics, and antibiotic prescription. J Dent Educ. 2008;72(1):81–6.CrossRef

28.

Hardigan PC, Succar CT, Fleisher JM. An analysis of response rate and economic costs between mail and web-based surveys among practicing dentists: a randomized trial. J Community Health. 2012;37(2):383. https://doi.org/10.1007/s10900-011-9455-6.CrossRefPubMed

29.

Azarpazhooh A, Dao T, Figueiredo R, Krahn M, Friedman S. A survey of dentists’ preferences for the treatment of teeth with apical periodontitis. J Endod. 2013;39(10):1226–33. https://doi.org/10.1016/j.joen.2013.06.023.CrossRefPubMed

30.

Chvartszaid D. A survey regarding the nature and type of dental implant complications in private practices in the province of Ontario. Ottawa: Library and Archives Canada; 2012.

Title: What non-clinical factors influence the general dentist–specialist relationship in Canada?
Authors: Harpinder Kaur
Sonica Singhal
Michael Glogauer
Amir Azarpazhooh
Carlos Quiñonez
Publication date: 01-12-2021
Publisher: BioMed Central
Published in: BMC Oral Health / Issue 1/2021
Electronic ISSN: 1472-6831
DOI: https://doi.org/10.1186/s12903-021-01782-y

Keynote webinar | Spotlight on medication adherence

Springer Medicine

What non-clinical factors influence the general dentist–specialist relationship in Canada?

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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