title: Paying for treatments? Influences on negotiating clinical need and decision-making for dental implant treatment.
abstract: BACKGROUND
  The aim of this study is to examine how clinicians and patients negotiate clinical need and treatment decisions within a context of finite resources. Dental implant treatment is an effective treatment for missing teeth, but is only available via the NHS in some specific clinical circumstances. The majority of people who receive this treatment therefore pay privately, often at substantial cost to themselves. People are used to paying towards dental treatment costs. However, dental implant treatment is much more expensive than existing treatments--such as removable dentures. We know very little about how dentists make decisions about whether to offer such treatments, or what patients consider when deciding whether or not to pay for them.
  
  
  METHODS
  Mixed methods will be employed to provide insight and understanding into how clinical need is determined, and what influences people's decision making processes when deciding whether or not to pursue a dental implant treatment. Phase 1 will use a structured scoping questionnaire with all the General dental practitioners (GDPs) in three Primary Care Trust areas (n = 300) to provide base-line data about existing practice in relation to dental implant treatment, and to provide data to develop a systematic sampling procedure for Phase 2. Phases 2 (GDPs) and 3 (patients) use qualitative focused one to one interviews with a sample of these practitioners (up to 30) and their patients (up to 60) to examine their views and experiences of decision making in relation to dental implant treatment. Purposive sampling for phases 2 and 3 will be carried out to ensure participants represent a range of socio-economic circumstances, and choices made.
  
  
  CONCLUSIONS
  Most dental implant treatment is conducted in primary care. Very little information was available prior to this study about the quantity and type of treatment carried out privately. It became apparent during phase 2 that ISOD treatment was an unusual treatment in primary care. We thus extended our sample criteria for Phase 3 to include people who had had other implant supported restorations, although not single tooth replacements.
authors.affiliation: Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK. catherine.exley@ncl.ac.uk
authors.forename: Catherine E
authors.initials: CE
authors.lastname: Exley
authors.forename: Nikki S
authors.initials: NS
authors.lastname: Rousseau
authors.forename: Jimmy
authors.initials: J
authors.lastname: Steele
authors.forename: Tracy
authors.initials: T
authors.lastname: Finch
authors.forename: James
authors.initials: J
authors.lastname: Field
authors.forename: Cam
authors.initials: C
authors.lastname: Donaldson
authors.forename: J Mark
authors.initials: JM
authors.lastname: Thomason
authors.forename: Carl R
authors.initials: CR
authors.lastname: May
authors.forename: Janice S
authors.initials: JS
authors.lastname: Ellis
mesh_terms: D003657:Decision Making; D003757:Dental Implantation / Q000191:economics*; D003812:Dentist-Patient Relations; D005382:Financing, Personal; D006301:Health Services Needs and Demand; D006801:Humans; D007407:Interviews as Topic; D017008:Negotiating; D010358:Patient Participation; D013222:State Medicine; D006113:United Kingdom