Incentivising Application of Fluoride Varnish in General Dental Practice in Scotland

Abstract

Aim: The aim of this study was to evaluate a system-wide financial incentive to increase fluoride varnish application (FVA) to the teeth of 2 to 5 year olds in general dental practice in Scotland, through the introduction of a fee-for service payment into the Statement of Dental Remuneration in October 2011. Two questions were asked: what impact did the intervention have on general dental practitioners (GDPs) varnishing behaviour and what were the mechanisms through which the intervention may have influenced behaviour?

Methods: A cohort study was undertaken in which demographics, frequency of FVA and potential mechanisms of behaviour change, were assessed via a postal questionnaire, distributed between August and October 2011 and then 16 months later after the introduction of the incentive. The questionnaire was piloted on a convenience sample of eight GDPs. All GDPs practising in Scotland (2526) were eligible to participate the first time the questionnaire was distributed. The 1090 who responded were sent the questionnaire for a second time 16 months later. Paired t- tests were used to compare changes in means over time in the same individuals and linear regression to determine whether a change in FVA over time was associated with change in potential behavioural mechanisms over time. Glasgow University Medical Veterinary and Life Sciences Ethics Committee approval was obtained.

Results: Of the 1090 GDPs who responded to the original mailing of the questionnaire, 709 (65%) were followed up. The frequency of FVA increased over the 16 months for all GDPs. However, the greatest increase occurred when practitioners reported their varnishing practice in relation to children aged 2-5 years, the group for which a payment had been introduced. The one potential mechanism that appeared to drive an increase in frequency of FVA over the sixteen months was whether practitioners perceived others (colleagues or parents) to support varnish application.

Conclusions: In the population studied the introduction of a financial incentive promoted FVA. The results suggest that financial incentives may operate by altering complex inter-linked belief systems. A gap remains between GDPs behaviour and current clinical guidelines.