The response rate was 65% for dentists (97 of the 145 dentists responded) and 90% for dental hygienists (44 of the 49 dental hygienists responded). In total, 141 (73%) dentists and dental hygienists responded. Five dental hygienists and one dentist were excluded from further analyses because they had not treated drug users. Thus, the final sample for analyses comprised of 135 clinicians, 96 dentists, and 39 dental hygienists. The majority of respondents were female (74%).
While all dental hygienists were graduated from Norway, 31% of responding dentists were educated outside of Norway. Forty-one percent of dentists educated in Norway, 38% of dentists educated abroad and 68% of the dental hygienists had had an undergraduate education in dental management of drug users. The majority of respondents (72%), both dentists (71%) and dental hygienists (74%), had had postgraduate education in the treatment of drug users at their working place, 62% of them had done so during the last year. Among all respondents, 56% of dentists and 62% of dental hygienists reported having over 10 years of clinical experience.
Most respondents (71%) did not treat drug users very often. A third of the dentists (35%) and 10% of the dental hygienists had treated five or more drug users per month (p < 0.05). There was a tendency that clinicians with more clinical experience treated drug users more often (not statistically significant).
Seventy-five percent of respondents reported that they set up longer appointments for drug users than for other patients. Dental hygienists reported that drug users required more time for communication (93%), motivational interviews (80%), and preventive procedures (90%), while dentists reported a need for additional time for communication (70%) treatment planning (69%) and treatment procedures (73%).
The majority of the respondents stated that drug users often had missing appointments and poor compliance with oral hygiene advice, in addition to poor general hygiene and increased risk for transmitted diseases (Table 1). The respondents also experienced that drug users had dental fear more often compared with other patient groups; however, those who treated drug users more often reported less dental fear. There were no statistically significant differences in the attitudinal responses between dentists and dental hygienists. No other individual characteristics of dentists and dental hygienists (gender, country of graduation, years in clinical practice, undergraduate or postgraduate education on dental management) were statistically significantly associated with their attitudes towards drug users as dental patients.
Table 1. Dental professionals’ experiences of drug users as dental patients in the PDS. Distribution (%) of respondents with positive responses (agree or strongly agree) in relation to the number of drug users treated per month.
Drug users
|
Total
(n =133)
%
|
Number of drug users treated per month
|
Less than 5
(n = 96)
%
|
5 or more
(n = 37)
%
|
-have dental fear more often compared with other patient groups
|
85
|
90
|
76*
|
-often have missing appointments
|
91
|
93
|
89
|
-have poor compliance with oral hygiene advice
|
76
|
72
|
86
|
-have poor general hygiene
|
74
|
72
|
78
|
-have increased the risk for transmitted diseases
|
84
|
82
|
89
|
*indicates statistically significant differences (Chi-squared test, p < 0.05).
The majority of dentist and dental hygienists reported that there is acceptance for using more time for examination and treatment of drug users in their PDS clinics (Table 2). Thirty-nine percent of the respondents experienced economic barriers to providing treatment. A significantly higher proportion of clinicians treating drug users often reported economic barriers; dentists experienced this significantly more often compared to dental hygienists (43% versus 26%; p < 0.05). About 80% of the respondents felt that it was important to maintain the free of charge necessary dental treatment for this patient group (Table 2).
Table 2. Dental professionals’ experiences of organizational facilitation of the treatment of drug users in their PDS units. Distribution (%) of respondents with positive responses (agree or strongly agree) in relation to the number of drug users treated per month.
|
Total
(n = 133)
%
|
Number of drug users treated per month
|
Less than 5
(n = 96)
%
|
5 or more
(n = 37)
%
|
It is accepted to use more time for examination of drug users
|
68
|
72
|
60
|
It is accepted to use more time for treatment of drug users
|
73
|
72
|
76
|
There are economic barriers in treating drug users
|
39
|
32
|
56*
|
It is important to maintain free of charge dental treatment for drug users
|
81
|
83
|
76
|
*indicates statistically significant differences (Chi-squared test, p < 0.05).
As shown in Table 3, more than 90% of the respondents felt competent in the clinical treatment of this group. A slightly lower proportion (84%) felt competent in communication with them and 71% considered dental treatment of drug users as professionally satisfying. Still, 17% of respondents felt anxious to treat drug users, and 80% felt they needed more knowledge in dental treatment of this group. There were no significant differences in relation to the number of drug users treated per month.
Table 3. Dental professionals’ perceived competence in treating drug users in the PDS. Distribution (%) of respondents with positive responses (agree or strongly agree) to questions presented in the table and in relation to the number of drug users treated per month.
|
Total
(n = 132)
%
|
Number of drug users treated per month
|
Less than 5
(n = 96)
%
|
5 or more
(n = 36)
%
|
I feel anxious to treat drug users
|
17
|
18
|
14
|
I feel competent in communication with drug users
|
84
|
84
|
84
|
I feel competent in the treatment of drug users
|
93
|
93
|
95
|
I need more knowledge in the dental treatment of this group
|
80
|
78
|
86
|
Table 4. Multivariable logistic regression analysis of associations between selected positive attitudinal statements (agree or strongly agree) and explanatory variables (number of drug users treated per month, profession, country of education and years of clinical experience (n=133). Odds ratios (OR), 95% confidence intervals (CI) and P-values.
Explanatory variables
|
Missing appointments1
|
Risk of transmitted diseases2
|
More time for treatment3
|
Economic barriers for treatment4
|
OR (95% CI)
|
P-value
|
OR (95% CI)
|
P-value
|
OR (95% CI)
|
P-value
|
OR (95% CI)
|
P-value
|
Drug user treated per month (ref: < 5)
|
|
|
|
|
|
|
|
|
5 or more
|
0.51 (0.12, 2.14)
|
0.36
|
1.86 (0.52, 6.59)
|
0.34
|
1.41 (0.56, 3.56)
|
0.47
|
2.46 (1.08, 5.63)
|
0.03
|
Profession (ref:Dental hygienist)
|
|
|
|
|
|
|
|
|
Dentist
|
0.94 (0.20, 4.39)
|
0.94
|
2.60 (0.74, 9.09)
|
0.14
|
0.82 (0.30, 2.21)
|
0.70
|
1.40 (0.56, 3.49)
|
0.47
|
Educated in Norway (ref: Yes)
|
|
|
|
|
|
|
|
|
No
|
3.69 (0.42, 32.59)
|
0.24
|
0.15 (0.04, 0.52)
|
< 0.01
|
0.34 (0.13, 0.88)
|
0.03
|
1.79 (0.72, 4.47)
|
0.21
|
Clinical experience (ref: >10 years)
|
|
|
|
|
|
|
|
|
10 years or less
|
0.23 (0.06, 0.94)
|
0.04
|
1.46 (0.53, 3.98)
|
0.46
|
1.13 (0.51, 2.52)
|
0.77
|
0.89 (0.43, 1.87)
|
0.76
|
1 Drug users often have missing appointments
2 Drug users have increased the risk for transmitted diseases
3 It is accepted to use more time for treatment of drug users
4 There are economic barriers in treating drug users
Table 4 shows the results of the multivariable analyses exploring associations between number of drug users treated per month, the profession of the clinicians (dental hygienist versus dentist), country of education and years of clinical experience and selected attitudinal statements. Less experienced clinicians were less likely to experience drug users having missing appointments (OR 0.23, CI 0.06, 0.94). Clinicians educated outside of Norway were less likely to perceive drug users having increased the risk for transmitted diseases (OR 0.15, CI 0.04, 0.52) as well as to accept to use more time for treatment of drug users (OR 0.34, CI 0.13, 0.88). The odds of experiencing economic barriers were higher among clinicians treating 5 or more drug users per month (OR 2.46, CI 1.08, 5.63).
Forty percent of the respondents reported that they had daily, weekly, or monthly communication with employees at rehabilitation institutions. A third of the dentists (33%) and 21% of the dental hygienists responded that they were satisfied with the collaboration they had with the RIs.
The respondents in this study answered that the interprofessional collaboration was facilitated when the RI staff was easily available for communication (e.g., by telephone), felt responsible for assisting drug users in coping with dental appointments, and when they had knowledge of the treatment included and not included in the free dental care provided in the PDS (Table 5). Dental personnel emphasized the importance of having the necessary knowledge about patients’ medications and general health status. Several respondents pointed out that the fact that “patients are driven and followed by the RI staff to the dental clinic” results in fewer drop-outs and in a higher quality of dental treatment for drug users. At the same time, lack of communication and contact between the two service sectors was seen as a barrier for collaboration (Table 5).
Motivated patients were also a facilitator for successful collaboration between dental clinics and rehabilitation institutions. The respondents appreciated the support from RI staff, highlighting the importance of dental care but also not rising unrealistic high expectations on dental treatment. “Patients with high expectations and no understanding of principles of dental treatment” were seen as an obvious barrier for interprofessional collaboration (Table 5).
Table 5: Barriers and facilitators for interprofessional collaboration seen from dental professionals’ perspectives. *RI: Rehabilitation institution
Theme
|
Barriers
|
Facilitators
|
Professionals in the RI*s
|
· Lack of communication
· Difficult to communicate
· A large number of employees
· A large number of patients
· Long waiting time for dental treatment
|
· Good communication
· Easy to communicate by phone
· Holding appointments
· Informing about appointments changes
|
· Lack of patient follow-up by RI* personnel
· Lack of information about patients before dental appointment/treatment
|
· Good patient follow-up by RI* personnel
· Good information about patients ahead of a dental appointment
· RI* personnel drive patients to a dental clinic
|
· Lack of knowledge about drug users and their statutory rights
|
· Good knowledge about drug users and their statutory rights
|
Patients (drug users)
|
· Lack of motivation
· Negative attitudes
· Appointments drop-outs
|
· RI* personnel motivate patients
|
· Lack of knowledge about statutory rights
· Lack of knowledge about treatments limitations
· A high expectation of dental treatment
|
· RI* personnel informs patients about their statutory rights
|
Organizational context
|
|
· Leadership support
|
· Lack of meeting arenas
|
· Regular collaboration meetings
|