Retrospective review of service utilisation for Personal Dental Services

Study Objective: To determine the effect of the introduction of a capitation based PDS scheme in Lambeth, Southwark and Lewisham Primary Care Trusts on the number of registered patients and treatments performed. Methods: Analyses of patient registration data (Data Set 1, DS1) and treatment data (DS2) provided by the Dental Practice Board were undertaken for 1 year pre PDS period (Oct 97-Sept 98) and post introduction of the PDS(Oct 98- Mar 03) for DS1 and five years post PDS for DS2. Analyses of the clinic notes for 1500 patients (DS3) was also undertaken. To determine whether there had been a post PDS as compared to pre PDS, (PoPr) increase in registration levels, a summary mean was used as a reference for the typical level pre PDS and the lower 95% CIs of the post PDS means were compared to this. Using Generalised Estimating Equations, overall trends for uptake, post PDS were identified. Treatment patterns were assessed using both DS2 and DS3. DS3 additionally enabled pre and post test analyses such as exemption status of patients. Results: There was a small significant increase in the numbers of children registered, PoPr, however there was no increase in total registrations (children + adults) identified (p<0.05). A significant reduction in the number of treatment items was identified, -13% (95% CI, -19%, -7%), PoPr, which may indicate that a less invasive style of service was provided. However this interpretation requires to be qualified by the small changes identified for changes for different treatment types. Conclusion: The PDS achieved mixed results for its service utilisation objectives. Facilitating change in practice style and performance monitoring require further developments. This study was funded by Southwark Primary Care Trust, who are the host commissioners across the three PCTs.