A multimethod investigation including direct observation of 3751 patient visits to 120 dental offices

Stephen Wotman¹, Catherine A Demko¹, Kristin Victoroff¹, Joseph J Sudano², James A Lalumandier¹

¹Department of Community Dentistry, Case Western Reserve University, School of Dental Medicine, Cleveland, OH, USA; ²Center of Health Care Research and Policy, Case Western Reserve University, School of Medicine, Cleveland, OH, USA

Abstract: This report defines verbal interactions between practitioners and patients as core activities of dental practice. Trained teams spent four days in 120 Ohio dental practices observing 3751 patient encounters with dentists and hygienists. Direct observation of practice characteristics, procedures performed, and how procedure and nonprocedure time was utilized during patient visits was recorded using a modified Davis Observation Code that classified patient contact time into 24 behavioral categories. Dentist, hygienist, and patient characteristics were gathered by questionnaire. The most common nonprocedure behaviors observed for dentists were chatting, evaluation feedback, history taking, and answering patient questions. Hygienists added preventive counseling. We distinguish between preventive procedures and counseling in actual dental offices that are members of a practice-based research network. Almost a third of the dentist’s and half of the hygienist’s patient contact time is utilized for nonprocedure behaviors during patient encounters. These interactions may be linked to patient and practitioner satisfaction and effectiveness of self-care instruction.

Keywords: dental practice, dental practice core activities, direct observation of dental practice, Dental Davis Observation Code, dentist, hygienist patient behaviors