scholarly journals Assessing the perceived impact of post Minamata amalgam phase down on oral health inequalities: a mixed-methods investigation

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
V. R. Aggarwal ◽  
S. Pavitt ◽  
J. Wu ◽  
B. Nattress ◽  
P. Franklin ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Oral Health ◽  
Qualitative Study ◽  
Health Services ◽  
Health Inequalities ◽  
Dental Amalgam ◽  
Free Text ◽  
Oral Health Services ◽  
Phase Out ◽  
The Impact

Abstract Background Data from countries that have implemented a complete phase out of dental amalgam following the Minamata agreement suggest increased costs and time related to the placement of alternatives with consumers absorbing the additional costs. This aim of this study was to investigate the impact of a complete phase out of dental amalgam on oral health inequalities in particular for countries dependent on state run oral health services. Methods A mixed methods component design quantitative and qualitative study in the United Kingdom. The quantitative study involved acquisition and analysis of datasets from NHS Scotland to compare trends in placement of dental amalgam and a survey of GDPs in Yorkshire, UK. The qualitative study involved analysis of the free text of the survey and a supplementary secondary analysis of semi-structured interviews and focus groups with GDPs (private and NHS), dental school teaching leads and NHS dental commissioners to understand the impact of amalgam phase down on oral health inequalities. Results Time-trends for amalgam placement showed that there was a significant (p < 0.05) reduction in amalgam use compared with composites and glass ionomers. However dental amalgam still represented a large proportion (42%) of the restorations (circa 1.8 million) placed in the 2016–2017 financial year. Survey respondents suggest that direct impacts of a phase down were related to increased costs and time to place alternative restorations and reduced quality of care. This in turn would lead to increased tooth extractions, reduced access to care and privatisation of dental services with the greatest impact on deprived populations. Conclusion Amalgam is still a widely placed material in state run oral health services. The complete phase down of dental amalgam poses a threat to such services and threatens to widen oral health inequalities. Our data suggest that a complete phase out is not currently feasible unless appropriate measures are in place to ensure cheaper, long-lasting and easy to use alternatives are available and can be readily adopted by primary care oral health providers.

scholarly journals The Effect of Physician Oral Health Services on Dental Use and Expenditures under General Anesthesia

2019 ◽  
Vol 5 (2) ◽  
pp. 146-155 ◽  
Author(s):  
B.D. Meyer ◽  
R. Wang ◽  
M.J. Steiner ◽  
J.S. Preisser
Keyword(s):  
Health Care ◽  
Early Childhood ◽  
Oral Health ◽  
Health Services ◽  
General Anesthesia ◽  
Early Childhood Caries ◽  
Dental Treatment ◽  
Oral Health Care ◽  
Oral Health Services ◽  
The Impact

Background: Despite early evidence touting the effectiveness of physician-provided oral health services (POHS), recent evidence suggests these services might have little impact on caries-related outcomes in children. General anesthesia (GA) is often used to treat early childhood caries and may be considered the most extreme utilization outcome. We sought to assess the impact of POHS utilization on dental GA utilization and expenditures. Methods: We used the Medicaid claims of a birth cohort of children born in 2008 in North Carolina ( N = 32,558) to determine the impact of POHS on dental utilization and expenditures under GA for individual children. Children were followed until their eighth birthday. We analyzed the association of the number of prior POHS visits with visit-specific outcomes of dental treatment under GA using population-averaged models fit with generalized estimating equations with exchangeable working correlation structure. Results: Children with 2 or more previous POHS visits had reduced odds of GA (odds ratio [OR] = 0.93; confidence interval [CI], 0.87–0.99; P = 0.029) and expenditures ($114; CI,−$152.61 to −$75.19; P < 0.001) compared to those without physician-provided oral health visits, adjusting for age, sex, race/ethnicity, and geographic residence. Dental expenditures did not differ between POHS and non-POHS subjects at non-GA visits. Conclusions: POHS decreased the odds of having dental GA treatment and dental expenditures at GA visits. The role of physicians in oral health care can reduce the impact on the most severe outcome—treatment under general anesthesia. Knowledge Transfer Statement: The results of this study have important financial implications for state Medicaid programs and disease management programs trying to mitigate the costs of treating early childhood caries under general anesthesia. Children who receive physician oral health care are less likely to use and more likely to save money on general anesthesia to complete dental treatment.

scholarly journals Non-financial barriers in oral health care: a qualitative study of patients receiving opioid maintenance treatment and professionals’ experiences

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Siv-Elin Leirvaag Carlsen ◽  
Katja Isaksen ◽  
Lars Thore Fadnes ◽  
Ole Jørgen Scheie Lygren ◽  
Anne Nordrehaug Åstrøm
Keyword(s):  
Health Care ◽  
Oral Health ◽  
Qualitative Study ◽  
Health Services ◽  
Health Care Services ◽  
Maintenance Treatment ◽  
Oral Health Care ◽  
Opioid Maintenance Treatment ◽  
Care Services ◽  
Oral Health Services

Abstract Background People with substance use disorders often have poor oral health, which can negatively impact their quality of life. Since 2005, patients receiving opioid maintenance treatment (OMT) in Norway have been eligible for free oral health care services offered through public oral health clinics. Despite a large need for oral health services amongst patients in OMT, figures suggest that the use of these services is low amongst this patient group. It has been unclear which barriers that contribute to this. This qualitative study explores the underlying barriers to the use of oral health care services amongst patients in OMT, from the perspective of the patients as well as dental health care workers (DHW). Methods Through a combination of focus group interviews and individual interviews, data were collected from 63 participants; 30 patients in OMT and 33 DHW. Thematic analysis identified key themes for the use (or not) of oral health care services amongst patients in OMT. Results Both individual and structural barriers prevent OMT patients from using the free oral health care services offered to them. These barriers include struggling to attend appointments, anxiety and fear of dentists, discrepancies between patients’ expectations and the services offered and perceived stigma. OMT patients’ lack of information regarding their rights and access to oral health services was also a barrier, as was DHWs’ lack of knowledge and information of the OMT system and what they can offer patients. Conclusions OMT patients face several barriers in accessing and using oral health care services. However, through a number of relatively simple measures, it is possible that the use of oral health services amongst OMT patients can be increased.

scholarly journals Epidemiological profile of patients utilising public oral health services in Limpopo province, South Africa

2017 ◽  
Vol 9 (1) ◽  
Author(s):  
Lawrence K. Thema ◽  
Shenuka Singh
Keyword(s):  
Oral Health ◽  
Health Services ◽  
Limpopo Province ◽  
World Health ◽  
Age Group ◽  
Oral Diseases ◽  
District Hospitals ◽  
Oral Health Services ◽  
Epidemiological Profile ◽  
The Impact

Background: Despite the impact of oral diseases on the quality of life, there is limited updated evidence on oral health status in Limpopo province.Objectives: To determine the epidemiological profile of patients utilising public oral health services in Limpopo province.Method: This was a descriptive retrospective clinical chart review conducted in five purposively selected district hospitals in Limpopo province. The collected data included the patient’s sociodemographic information, reasons for dental consultation, information on the dental or oral diseases and the treatment received. Five hundred clinical files were systematically selected (100 from each district hospital) for the period 01 January 1995 to 31 December 2013. Data were collected using the World Health Organization’s indicator age groups, namely 6-year-olds, 12-year-olds, 18-year-olds and 35–44-year-old groups. A data capturing sheet was used to record the collected information. Data were analysed using the statistical software package for social sciences SPSS version 23.0.Results: The majority of patients were in the age group of 6 to 20 years (n = 375, 75%). The majority were male patients (n = 309; 62%). Dental caries was the most common complaint (n = 298, 60%). The second most common main complaint in this age group was retained primary or deciduous teeth (n = 60, 12%) affecting children mainly in the age group of 6 to 12 years. The most common clinical procedure across all five districts was dental extractions (n = 324, 64%). Other clinical interventions included scaling and polishing (n = 33, 12%) and dental restorative care (n = 20, 3%).Conclusion: There is an urgent need to reorient oral health service delivery in Limpopo province to focus more on preventive oral health programmes.

scholarly journals Exploring the Impact of ACA on Rural‐Urban Disparity in Oral Health Services Among US Noninstitutionalized Adults

2020 ◽  
Vol 37 (1) ◽  
pp. 103-113 ◽  
Author(s):  
Wei‐Chen Lee ◽  
Chih‐Ying Li ◽  
Hani Serag ◽  
Maryam Tabrizi ◽  
Yong‐Fang Kuo
Keyword(s):  
Oral Health ◽  
Health Services ◽  
Oral Health Services ◽  
The Impact

scholarly journals Reorienting Oral Health Services to Prevention: Economic Perspectives

2021 ◽  
pp. 002203452098679
Author(s):  
C.R. Vernazza ◽  
S. Birch ◽  
N.B. Pitts
Keyword(s):  
Resource Allocation ◽  
Cost Effectiveness ◽  
Oral Health ◽  
Health Services ◽  
Pay For Performance ◽  
Fee For Service ◽  
Life Years ◽  
Oral Health Services ◽  
Context Specific ◽  
The Impact

Despite the recognized need to change the emphasis of health services by shifting the balance from treatment to prevention, limited progress has been made in many settings. This is true in oral health, where evidence for preventive interventions that work has not been systematically exploited in oral health services. While reorienting health services is complex and context specific, economics can bring a helpful perspective in understanding and predicting the impact of changes in resource allocation, provider remuneration systems, and patient payments. There is an increasing literature on the economics of different prevention approaches. However, much of this literature focuses on the costs and potential savings of alternative approaches and fails to take into account benefits. Even where benefits are taken into account, these tend to be narrowly focused on clinical outcomes using cost-effectiveness analysis, which may be of little relevance to the policy maker, patient, and the public. Some commonly used economic approaches (such as quality-adjusted life years and incremental cost-effectiveness ratios) may also not be appropriate to oral health. Using alternative techniques, including wider measures of benefit and employing priority setting and resource allocation tools, may provide more comprehensive information on economic impact to decision makers and stakeholders. In addition, it is important to consider the effects of provider remuneration in reorienting services. While there is some evidence about traditional models of remuneration (fee for service and capitation), less is known about pay for performance and blended systems. This article outlines areas in which economics can offer an insight into reorientation of health systems toward prevention, highlighting areas for further research and consideration.

scholarly journals Impact of COVID-19 pandemic social restriction measures on people with rheumatic and musculoskeletal diseases in the UK: a mixed-methods study

BMJ Open ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. e048772
Author(s):  
Toby O Smith ◽  
Pippa Belderson ◽  
Jack R Dainty ◽  
Linda Birt ◽  
Karen Durrant ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Qualitative Study ◽  
Online Survey ◽  
Musculoskeletal Diseases ◽  
Community Dwelling ◽  
Secondary Outcome ◽  
Healthcare Provision ◽  
Social Restriction ◽  
The Uk ◽  
The Impact

ObjectivesTo determine the impact of COVID-19 pandemic social restriction measures on people with rheumatic and musculoskeletal diseases (RMDs) and to explore how people adapted to these measures over time.DesignMixed-methods investigation comprising a national online longitudinal survey and embedded qualitative study.SettingUK online survey and interviews with community-dwelling individuals in the East of England.ParticipantsPeople in the UK with RMDs were invited to participate in an online survey. A subsection of respondents were invited to participate in the embedded qualitative study.Primary and secondary outcome measuresThe online survey, completed fortnightly over 10 weeks from April 2020 to August 2020, investigated changes in symptoms, social isolation and loneliness, resilience and optimism. Qualitative interviews were undertaken assessing participant’s perspectives on changes in symptoms, exercising, managing instrumental tasks such a shopping, medication and treatment regimens and how they experienced changes in their social networks.Results703 people with RMDs completed the online survey. These people frequently reported a deterioration in symptoms as a result of COVID-19 pandemic social restrictions (52% reported increase vs 6% reported a decrease). This was significantly worse for those aged 18–60 years compared with older participants (p=0.017). The qualitative findings from 26 individuals with RMDs suggest that the greatest change in daily life was experienced by those in employment. Although some retired people reported reduced opportunity for exercise outside their homes, they did not face the many competing demands experienced by employed people and people with children at home.ConclusionsPeople with RMDs reported a deterioration in symptoms when COVID-19 pandemic social restriction measures were enforced. This was worse for working-aged people. Consideration of this at-risk group, specifically for the promotion of physical activity, changing home-working practices and awareness of healthcare provision is important, as social restrictions continue in the UK.

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