ABSTRACT
OBJECTIVE: The objective of this study was to produce a standardized medical risk-related history (MRRH) in order to identify the medically compromised patient (MCP) attending the general dental practitioner for treatment, to develop such a history (EMRRH), and to validate it in dental practices in 10 European countries. STUDY DESIGN: The Dutch MRRH, adapted to allow for legal and cultural differences of the participating countries was introduced. After consensus and repeated testing, the questionnaire was validated. In this last phase, 1000 patients older than 18 attending dental practices were selected, 100 per country; 994 medical histories were suitable for statistical analysis. Validation was carried out by a physician accustomed to making preoperative assessments, including the ASA risk classification. RESULTS: Mean specificity per country was 99.1 and per EMRRH item was 99.0. Mean sensitivity per country was 93.2 and per item was 93.7. Cohen's kappa for the countries involved was 0.81 to 0.98 and for subsequent questions was 0.81 to 0.97. CONCLUSION: The EMRRH was found to be valid in the detection of medically compromised patients in 10 European countries.
Subject(s)
Dental Care for Chronically Ill , Medical History Taking , Surveys and Questionnaires , Adolescent , Adult , Aged , Aged, 80 and over , Europe , Female , Humans , Male , Middle Aged , Observer Variation , Risk Assessment , Self Disclosure , Sensitivity and SpecificityABSTRACT
OBJECTIVES: To establish the effects of the 1995 insurance system reform on dental utilisation. STUDY DESIGN: Four categories of patients experiencing homogeneous insurance changes - public/private insurance with and without additional private dental insurance--were analysed. The reform was hypothesised to increase dental expenditure for the Sickfund with (S+), and privately insured with (P+) and without (P-) additional dental insurance. Sickfund insured without additional dental insurance (S-) were not expected to change dental expenditure. Volume effects were also hypothesised per insurance group. These eight hypotheses were tested using longitudinal dental utilisation data of regularly attending adult dental patients: 91 general dental practitioners provided 803 utilisation records. RESULTS: The expected increase by S+ of dental expenditure was corroborated by the results. The three other hypotheses regarding dental expenditure were not supported by the results. The hypotheses regarding volume of dental services were partially supported. The S+ significantly increased their uptake of crowns. The S- showed constant uptake of crowns, endodontics and extractions as expected. The results for P+ and P- showed the constant uptake of restorations. The P+ group also showed the hypothesised significant increase in endodontics. CONCLUSIONS: Having additional dental insurance did not seem to influence the use of dental care in this population of regular attending adult patients. The basic health insurance (Sickfund or private) seemed to have an effect on dental utilisation. The results indicate an association of (expected) treatment need and the application for additional dental insurance.