Use and effectiveness of chest radiography and low-back radiography in screening.

One of the Food and Drug Administration's educational programs to optimize the use of medical radiation is the investigation of the efficacy of selected x-ray film examinations. The goal of this program is to provide clinical information needed to aid physicians in their judgment. The routine chest-radiograph screening examination has been studied, and recommendations for five applications of chest-radiograph screening have been published. These recommendations, plus results of FDA research on the efficacy of low-back radiography, are discussed.

Skull film radiography in the management of head trauma.

The contribution of plain skull radiography to the management of head trauma has been a subject of debate for more than 20 years. In an effort to reduce overutilization, criteria have been developed to identify those patients likely to have positive diagnostic results; these were called "high-yield criteria." Such high-yield criteria have been shown to reduce significantly the ordering of skull radiographs without any apparent adverse effect on patients. Several issues must be addressed before high-yield criteria or referral criteria can be promulgated on a nationwide basis. First, it must be determined whether the criteria applicable to a pediatric population differ from the criteria applicable to an adult population. Second, studies must be conducted to determine the outcome of patients who are not radiographed when high-yield criteria are used. A more fundamental issue, perhaps, is whether the identification of a fracture has any impact on patient management. It may, in fact, be more relevant (as Masters suggests) to develop a set of criteria to identify those patients in whom significant sequelae would be expected. Physician acceptance of referral criteria for ordering skull radiographs may depend ultimately on the direction taken on the medicolegal issue in this country, and on patient and physician attitudes regarding the necessity of knowing whether the patient has sustained a simple skull fracture.

Patient-selection criteria for panoramic radiography.

The purpose of this study was to determine whether selection criteria could be developed for the use of panoramic radiographs in the treatment planning of patients seeking dental care. A total of 1,424 patients were included in this 10-month study. Clinicians were asked to indicate what signs or symptoms caused them to order a panoramic radiograph. After the radiograph was taken, the referring clinician was asked to indicate the extent that the panoramic radiograph influenced the patient's care. The panoramic examination was found to be most productive in dentulous patients when no other radiographs were ordered and least productive in dentulous patients who had already had a full-mouth set of radiographs. Considering all patients, it is possible to reduce the number of panoramic examinations by 73% while missing 6% of the findings that influence patient treatment. The most important selection criteria for the panoramic examination are whether the radiograph was ordered for a "general screening examination" (a negative predictor) and whether the radiograph was ordered for any specific examination (a positive predictor).

Network capitation practices: a new concept.

The percentage of consumers in the U. S. covered by dental insurance has increased dramatically over the last 10 years. As dental insurance grows, it is becoming increasingly important to examine the context of dental care payment systems. At present, almost all insurance programs are geared toward the fee-for-service system, which reimburses dentists a fixed sum for each type of procedure. The exceptions to fee-for-service dental insurance plans are few. A capitation program for dental care, which reimburses dentists a fixed amount per enrolled patient regardless of services rendered, offers many advantages for both consumers and providers and should be available as an option. Network capitation represents a new approach to the payment of dental care. A network capitation program is being developed in the United States and will use an approach involving two contracts, one which will be used with an insurance company, and the second with a network of private practitioners. The insurance company will supply dental practices with dental patients and funds on a capitation basis. Patients will be given the choice of fee-for-service or capitation. Network capitation allows fee-for-service solo or group practitioners to incorporate capitation patients into their practice.

Professional encroachment: a comparison of the emergence of denturists in Canada and Oregon.

In 1978, supporters of denturism in Oregon succeeded in passing an initiative which allows denturists to provide dentures directly to the public. The steps which led to the referendum included three unsuccessful attempts to have the state legislature enact a law legalizing denturism. After capturing broad-based consumer support, the issue was placed on the ballot and passed by an overwhelming margin. Both the denturists and the dentists in Oregon adopted strategies similar to those used in Canada over 20 years ago when the issue was raised in a number of provinces. As was the case in Canada, the denturists prevailed. Denturists stressed the price differential and the issue of freedom of choice. Dentists stressed health and safety issues. The public perceived the dentists' campaign as negative and self-serving. This perception may have contributed to the election results. In order to avoid this tarnished image, dentists must anticipate the public's needs, and formulate strategies to meet such needs.