RESUMO
The question of oral health care and access to it for persons with disabilities is a key public health issue. This contribution describes the general landscape of access to oral health care for persons with disabilities since Law no.2005-102 of February 11, 2005, taking a broad approach that spans initial training and continuing education in the sector, the Romain Jacob charter, and the implementation of several networks. It also provides an analysis of the use of financial measures to incentivize the recognition of overtime spent providing care for persons with disabilities. The results of this study show that: considerable progress has been made in training; the missions of disability specialists must be redefined at the departmental level to enable these professionals to play their role; the enhanced financial recompense offered for this care is a step in the right direction but is insufficient to improve access to care for persons with disabilities; and, although care networks have proliferated, their future is uncertain given the precariousness of their funding. They remain, however, a system for providing care operating in parallel to mainstream care. While definite progress has been made over the past ten years, the Handifaction barometer shows that there is still much room for improvement as regards persons with disabilities' satisfaction with access to oral health care in France.
La question des soins buccodentaires et d'accès aux soins des personnes en situation de handicap est une question de santé publique primordiale. L'objectif est de décrire le paysage général de l'accès aux soins oraux des Personnes en situation de handicap depuis la loi du 11 février 2005. Un descriptif allant de la formation initiale à la formation continue en passant par l'engagement à appliquer la charte Romain Jacob et à la mise en place d'un certain nombre de réseaux est rapporté. Une analyse de l'utilisation des mesures pécuniaires incitatives à la prise en compte du temps supplémentaire de prise en soin des personnes handicapés est réalisé. Les résultats de ce descriptif montrent : Que de grands progrès ont été réalisés en matière de formation. Qu'une redéfinition des missions des référents handicap au niveau des ordres départementaux est nécessaire pour qu'ils puissent jouer leur rôle. Que la valorisation financière avec le supplément appliqué à la prise en charge est une avancée mais reste insuffisante pour améliorer l'accès aux soins des personnes en situation de handicap.Que les réseaux de soins se sont multipliés mais ont un avenir incertain compte tenu de la précarité de leur financement. Ils restent, cependant, un système de prise en charge parallèle à l'accès aux soins de droit commun. Si des progrès certains ont été constatés ces dix dernières années, le baromètre d'Handifaction reste très perfectible quant à la satisfaction des personnes en situation de handicap de l'accès aux soins buccodentaire sur le territoire.
Assuntos
Assistência Odontológica para a Pessoa com Deficiência , Pessoas com Deficiência , Acessibilidade aos Serviços de Saúde , Humanos , Assistência Odontológica , França , Saúde BucalRESUMO
BACKGROUND: Persons with schizophrenia are particularity susceptible to poor oral health. Symptoms of schizophrenia often affect oral health behaviors and lifestyle. The aim was to explore coping strategies used by people with schizophrenia in oral health in order to understand and to best involve them in the management of their own oral health in daily life. MATERIALS AND METHODS: This is systematic review reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statements. We included cross-sectional and longitudinal quantitative and qualitative studies that 1) examined coping strategies regarding oral health in persons with schizophrenia or 2) examined coping strategies were used in dental care. We included studies conducted with at least one PWS aged 18 years old more and without restriction on sex, socioeconomic status, or language. RESULTS: The 8 studies included suggest that coping strategies depends on complex translation processes that can be either personal (e.g., psychological symptomatology, neuropsychological functioning to adversely affect hope, self-esteem, self-stigma, self-determination, sense of coherence, and resilience) and/or environmental factors (e.g., peer support and efficacy of rehabilitations programs). We further identified that the main factor influencing coping strategies was dental stress situation. CONCLUSIONS: This review suggests that coping strategies play a crucial role in the recovery process for oral health of PWS. Translation processes in oral health should be more explored in the future to clarify the capacity of PWS to cope with essential self-care in oral health on daily life.
RESUMO
OBJECTIVE: The aim of this study was to test the feasibility of a therapeutic educational program in oral health (TEPOH) for persons with schizophrenia (PWS). DESIGN: In a qualitative study, we explored the representation of oral health before and after a TEPOH. Clinical Setting: PWS are at greater risk of decayed and missing teeth and periodontal diseases. In a previous publication, we described the different steps in building a TEPOH by taking into account the experiences of PWS concerning oral health quality of life. This TEPOH aimed at promoting a global health approach. Participants: Voluntary PWS and their caregivers were recruited during face-to-face interviews at "Les Boisseaux" (a psychiatric outpatient centre) in Auxerre (France) and were included in the study between November and December 2016. Intervention: We explored the experiences of participants and their perceptions of oral health before and after the TEPOH with focus group meetings. RESULTS: Four females and three males participated in the study, and the mean age was 29.4 ± 5. Before the TEPOH, the PWS produced 28 ideas about oral health perception and 37 after the TEPOH. After the TEPOH, elements relating to the determinants of oral health (smoking and poor diet) emerged. CONCLUSIONS: These results show an evolution in oral health representation, and after some adjustments to the TEPOH, the second step will be to test this program in a large sample to generate a high level of evidence of the impact of TEPOH in the long term.
RESUMO
BACKGROUND: The aim of this work was to present the creation of appropriate tools to evaluate the coping strategies in Oral-Health-related Quality of Life (OHrQOL) implemented by persons with schizophrenia (PWS), the Schizophrenia Coping Oral Health Profile (SCOOHP), and the results of a feasibility study. METHODS: A qualitative investigation was conducted between June 2016 and May 2017.The first step included 26 semi-structured individual interviews, 20 with PWS and 6 with health professionals (HPs), and 2 focus groups (PWS and HPs) to explore the experiences of the participants and how they felt about coping strategies in OHrQOL. The second step was a feasibility study involving a statistical analysis to test the acceptability and internal consistency (Cronbach's α) of the SCOOHP. RESULTS: The analysis of these interviews allowed for us to obtain 277 items from 3545 verbatim transcriptions related to various dimensions of OHrQOL. We presented the items selected in coping concepts in this study. After selecting items in several stages, we drew up the SCOOHP scale with 23 items (15 items for positive coping and 8 items for negative coping). The feasibility study showed good acceptability, good understanding of the items and good consistency reliability (α = 0.59). CONCLUSIONS: This is the first study that has enabled us to draw up a specific tool to assess coping strategies in OHrQOL of PWS. A multicentre study involving a larger sample of PWS is underway in order to perform the psychometric validation of the SCOOHP. TRIAL REGISTRATION: Clinical Trials Gov NCT02730832. Date registered: 21 March 2016.