Health economic analyses of domiciliary dental care and care at fixed clinics for elderly nursing home residents in Sweden.

OBJECTIVES: Dental care for elderly nursing home residents is traditionally provided at fixed dental clinics, but domiciliary dental care is an emerging alternative. Longer life expectancy accompanied with increased morbidity, and hospitalisation or dependence on the care of others will contribute to a risk for rapid deterioration of oral health so alternative methods for delivering oral health care to vulnerable individuals for whom access to fixed dental clinics is an obstacle should be considered. The aim was to analyse health economic consequences of domiciliary dental care for elderly nursing home residents in Sweden, compared to dentistry at a fixed clinic. METHODS: A review of relevant literature was undertaken complemented by interviews with nursing home staff, officials at county councils, and academic experts in geriatric dentistry. Domiciliary dental care and fixed clinic care were compared in cost analyses and cost-effectiveness analyses. RESULTS: The mean societal cost of domiciliary dental care for elderly nursing home residents was lower than dental care at a fixed clinic, and it was also considered cost-effective. Lower cost of dental care at a fixed dental clinic was only achieved in a scenario where dental care could not be completed in a domiciliary setting. CONCLUSIONS: Domiciliary dental care for elderly nursing home residents has a lower societal cost and is cost-effective compared to dental care at fixed clinics. To meet current and predicted need for oral health care in the ageing population alternative methods to deliver dental care should be available.

Patient safety in domiciliary dental care for elderly nursing home residents in Sweden.

OBJECTIVE: To analyse patient safety in domiciliary dental care, with data from a quality registry. DESIGN: Retrospective analysis. CLINICAL SETTING: Domiciliary dental care, private caregiver, Sweden, 2012-2014. METHODS: All reported events in the quality registry at a provider of domiciliary dental care, (2012-05-01 to 2014-06-30) were categorized into 14 domains, and for severity as 'minor', 'moderate', or 'serious' events. The reported events were also independently assessed by an experienced reviewer for national requirements of reporting patient safety related events. RESULTS: The quality registry covered 724 (0.03%) reported events during 218,586 consecutive treatment sessions in domiciliary dental care, including 628,070 registered dental procedures. Fifty (6.9%) of the reported events were patient safety related, of which 11 (1.5%) events were reportedly of minor severity, 20 (2.8%) as moderate, and 19 (2.6%) as serious. For all degrees of severity, the most frequently reported events were related to problems with patient identity control (3.3%). None of the events required reporting to national authorities. CONCLUSIONS: Domiciliary dental care has a low frequency of patient safety related events (0.03% of all treatments). Identity controls need to be emphasised in nursing homes or where individuals are dependent on the care of others.

Validity of a questionnaire survey: the role of non-response and incorrect answers.

Errors in questionnaire surveys are usually of one of two sources: non-responses or incorrect answers. The aim was to investigate the validity of a questionnaire survey and to estimate the respective bias of these answers. Of 9,283 subjects selected to receive a questionnaire by post, 3,949 (43%) responded, and, of these, 3,400 correctly reported their Swedish social security number. Answers in the questionnaire survey were given as proportions of the claims registered at local insurance offices. In the group of respondents who had correctly reported their social security number, the answers were compared individually with the registrations in dental insurance claims. In Sweden, these claims are labeled with the patient's social security number and it is thereby possible to make such comparisons. It was shown that errors were caused by non-response and also by respondents giving incorrect answers. Incorrect answers accounted for approximately one-third of the total bias. The remaining bias was caused by a non-response error. It is concluded that questionnaire studies have a bias caused by both non-response and incorrect answers and that together these can be substantial. Scientific reports that include questionnaire surveys must describe the procedure carefully. If possible, other sources of information should be considered.

Dental care of young adults in west Sweden.

107 Swedish subjects, all 20 years old, were studied for the first three years (1990-1992) after they had left the organised dental care for children and adolescents (which is free of charge for all youth through the age of 19). They were registered in four different risk-grouping systems in order to estimate the amount of their future dental care. Three of the systems used registrations from the Public Dental Service records and in the fourth one a dentist made a subjective estimation. The follow-up used dental insurance claims to study performed treatments, courses of treatments and cost. The risk group system that used subjective estimations appeared to be the one that most accurately predicted the actual dental care consumption. Approximately 70% of the subjects received some kind of dental care during the three years. The distribution was not confined to any particular risk group. Ten per cent had received complete dental care annually. Twenty-five per cent went to a private dentist and 75% continued to go to the Public Dental Service. Those who went to a private dentist received substantially more treatment and the annual cost was a little more than twice as much as in the Public Dental Service.

Evaluation of three years of dental care of adolescents in the Public Dental Service in west Sweden.

107 individuals, randomly selected from the County of Göteborg and Bohuslän, all born in 1970 were followed regarding the dental care received 1987-1989. The records of each individual from the actual time were collected and information on diagnosis and treatment measures was gathered. Radiographs from the actual time were studied by one of the authors. Sixty-two per cent of the adolescents had been examined and treated all 3 years. Six percent had not been seen at all. The sample was divided into three groups depending on the patient's DFSa value at the examination the first year. This classification appeared to correlate well with caries development in the following years. One-fourth of the sample was responsible for the major part of the non-attendance and late cancellations. The dental health of these subjects was below average, and non-attendance seemed to be a further risk factor. The preventive measures undertaken during the study appeared to correlate poorly with the actual situation of the patient and the presence or absence of potential risk factors.

Pattern of attendance to dentists and hygienists in the County of Göteborgs and Bohus län during 1990-1992.

AIM: To describe the dental care consumption in a random sample of the population of a Swedish county 1990-1992 and to compare this with results from other Swedish studies, especially those using different self-reporting methods. SUBJECTS: One sixtieth of all adult inhabitants in the County of Göteborgs and Bohus län (all individuals born on the 17th day of an odd month) formed the sample. DESIGN: All insurance claims sent from both public and private dentists to the local insurance offices were registered in a data base. Thus every treatment registration was collected into this data base, independently, whether it was made in a private clinic or in the Public Dental Service and whether or not by a dental hygienist or other grade. Since almost all dental care in Sweden was performed within the dental insurance system, these registrations could be regarded as very near to the total dental care consumption of this group. The registrations were related to the age of the patient, the type of care (acute/regular), regularity, dental hygienist treatment and other factors. RESULTS: It was found that the youngest and the oldest patients visited a dentist less often, that approximately a quarter received hygienist care, that many received emergency treatment sometime during the observation period but that a majority also had regular dental care. Studies using a self-reporting technique reported a systematically higher level of consumption than those using insurance claim registration. CONCLUSIONS: Dental care consumption studies using self-reporting methods will probably overestimate the actual consumption. Emergency treatment is frequent even among patients who go to a dentist regularly.

Dentists' work location in relation to their origin.

The aim of this study was to map dentist' work location and put it in relation to the place where they went to secondary school. All dentists in Sweden who graduated from Swedish dental schools in 1983/84, 1984/85 and 1985/86 were studied. For all these the place where they went to secondary school and the place where they work as dentists were registered. Sweden was divided into 14 areas: central, middle and remote with respect to urbanisation, location of dental schools etc. All dentists were placed in one of the 14 areas according to their secondary school education and where they worked as active dentists. This clearly showed that dentists very often go back to the area where they have had their secondary school education.

Number of applicants and examination frequency at the dental schools in Sweden 1968-1992.

The number of applicants to the dental schools in Sweden 1968-1987 has been documented. It was shown that there was a large number of applicants up to 1980. Then the number dropped dramatically. It was at its lowest in 1985 but increased slowly after this date. The number of applicants was related to other variables: the birth rate, education capacity, real wage and unemployment. A correlation and time series analysis shows that only real wage has an impact on the number of applicants. The number of applicants has also been related to the examination rate. The results show that the examination rate decreases when the application rate is going down.

Assessing the costs of activator treatments in general practice.

From a register of patients with malocclusion, 1688 patients were selected, of which 208 (12.3 per cent) had received activator treatment in general practice. Fifteen patients having moved from the area, the remaining 193 patients were selected for the study. From the patients' records, activator treatment time, and the costs of activator and additional orthodontic treatment were estimated. The results of activator treatment were graded according to a three-grade scale. Most activator treatments (83 per cent) had a duration of 2 years or less. Approximately half (48 per cent) of the patients were estimated to have good or excellent results. There was great variation in activator treatment costs and these did not appear to be associated with treatment results. There were also extreme variations between patients in number of visits to the clinic as well as in chairside-time. Additional orthodontic treatments were performed by the GDPs in 55 per cent of the patients and 12 per cent of the patients were referred to orthodontic specialist clinics for treatment.

No-fault-compensation, patient guarantee, peer review committees: the Swedish experience.

Complaints from patients about dental treatment are on the increase internationally and especially in the USA. The Swedish system for dealing with patients' complaints embraces four different pathways which are described in this paper. One of those is a no-fault-compensation system, which is wholly separate from a procedure under the control of the Swedish licensing authority which deals exclusively with assessing professional negligence. A further, voluntary procedure for dealing with patient complaints is mediated by the Swedish Dental Association and its branches. The paper analyses the type and number of complaints and their assessment under the different procedures.