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| 2. |
- Johansson, Veronica, et al.
(författare)
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Multivariate analyses of patient financial systems and oral health-related quality of life
- 2010
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Ingår i: Community Dentistry and Oral Epidemiology. - : Wiley. - 0301-5661 .- 1600-0528. ; 38:5, s. 436-444
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: Since 1999, the public dental health service (PDHS) in the county of Värmland, Sweden, has two co-existing patient financial systems, i.e. ways for the patient to pay for dental care services. Alongside the traditional system of fee-for-service payment, i.e. paying afterwards for provided services, a new system of contract care is offered. In this system, dental care is covered by a contractual agreement, for which the patient pays an annual fee and receives care covered by the contract without additional costs. The aim of this article was to study whether patient financial system was associated with oral health-related quality of life (OHRQoL). Methods: A questionnaire was answered by 1324 randomly selected patients, 52% from contract care and 48% from fee-for-service. The questionnaire contained questions about how much one was prepared to pay for dental care, how much one paid for dental care the previous year, OHIP-14 (measured OHRQoL), dental anxiety, humanism of caregiver, SF-36 (measured general health), multidimensional health locus of control, sense of coherence (SOC), self-esteem and demographics. Data on patient financial system, gender and age were obtained from the sampling frame. The material was analysed with a hierarchical block method of multiple regression analysis. Results: When controlling for all other variables, patient financial system was one of the strongest associations with OHRQoL: patients in fee-for-service had worse OHRQoL than those in contract care. OHRQoL was also associated with general health, SOC and to some extent also with psychological and economic factors. Of the social variables, only being foreign born was significant: it was associated with worse OHRQoL. Conclusions: Patient financial system was associated with OHRQoL when controlling for confounding factors: patients in contract care had better OHRQoL than those in fee-for-service care.
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| 3. |
- Johansson, Veronica, et al.
(författare)
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Patients' health in contract and fee-for-service care : I. A descriptive comparison
- 2007
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Ingår i: Swedish Dental Journal. - 0347-9994. ; 31:1, s. 27-34
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Tidskriftsartikel (refereegranskat)abstract
- Fee-for-service care, paying afterwards for services provided, is the traditional adult patient financial system in dentistry in Sweden. The public dental health service (PDHS) in the county of Värmland has since 1999 also an alternative system, contract care. There, a fixed sum of money is paid annually for dental care, which then is received without additional costs. This study compares the demographics, general health and oral health-related quality of life (OHRQoL) in the patient financial systems fee-for-service and contract care in the PDHS in Värmland. A questionnaire was answered by 1,324 patients, response rate 57%. A non-response analysis was undertaken. The non-response analysis showed that the likelihood for answering the questionnaire was higher for women, for respondents in contract care and for increasing age. Further analyses revealed that the non-respondents were healthier than the respondents and that experience of pain in the mouth was the only variable increasing the likelihood of response. General health was studied with the SF-36 and OHRQoL with the OHIP-14. The demographics studied were gender, age, birth country, marital status, education and social network. The results showed that there were differences in patients' health between the patient financial systems. Respondents in contract care had better OHRQoL than those in fee-for-service care. They also had better general health in four of the dimensions of SF-36, were younger, better educated, born in Sweden and were married/living with somebody to a larger extent than fee-for-service care respondents. Fee-for-service care respondents experienced higher social affinity with their housing area. In conclusion, patients in contract care had better general health and OHRQoL than patients in fee-for-service care. There were social differences in choice of financial system and biased non-response.
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| 4. |
- Johansson, Veronica, et al.
(författare)
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Patients' health in contract and fee-for-service care : a descriptive analysis
- 2006
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Ingår i: Community Dental Health. - 0265-539X. ; 23:3, s. 187-188
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- AIM Fee-for-service, paying afterwards for services provided, is the traditional patient financial system in dentistry in Sweden. The public dental health service (PDHS) in Värmland has since 1999 also an alternative system: contract care, where a fixed sum of money is paid annually for dental care, which is then received without additional cost. This study describes demographic as well as general and oral health-related characteristics among patients in a service study comparing the two patient financial systems, fee-for-service and contract care, in the PDHS in Värmland. METHODS A questionnaire was answered by 1,324 patients (response rate 57%). Of the respondents, 52% were in contract care and 48% in fee-for-service. A non-response analysis and a special study of the non-respondents were undertaken. General health was studied with SF-36, measuring health in eight dimensions: physical functioning, role-physical, bodily pain, general health, vitality, social functioning, role-emotional, and mental health. Oral health was studied with OHIP-14, measuring oral health in seven dimensions (functional limitation, physical pain, psychological discomfort, physical disability, psychological disability, social disability and handicap) and as an index. The demographic factors included gender, age, birth country, marital status, education, and social affinity with neighbourhood and housing area. The data were analysed with contingency tables, Chi-square tests, t-tests, Mann-Whitney non-parametric tests and logistic regression analyses. RESULTS The non-response analysis revealed that the likelihood for answering the questionnaire was higher for women (OR=1.27), for respondents in contract care (OR=1.43) and for each year of life (OR=1.02). A short telephone interview with 40 non-respondents in each financial system indicated that the non-respondents had better oral health than the respondents. The non-respondents had experienced less pain in the mouth, less difficulties doing their usual jobs and had found life more satisfying than the respondents. There were no significant differences in gender or age. In the study population, differences in health were observed between the financial systems. Respondents in contract care had better oral health than those in fee-for-service (p=0.019). They had also better general health in half of the dimensions of SF-36 (physical functioning: p<0.001; role-physical: p=0.002; general health: p<0.001; social functioning: p=0.045), were younger (p<0.001), better educated (p< 0.001), were born in Sweden more often (p<0.001) and were more often married/living with somebody (p=0.011) than were the fee-for-service respondents. The fee-for-service respondents experienced higher social affinity with their housing area (p=0.049). CONCLUSION There was bias in nonresponse. Contract care patients had better general and oral health than patients in fee-for-service. Acknowledgement: The study was financed by the Swedish Research Council.
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| 5. |
- Paulander, Jörgen, 1942, et al.
(författare)
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Intra-oral pattern of tooth and periodontal bone loss between the age of 50 and 60 years. A longitudinal prospective study.
- 2004
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Ingår i: Acta odontologica Scandinavica. - : Informa UK Limited. - 0001-6357 .- 1502-3850. ; 62:4, s. 214-22
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: In a 10-year prospective study we analyzed (i) the intra-oral pattern of and (ii) potential risk factors for tooth and periodontal bone loss in 50-year-old individuals. METHODS: A randomized subject sample of 50-year-old inhabitants in the County of Varmland, Sweden, was examined at baseline and after 10 years. Data from full-mouth clinical and radiographic examinations and questionnaire surveys of 309 (72%) of the individuals who were dentate at baseline were available for analysis. Non-parametric tests and binary logistic multiple regression models were used for statistical analysis of the data. RESULTS: 4.1% of the 7,101 teeth present at baseline, distributed among 39% of the subjects, were lost during the 10-year interval. The incidence of tooth loss was highest among mandibular molars (7.5%) and lowest among canines (1.8%). The relative risk (RR) for tooth loss for endodontically compromised teeth was 4.1 and for furcation-involved molars 2.4-6.5, depending on tooth position. Logistic regression analysis identified baseline alveolar bone level (ABL), endodontic conditions, CPITN score (Community Periodontal Index of Treatment Needs), tooth position, caries, and educational level as risk factors for tooth loss. The overall mean 10-year ABL change was -0.54 mm (S.E. 0.01). On a tooth level the ABL change varied between -0.35 mm (mandibular molars) and -0.79 mm (mandibular incisors). Smokers experienced a greater (20-131% depending on tooth type) mean bone loss than non-smokers. The logistic regression model revealed that tooth position, smoking, and probing pocket depth > or =4 mm were risk factors for bone loss of >1 mm. No pertinent differences were observed with respect to risk factors for ABL change in the subgroup of non-smokers compared to the results of the analysis based on the entire subject sample. CONCLUSION: Tooth loss was more common in the molar than in the anterior tooth regions, while periodontal bone loss had a random distribution in the dentition. The predominant risk factors identified with regard to further radiographic bone loss were "probing pocket depth > or =6 mm" and "smoking".
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| 6. |
- Paulander, Jörgen, 1942
(författare)
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Oral epidemiological studies in a Swedish adult population focusing on periodontal disease.
- 2004
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Epidemiological surveys are used for prospective planning, and retrospective control of dental health goals in relation to personnel and economic resources. The general aim of this thesis was to describe and analyze oral conditions, mainly from a periodontal perspective, in the adult population in the County of Värmland, Sweden, and to identify potential risk associations/factors. Randomly selected population samples of 35-, 50-, 55-, 65- and 75-year-old subjects, stratified by urban/rural living, were examined by means of questionnaires radiographs and clinical registrations for cross-sectional analyzes. In addition a 10-year-prospective longitudinal study was performed in the 50-year-old subjects. Periodontal conditions were recorded by the use of periodontal attachment level (PAL), Community Periodontal Index of Treatment Needs (CPITN), furcation involvements and alveolar bone level (ABL) measurements. Risk analyzes included factors related to dental/oral conditions, general health, and behavioral and environmental conditions. Risk associations/factors were evaluated utilizing both bivariate and multivariate models.The cross-sectional studies revealed that symptoms of caries and periodontal disease accumulated with age. Smokers compared to never-smokers and low educated compared to high educated subjects had fewer remaining teeth and a higher prevalence of both caries and periodontal disease.Periodontally healthy subjects were characterized by a high number of remaining teeth, a low number of caries lesions, a positive lifestyle, and were predominantly women. Subjects with severe periodontal disease were associated with a reduced number of remaining teeth, male gender, cigarette consumption and poor lifestyle. In 50-year-olds, the mean ABL loss over 10 years was small and only few subjects suffered severe disease progression. Tooth loss was more common in the molar than in the anterior tooth regions, while periodontal bone loss had a random distribution in the dentition. In descending order, probing pocket depth >= 4 mm, smoking, number of remaining teeth and impaired general health were risk factors for periodontal disease progression. Analysis on the tooth level disclosed no additional risk factors. Lifestyle factors, apart from smoking, had a low predictive value in the identification of subjects with stable periodontal conditions as well as subjects with progressive periodontal disease.ConclusionsThe cross-sectional survey in this series of studies showed that the prevalence of severe periodontal disease in the examined population was low but increased by age. Furthermore, it was more likely to find advanced periodontal destruction in smokers and subjects with low education.In the longitudinal cohort study the periodontal disease progression was slow in the majority of subjects. Already established periodontal disease and smoking habits were the main risk factors for periodontal disease progression. Minimal periodontal disease progression was poorly explained by lifestyle factors.
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| 7. |
- Paulander, Jörgen, 1942, et al.
(författare)
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Some characteristics of 50/55-year-old individuals with various experience of destructive periodontal disease: a cross-sectional study.
- 2004
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Ingår i: Acta odontologica Scandinavica. - : Informa UK Limited. - 0001-6357 .- 1502-3850. ; 62:4, s. 199-206
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To analyze the association between subject characteristics and degree of destructive periodontal disease in a randomly selected sample of 50/55-year-old individuals. METHODS: A randomized and geographically stratified (urban/rural districts) subject sample composed of dentate 50-year-old (n = 190) and 55-year-old individuals (n = 359) from the county of Varmland, Sweden were examined. Data were collected through full mouth clinical and radiographic examinations and by the use of questionnaires. Based on the cumulative distribution of the individuals with respect to mean probing attachment loss (PAL), subgroups of subjects with the lowest (L20%) and highest (H20%) experience of PAL were identified. Similar classifications were made for never-smokers and current smokers. Correlation analyses and forward stepwise logistic regression models were performed. RESULTS: The subgroup with the most extensive PAL loss (H20%) included a significantly higher proportion of (i) males (60 vs 33%), (ii) subjects with low educational level (65 vs 41%), (iii) smokers (49 vs 15%), and had (iv) less favorable lifestyle characteristics than the subgroup with minimal experience of PAL loss (L20%). The same pattern of differences was observed when the analysis was restricted to never-smokers, with the addition of a significantly lower proportion of subjects living in urban areas (40 vs 69%) in the H20% compared to the L20% subgroup. The stepwise logistic regression analysis revealed that number of teeth and smoking habits were significant factors in the identification of individuals in the L20% subgroup. For the H20% subgroup, number of teeth, gender, number of cigarettes/day and lifestyle index were significant explanatory variables. CONCLUSION: Number of remaining teeth and smoking habits were identified as the main discriminating factors for classification of subjects with regard to degree of destructive periodontal disease.
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| 8. |
- Paulander, Jörgen, 1942, et al.
(författare)
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Some risk factors for periodontal bone loss in 50-year-old individuals. A 10-year cohort study
- 2004
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Ingår i: Journal Of Clinical Periodontology. ; 31:7, s. 489-96
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: The aim of this 10-year prospective study of 50-year-old individuals was to analyze the incidence of periodontal bone loss and potential risk factors for periodontal bone loss. METHODS: The subject sample was generated from an epidemiological survey performed in 1988 of subjects living in the County of Varmland, Sweden. A randomized sample of 15% of the 50-year-old inhabitants in the county was drawn. At the 10-year follow-up in 1998, 320 (75%) of the 449 individuals examined at baseline were available for re-examination, out of which 4 had become edentulous. Full-mouth clinical and radiographic examinations and questionnaire surveys were performed in 1988 and 1998. Two hundred and ninety-five individuals (69%) had complete data for inclusion in the analysis of radiographic bone changes over 10 years. Non-parametric tests, correlations and stepwise multiple regression models were used for statistical analysis of the data. RESULTS: The mean alveolar bone level (ABL) in 1988 was 2.2 mm (0.05) and a further 0.4 mm (0.57) (p=0.000) was lost over the 10 years. Eight percent of the subject sample showed no loss, while 5% experienced a mean bone loss of >/=1 mm. Smoking was found to be the strongest individual risk predictor (RR=3.2; 95% CI 2.03-5.15). When including as smokers only those individuals who had continued with the habit during the entire 10-year follow-up period, the relative risk was slightly increased (3.6; 95% CI 2.32-5.57). Subjects who had quit smoking before the baseline examination did not demonstrate a significantly increased risk for disease progression (RR=1.3; 95% CI 0.57-2.96). Stepwise multiple regression analysis revealed that smoking, % approximal sites with probing pocket depth >/=4 mm, number of teeth and systemic disease were significant explanatory factors for 10-year ABL loss (R(2)=0.12). For never smokers, statistically significant predictors were number of teeth, mean ABL, % periodontally healthy approximal sites and educational level (R(2)=0.20). CONCLUSION: The inclusion of smokers in risk analysis for periodontal diseases may obstruct the possibility to detect other true risk factors and risk indicators.
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| 9. |
- von Bültzingslöwen, Inger, 1947, et al.
(författare)
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Swedish Quality Registry for Caries and Periodontal Diseases - a framework for quality development in dentistry.
- 2019
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Ingår i: International dental journal. - : Elsevier BV. - 1875-595X .- 0020-6539. ; 69:5, s. 361-368
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Tidskriftsartikel (refereegranskat)abstract
- There is a need for monitoring dental health and healthcare, as support for quality development, allocation of resources and long-term planning of dental care. The aim of this paper is to describe the concept and implementation of the Swedish Quality Registry for Caries and Periodontal Diseases (SKaPa).The SKaPa receives information by automatic transfer of data daily from electronic patient dental records via secure connections from affiliated dental care organisations (DCOs). The registry stores information about DCOs, dental professionals and patients. Information on a patient level includes personal identifier, gender, age, living area, dental status, risk assessments for caries and periodontitis, and dental care provided. In addition, data generated from a global question on patient-perceived oral health are uploaded. In total, more than 400 variables are transferred to the registry and updated daily.In 2018, all of the 21 public DCOs and the largest private DCO in Sweden were affiliated to SKaPa, representing a total of 1,089 public and 234 private dental clinics. The accumulated amount of information on dental healthcare covers 6.9 million individuals out of the total Swedish population of 10 million. SKaPa produces reports on de-identified data, both cross-sectional and longitudinal.As a nationwide registry based on automatic retrieval of data directly from patient records, SKaPa offers the basis for a new era of systematic evaluation of oral health and quality of dental care. The registry supports clinical and epidemiological research, data mining and external validation of results from randomised controlled trials.
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