| 1. |
- Johansson, Veronica, et al.
(författare)
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Contract and fee-for-service care - regression modelling of oral health-related quality of life
- 2007
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- In 1999, the public dental health service (PDHS) in the county of Värmland, Sweden, implemented contract care alongside the traditional patient financial system of fee-for-service care. In contract care, the patient pays a fixed sum annually for dental care and then receives basic dental care without additional costs. Aim The aim was to study the relation between patient financial system and oral health-related quality of life (OHRQoL). Methods In 2003, a questionnaire was sent to 2,400 consecutively selected patients in the PDHS in Värmland, 1,200 from each patient financial system. The questionnaire was answered by 1,324 participants (57% of those who could be reached). The questionnaire contained questions about willingness to pay for dental care, how much one had paid for dental care the previous year, OHRQoL (measured with the OHIP-14), dental anxiety, humanism of caregiver, general health (measured with the SF-36), multidimensional health locus of control, sense of coherence, self-esteem and demographics. Data on patient financial system, gender and age were obtained from the sampling frame. The data were analysed with a block method of multiple linear regression, adding blocks of variables in six steps: financial system, economic factors, individual factors, social factors, psychological factors and health factors. The threshold for statistical significance was set at p≤0.05. Results OHRQoL was affected by the financial system of the respondent: those in fee-for-service care had a worse OHRQoL than those in contract care. OHRQoL was also affected by health, sense of coherence and to some extent by psychological and economical factors. Of the social variables, only being foreign born had a significant effect on OHRQoL. Conclusions OHRQoL was found to be affected by patient financial system. Acknowledgements The study was financed by the Swedish Research Council.
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| 2. |
- Johansson, Veronica, et al.
(författare)
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Financial systems' impact on dental care : a review of fee-for-service and capitation systems
- 2007
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Ingår i: Community Dental Health. - 0265-539X. ; 24:1, s. 12-20
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Tidskriftsartikel (refereegranskat)abstract
- Objective This review covers the impact of financial systems on dental care. Background Remuneration in fee-for-service (FFS) is done per service provided and in capitation (CAP) per patient enrolled. It may be expected that dentists’ incentive in CAP is to keep the number of services provided at a minimum, while in FFS it is to keep the number of services at a maximum. This should lead to a different impact on care, with the dentists in CAP focusing more on prevention and dentists in FFS more on restorative treatment. Six questions were put: Does CAP increase or decrease caries incidence? Does CAP increase or decrease restorative treatments? Does CAP increase preventive care? Does CAP increase or decrease productivity? Does CAP increase or decrease the dentist’s satisfaction with his/her work? Does CAP increase or decrease the patients’ satisfaction with the oral care provided? Methods Literature was obtained through searches in databases. A format was developed to define the literature of interest. Results CAP decreases restorative treatment and there is a tendency of decreased caries incidence. “Supervised neglect” cannot be established. CAP increases preventive care. A conclusion regarding productivity was not possible. The results on dentist’s satisfaction with work were inconclusive, as were the results regarding patient satisfaction. Conclusions CAP has a different impact on provided care than FFS. More research is needed in this area and focus on efficiency is of importance. This review was funded by the Swedish Research Council.
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| 3. |
- 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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| 4. |
- 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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| 5. |
- Sondell, Björn, et al.
(författare)
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Altered walking pattern in a virtual environment
- 2005
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Ingår i: Presence - Teleoperators and Virtual Environments. - Cambridge : MIT Press. - 1054-7460 .- 1531-3263. ; 14:2, s. 191-197
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Tidskriftsartikel (refereegranskat)abstract
- Falls and fractures among elderly persons constitute a major health problem. Many falls occur while walking and falls that occur during turning often result in a fracture. Methods aimed at understanding the complex mechanisms involved in walking should therefore assess tested individuals during walks and turns. In order to identify persons at risk and take the correct preventive measures, it is important to find methods that quantify movements as the tested persons are processing multisensory input. In a clinical setting this is sometimes difficult to achieve in a controlled manner, since tests are difficult to set exactly the same from one time to another. Using a virtual environment (VE) and a tracker system, conditions such as light, sound, events, body movements, and room size can be controlled and measured. Tests in VE can therefore be identically reproduced over and over again to evaluate if a person can withstand changing outer demands at any given moment. In order to perform quantitative measures 8 persons (21-74 years) were tested in immersive virtual reality. The VE was a corridor in which expected and unexpected events could be produced. Events studied were doors swinging open in front of the subjects during a walk and a virtual tilting of the environment. Trackers were used for collecting and analyzing the movement data. Our results show that the system was well tolerated among the subjects and that there was a clear tendency that the system could generate fall tendency among the subjects. There was also a difference among the subjects regarding walking strategies when subjected to the various events.
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| 6. |
- Backman, Anders, et al.
(författare)
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easyADL – Wearable Support System for Independent Life despite Dementia
- 2006
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Ingår i: ACM CHI 2006 Workshop onDesigning Technology for People with Cognitive Impairments.
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Konferensbidrag (refereegranskat)abstract
- This position paper outlines the easyADL project, a two-year project investigating the possibility of using wearable technology to assist people suffering the dementia disease in performing Activities of Daily Living (ADL). An introduction to the egocentric interaction modeling framework is provided and the virtual reality based development methodology is discusssed.
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| 7. |
- Ekholm, Elisabeth, et al.
(författare)
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Expression of stratum corneum chymotryptic enzyme in human sebaceous follicles
- 1998
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Ingår i: Acta Dermato-Venereologica. - : Society for the Publication of Acta Dermato - Venereologica. - 0001-5555 .- 1651-2057. ; 78:5, s. 343-347
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Tidskriftsartikel (refereegranskat)abstract
- Stratum corneum chymotryptic enzyme (SCCE) may be involved in desquamation, a process necessary for maintaining a normal anatomy at all sites where there is continuous turnover of cornified epithelia. Using immunohistochemistry and in situ hybridization, we have, in this work, analysed SCCE expression in the sebaceous follicle. We found expression of SCCE in luminal parts of the pilary canal, common sebaceous ducts and proximal sebaceous ducts. In addition, SCCE was seen in cells apparently situated within the distal parts of the glandular lobules. Co-expression of SCCE and keratin 10 was seen only in the pilary canal and the common sebaceous ducts. The results give further support for SCCE being involved in desquamation-like processes. The association with cornification seems to be more general for SCCE than for keratin 10. The possible role of SCCE in diseases involving disturbances in the turnover of cornified cells in the sebaceous follicle, such as acne vulgaris, is a question for future studies.
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| 8. |
- Eliasson, Alf, 1957-, et al.
(författare)
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Five-year results with fixed complete-arch mandibular prostheses supported by 4 implants
- 2000
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Ingår i: International Journal of Oral & Maxillofacial Implants. - : Quintessence Publishing. - 0882-2786 .- 1942-4434. ; 15:4, s. 505-510
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Tidskriftsartikel (refereegranskat)abstract
- This study examined whether it is possible to restore an edentulous mandible with a complete-arch fixed prosthesis retained by only 4 implants without decreasing the survival rate. One hundred nineteen patients received complete-arch mandibular prostheses retained by 4 implants. Most patients were followed for 3 years or more. All patients followed a routine protocol, including annual check-ups and regular radiographic examinations. Twenty-one patients dropped out. Radiographic measurements used the threads of the implants as a basis for comparison. No indication was found that the number of supporting implants could have influenced the observed frequency of technical and surgical complications. Three implants were lost, 2 after 1 year and 1 after 5 years. A statistically significant difference in bone loss between the mesial and distal implants was found. The number of fractured resin teeth in mandibular prostheses was higher when patients had an implant-supported prosthesis in the maxilla. The present study revealed an implant survival rate of 98.6% after 5 years. Therefore, it was concluded that there may not be a need for more than 4 implants to support a fixed mandibular prosthesis, when implants at least 10 mm long can be used.
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