Gilbert Gregg H, Weems Richard A, Litaker Mark S, Shelton Brent J
Department of Diagnostic Sciences, UAB School of Dentistry, SDB Room 109, 1530 3rd Avenue South, Birmingham, AL 35294-0007, USA.
Health Serv Res. 2006 Oct;41(5):1915-37. doi: 10.1111/j.1475-6773.2006.00537.x.
To quantify the role of practice characteristics in patient-specific receipt of dental diagnostic radiographic services.
DATA SOURCE/STUDY SETTING: Florida Dental Care Study (FDCS). Study Design. The FDCS was a 48-month prospective observational cohort study of community-dwelling adults. Participants' dentists were asked to complete a questionnaire about their practice characteristics.
DATA COLLECTION/EXTRACTION METHODS: In-person interviews and clinical examinations were conducted at baseline, 24, and 48 months, with 6-monthly telephone interviews in between. A single multivariate (four radiographic service outcomes) multivariable (multiple explanatory covariates) logistic regression was used to model service receipts.
These practice characteristics were significantly associated with patient-specific receipt of radiographic services: number of different practices attended during follow-up; dentist's rating of how busy the practice was; typical waiting time for a new patient examination; practice size; percentage of patients that the dentist reported as interested in details about the condition of their mouths; percentage of African American patients in the practice; percentage of patients in the practice who do not have dental insurance; and dentist's agreement with a statement regarding whether patients should be dismissed from the practice. Effects had differential magnitudes and directions of effect, depending upon radiograph type.
Practice characteristics were significantly associated with patient-specific receipt of services. These effects were independent of patient-specific disease level and patient-specific sociodemographic characteristics, suggesting that practitioners do influence receipt of these diagnostic services. These findings are consistent with the conclusion that practitioners act in response to a mix of patients' interests, economic self-interests, and their own treatment preferences.
量化实践特征在患者接受牙科诊断性放射检查服务方面的作用。
数据来源/研究背景:佛罗里达牙科护理研究(FDCS)。研究设计。FDCS是一项针对社区居住成年人的为期48个月的前瞻性观察队列研究。研究要求参与者的牙医填写一份关于其执业特征的问卷。
数据收集/提取方法:在基线、24个月和48个月时进行面对面访谈和临床检查,期间每6个月进行一次电话访谈。采用单一多变量(四种放射检查服务结果)多因素(多个解释性协变量)逻辑回归对服务接受情况进行建模。
这些实践特征与患者接受放射检查服务显著相关:随访期间就诊的不同诊所数量;牙医对诊所繁忙程度的评分;新患者检查的典型等待时间;诊所规模;牙医报告的对口腔状况细节感兴趣的患者百分比;诊所中非洲裔美国患者的百分比;诊所中没有牙科保险患者的百分比;以及牙医对关于是否应将患者从诊所转出的声明的认同度。根据放射照片类型,影响的大小和方向有所不同。
实践特征与患者接受服务显著相关。这些影响独立于患者特定的疾病水平和患者特定的社会人口统计学特征,表明从业者确实会影响这些诊断服务的接受情况。这些发现与从业者根据患者兴趣、经济自身利益和自身治疗偏好的综合因素做出反应的结论一致。