Mickenautsch Steffen, Frencken Jo E, Van't Hof Martin
Division of Public Oral Health, University of the Witwatersrand, Johannesburg, South Africa.
J Appl Oral Sci. 2007 Feb;15(1):1-8. doi: 10.1590/s1678-77572007000100002.
To investigate potential barriers to the utilisation of the ART approach in a South African public oral health service.
7 barriers were identified: patient load/work load, operator opinion, patient opinion, service management, material supply, clinical ART skill, chair-side assistance. Operators were asked to answer a questionnaire one year after completing the ART training. Responses ranged from 1 = no barrier to 5 = highest barrier. Treatment data per operator were collected during 1 year after training, for both dentitions, including: number of extracted teeth, placed traditional restorations, ART restorations. The restoration/extraction (REX) ratio and the proportion of ART restorations (ART%) of the total number of restorations were calculated and correlated with the barrier variables. Pearson correlation, ANOVA and 2-tailed t-tests were used in the statistical analyses.
Patient load/work load (mean = 2.80: SE = 0.16) was the strongest barrier (p<0.001) and clinical ART skill was the weakest barrier (p<0.001). A significant correlation between material supply and mean REX score was observed in both dentitions. In primary teeth, the ART% correlated significantly with clinical ART skill (r= -0.63; p<0.01). In permanent teeth, statistically significant correlations were observed between ART% and patient load/work load (r = -0.54; p<0.05), patient opinion (r = -0.76; p<0.01), operator opinion (r = -0.53; p<0.05), chair-side assistance (r = -0.57; p<0.05), oral health service management (r = -0.46; p<0.05).
1 year after ART training completion high patient load/work load, followed by insufficient provision of materials/instruments, were the two most inhibiting barriers to the use of ART in the public oral health services. Dentists' perceptions of low clinical skill levels in performing ART confidently inhibited the use of ART in primary teeth in children.
调查南非公共口腔卫生服务中应用非创伤性修复治疗（ART）方法的潜在障碍。
识别出7个障碍因素：患者量/工作量、操作人员意见、患者意见、服务管理、材料供应、临床ART技能、椅旁协助。要求操作人员在完成ART培训一年后回答一份问卷。回答范围从1 =无障碍到5 =最高障碍。在培训后的1年中收集每位操作人员针对两种牙列的治疗数据，包括：拔牙数量、放置的传统修复体、ART修复体。计算修复/拔牙（REX）比率以及ART修复体占修复体总数的比例，并将其与障碍变量进行关联分析。统计分析采用Pearson相关性分析、方差分析和双侧t检验。
患者量/工作量（均值 = 2.80：标准误 = 0.16）是最强的障碍（p<0.001），而临床ART技能是最弱的障碍（p<0.001）。在两种牙列中均观察到材料供应与平均REX评分之间存在显著相关性。在乳牙中，ART修复体所占比例与临床ART技能显著相关（r = -0.63；p<0.01）。在恒牙中，观察到ART修复体所占比例与患者量/工作量（r = -0.54；p<0.05）、患者意见（r = -0.76；p<0.01）、操作人员意见（r = -0.53；p<0.05）、椅旁协助（r = -0.57；p<0.05）、口腔卫生服务管理（r = -0.46；p<0.05）之间存在统计学显著相关性。
在完成ART培训一年后，高患者量/工作量以及材料/器械供应不足是公共口腔卫生服务中使用ART的两个最主要阻碍因素。牙医对自身进行ART操作时临床技能水平较低的认知，严重阻碍了在儿童乳牙中使用ART。
