Sun Xiangyu, Bernabé Eduardo, Liu Xuenan, Zheng Shuguo, Gallagher Jennifer E
Department of Preventive Dentistry, Peking University School and Hospital of Stomatology, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, 22 Zhongguancun Avenue South, Haidian District, Beijing, 100081, People's Republic of China.
King's College London Dental Institute at Guy's, King's College and St Thomas' Hospitals, Population and Patient Health Division, London, SE5 9RS, UK.
BMC Public Health. 2017 Jun 20;17(1):586. doi: 10.1186/s12889-017-4384-7.
An appropriate level of human resources for oral health [HROH] is required to meet the oral health needs of population, and enable maximum improvement in health outcomes. The aim of this study was to estimate the required HROH to meet the oral health needs of the World Health Organization [WHO] reference group of 12-year-olds in China and consider the implications for education, practice, policy and HROH nationally.
We estimated the need of HROH to meet the needs of 12-year-olds based on secondary analysis of the epidemiological and questionnaire data from the 3rd Chinese National Oral Health Survey, including caries experience and periodontal factors (calculus), dentally-related behaviour (frequency of toothbrushing and sugar intake), and social factors (parental education). Children's risk for dental caries was classified in four levels from low (level 1) to high (level 4). We built maximum and minimum intervention models of dental care for each risk level, informed by contemporary evidence-based practice. The needs-led HROH model we used in the present study incorporated need for treatment and risk-based prevention using timings verified by experts in China. These findings were used to estimate HROH for the survey sample, extrapolated to 12-year-olds nationally and the total population, taking account of urban and rural coverage, based on different levels of clinical commitment (60-90%).
We found that between 40,139 and 51,906 dental professionals were required to deliver care for 12-year-olds nationally based on 80% clinical commitment. We demonstrated that the majority of need for HROH was in the rural population (72.5%). Over 93% of HROH time was dedicated to prevention within the model. Extrapolating the results to the total population, the estimate for HROH nationally was 3.16-4.09 million to achieve national coverage; however, current HROH are only able to serve an estimated 5% of the population with minimum intervention based on a HROH spending 90% of their time in providing clinical care.
The findings highlight the gap between dental workforce needs and workforce capacity in China. Significant implications for health policy and human resources for oral health in this country with a developing health system are discussed including the need for public health action.
需要适当水平的口腔卫生人力资源（HROH）来满足人群的口腔卫生需求，并最大程度地改善健康状况。本研究的目的是估计满足中国世界卫生组织（WHO）12岁参考人群口腔卫生需求所需的HROH，并考虑其对全国教育、实践、政策和HROH的影响。
我们基于对第三次全国口腔健康流行病学调查和问卷调查数据的二次分析，估计满足12岁儿童需求所需的HROH，包括龋齿经历和牙周因素（牙结石）、与牙齿相关的行为（刷牙频率和糖摄入量）以及社会因素（父母教育程度）。儿童患龋齿的风险分为从低（1级）到高（4级）的四个等级。我们根据当代循证实践，为每个风险等级建立了牙科护理的最大和最小干预模型。我们在本研究中使用的以需求为导向的HROH模型纳入了治疗需求和基于风险的预防措施，并采用了中国专家验证的时间安排。这些结果用于估计调查样本的HROH，根据不同的临床投入水平（60-90%），外推至全国12岁儿童和总人口，并考虑城乡覆盖情况。
我们发现，基于80%的临床投入，全国需要40139至51906名牙科专业人员为12岁儿童提供护理。我们证明，HROH的大部分需求存在于农村人口中（72.5%）。在该模型中，超过93%的HROH时间用于预防。将结果外推至总人口，全国HROH的估计数为316万至409万，以实现全国覆盖；然而，根据目前的HROH，基于将90%的时间用于提供临床护理的最低干预水平，估计仅能为5%的人口提供服务。
研究结果凸显了中国牙科劳动力需求与劳动力能力之间的差距。讨论了这一发展中卫生系统国家在卫生政策和口腔卫生人力资源方面的重大影响，包括公共卫生行动的必要性。
