Department of Operative and Preventive Dentistry, Charité - Universitätsmedizin Berlin, Berlin, Germany.
Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany.
Int Dent J. 2017 Oct;67(5):263-271. doi: 10.1111/idj.12316. Epub 2017 Jun 23.
A spatially unequal distribution of dentists or dental care professionals (D/DCPs), such as therapists or hygienists, could reduce the quality of health services and increase health inequities. This review describes the interventions available to enhance this spatial distribution and systematically assesses their effectiveness.
Electronic databases (Cochrane CENTRAL, Medline, Embase, CINAHL) were searched and cross-referencing was performed using a standardised searching algorithm. Randomised and non-randomised controlled trials, controlled before-and-after studies and interrupted time series were included. Studies investigating a minimum of one of four interventions (educational, financial, regulatory and supportive) were included. The primary outcome was the spatial distribution of D/DCPs. Secondary outcomes were access, quality of services and equity or adverse effects. This review was registered (CRD42015026265).
Of 4,885 articles identified, the full text of 201 was assessed and three (all investigating national policy interventions originally not aiming to change the distribution of D/DCPs) were included. In one Japanese study spanning 1980 to 2000, the unequal spatial distribution of dentists decreased alongside a general increase in the number of dentists. It remained unclear if these findings were associated. In a second Japanese study, an increase in the number of dentists was found in combination with a postgraduate training programme implemented in 2006, and this occurred alongside an increasingly unequal distribution of dentists, again without proof of cause and consequence. A third study from Taiwan found the introduction of a national universal-coverage health insurance to equalise the distribution of dentists, with statistical association between this equalisation and the introduction of the insurance.
The effectiveness of interventions to enhance the spatial distribution of D/DCPs remains unclear.
牙医或牙科保健专业人员（D/DCPs）的空间分布不均，如治疗师或保健师，可能会降低卫生服务质量并加剧健康不公平现象。本综述描述了可用于改善这种空间分布的干预措施，并系统地评估了它们的有效性。
电子数据库（Cochrane 中心、Medline、Embase、CINAHL）进行了检索，并使用标准化的搜索算法进行了交叉参考。纳入了随机和非随机对照试验、对照前后研究和中断时间序列。纳入了至少一项以下四项干预措施（教育、金融、监管和支持）的研究。主要结局是 D/DCPs 的空间分布。次要结局是获得服务的机会、服务质量和公平性或不良反应。本综述已注册（CRD42015026265）。
在 4885 篇文章中，有 201 篇文章的全文进行了评估，其中有 3 篇（均为研究最初并非旨在改变 D/DCPs 分布的国家政策干预措施）被纳入。在一项跨越 1980 年至 2000 年的日本研究中，牙医的空间分布不平等随着牙医数量的普遍增加而减少。这些发现是否相关尚不清楚。在第二项日本研究中，在 2006 年实施了一项研究生培训计划的同时，发现牙医数量增加了，而且牙医的分布也越来越不平等，同样没有因果关系的证据。第三项来自台湾的研究发现，引入全国性的全民医疗保险制度使牙医的分布更加均衡，这种均衡与保险的引入之间存在统计学关联。
增强 D/DCPs 空间分布的干预措施的有效性仍不清楚。
