Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St, Baltimore, MD, 21205, USA.
Department of Dentistry, Institute of Medicine, Tribhuhvan University, Maharajgunj, P.O. Box 152, Kathmandu, Nepal.
BMC Health Serv Res. 2020 May 11;20(1):412. doi: 10.1186/s12913-020-05276-5.
In many low- and middle-income countries, insufficient human resources limit access to oral health services. Shifting clinical tasks to less specialized health professionals, such as community health workers, has been used as a strategy to expand the health workforce, especially in remote or underserved locations. The objective of this study was to evaluate the validity of periodontal examinations conducted by auxiliary nurse midwives in a rural home setting in Nepal.
Twenty-one pregnant women < 26 weeks gestation from Sarlahi District, Nepal, underwent full mouth periodontal examinations measuring probing depth (PD) and bleeding on probing (BOP) on 6 sites per tooth by one of five auxiliary nurse midwives, who were trained for this study but had no previous training in dentistry. After a 15-min break, each participant was examined again by an experienced dentist. Measures of validity for PD and BOP were calculated comparing the pooled and individual auxiliary nurse midwives to the dentist. A multivariable GEE model estimated the effect of periodontal characteristics on agreement between the auxiliary nurse midwives and the dentist.
Participant mean age was 22 years (SD: ±3 years), mean PD was 1.4 mm (SD: 03 mm), and 86% of women had BOP (according to the dentist). Percent agreement, weighted kappa scores, and intraclass correlation coefficients for PD, with an allowance of ±1 mm, exceeded 99%, 0.7, and 0.9, respectively, indicating an acceptable level of agreement. Auxiliary nurse midwives tended to report higher PD scores relative to the dentist, although this over-estimation was small and unlikely to impact population-based estimates of important indicators of oral health status. GEE regression modeling indicated similar agreement for mandible vs. maxilla, left vs. right side, and PD (≤2 mm, > 2 mm), and lower agreement for posterior teeth and lingual and proximal sites.
Auxiliary nurse midwives were able to accurately conduct periodontal examinations in a rural home setting, suggesting the potential to shift tasks away from highly trained dentists and periodontal examiners in low-resource communities.
ClinicalTrials.gov Identifier: NCT01177111 (Nepal Oil Massage Study); registered on August 6th, 2010.
在许多低收入和中等收入国家，人力资源不足限制了人们获得口腔卫生服务。将临床任务转移给社区卫生工作者等非专业卫生专业人员，已被用作扩大卫生人力的策略，尤其是在偏远或服务不足的地区。本研究的目的是评估在尼泊尔农村家庭环境中，助理护士助产士进行牙周检查的有效性。
来自尼泊尔萨拉希地区的 21 名妊娠 26 周以下的孕妇接受了全面的口腔牙周检查，每位孕妇的每颗牙齿的 6 个部位都进行了探诊深度（PD）和探诊出血（BOP）测量，由五名助理护士助产士中的一名进行检查，这些护士助产士接受了此项研究的培训，但之前没有接受过牙科培训。15 分钟休息后，每位参与者由一名经验丰富的牙医再次进行检查。通过将助理护士助产士的检查结果与牙医的检查结果进行比较，计算 PD 和 BOP 的有效性测量值。使用多变量 GEE 模型估计牙周特征对助理护士助产士和牙医之间一致性的影响。
参与者的平均年龄为 22 岁（标准差：±3 岁），平均 PD 为 1.4 毫米（标准差：0.3 毫米），86%的女性出现 BOP（根据牙医的标准）。PD 允许的 ±1mm 内的百分一致性、加权 kappa 评分和组内相关系数分别超过 99%、0.7 和 0.9，表明一致性处于可接受水平。与牙医相比，助理护士助产士的 PD 评分往往偏高，但这种高估很小，不太可能影响口腔健康状况重要指标的基于人群的估计。GEE 回归模型表明，下颌与上颌、左侧与右侧、PD（≤2mm、>2mm）之间的一致性相似，而后牙和舌侧及近中位点的一致性较低。
助理护士助产士能够在农村家庭环境中准确地进行牙周检查，这表明有可能将任务从资源匮乏社区的高技能牙医和牙周检查人员转移出去。
ClinicalTrials.gov 标识符：NCT01177111（尼泊尔油按摩研究）；注册于 2010 年 8 月 6 日。
