Kantor ML; Association for Health Services Research. Meeting.
Abstr Book Assoc Health Serv Res Meet. 1998; 15: 321-2.
Department of Family Medicine, UMDNJ Robert Wood Johnson Medical School, New Brunswick, NJ 08903-0019, USA.
RESEARCH OBJECTIVE(S): In 1988, the Food and Drug Administration (FDA) Dental Radiographic Patient Selection Criteria Panel issued recommendations for the radiographic examination of the non-emergency, comprehensive-care dental patient. The essence of the recommendations was that radiographs should be prescribed according to selection criteria based upon the patient's needs. The purpose of this study is to assess the relationship between he use of selection criteria guidelines in U.S. and Canadian dental school clinics and three factors: (1) the credentials of the chief-of-service, (2) institutional funding (public versus private), and (3) geographic region. STUDY DESIGN: In 1997, all 64 U.S. and Canadian dental schools were surveyed regarding the preferred initial radiographic examination for the non-emergency, comprehensive care patient (adults with teeth/dentulous, adults without teeth/edentulous, and children). For each patient category, respondents (n=64) chose among six alternative combinations of films, or checked "other" and specified the examination if none of the choices applied. "Other" responses were of two types: (1) specific radiographic examinations not among the alternatives provided or (2) an indication that radiographs were prescribed according to selection criteria/patient need. Respondents were asked to indicate if they were formally credentialed in oral and maxillofacial radiology (Diplomate of the American Board of Oral and Maxillofacial Radiology, or Fellow/Member (oral Radiology) of the Royal College of Dentists in Canada). Thirty-four respondents were credentialed and 30 were not. There were 44 publicly- and 20 privately-funded schools. Responses were independently dichotomized on each of these variables and the film ordering distributions were compared using Fisher's exact test. To assess geographic variability, the examinations were dichotomized (selection criteria used versus not used) and the responses were compared across six geographic regions using Fisher's exact test. PRINCIPAL FINDINGS: For the dentulous adult patient, overall, 36% of the institutions used prescriptive radiology (i.e., selection criteria/patient need), and there was a statistically significant difference in the distribution of examination type only for the "credentialed" variable (p=0.023). Institutions with a credentialed chief-of-service were 2.17 times more likely to use prescriptive radiology than institutions without one. Further, routine use of non-productive, redundant examinations was limited to institutions without a credentialed chief-of-service (n=6). There was no statistically significant difference for either funding source or geographic region. For the edentulous adult patient, all institutions either used prescriptive radiology or obtained one of the examinations specified in the FDA guidelines, and there was no statistically significant differences in the film distributions for any of the three independent variables. For the child patient, overall, 23% of the institutions used prescriptive radiology, and there was no statistically significant difference for any of the three independent variables. CONCLUSIONS: Nine years after the introduction of the American Dental Association (ADA)-endorsed FDA guidelines, most U.S. and Canadian dental schools are still obtaining standard, routine radiographic examinations on new patients seeking comprehensive care. However, the presence of a credentialed chief-of-service has a positive effect on the use of selection criteria, at least for the adult patient with teeth. Institutional funding source and geographic region are not associated with the variability in the prescription of radiographic examinations for any patient type at these institutions. IMPLICATIONS FOR POLICY, DELIVERY OR PRACTICE: Recent graduates are likely to model their practices on what they were taught and what they observed in school. The effect of suboptimal practices learned in school are multiplied when graduates enter practice and provide services to thousands of patients. This concern and the results of this study suggest that the ADA Commission of Dental Accrediations's recently revised standards, which relax the requirement for formally trained and experienced radiologists (i.e. credentialed), may be premature and regressive.
Publication Types:
Keywords:
- Adult
- American Dental Association
- Canada
- Child
- Dental Clinics
- Dentists
- Humans
- Mouth, Edentulous
- Patient Selection
- Radiology
- Schools, Dental
- Teaching
- United States
- radiography
- hsrmtgs
Other ID:
UI: 102234655
From Meeting Abstracts