牙醫助理之輔助性介入對牙醫醫療效率之影響
∼以牙周病科為例∼

中文摘要背景：口腔保健和牙科醫療的工作需要有專業人員幫忙牙醫師來推動，才能提昇醫療品質和效率，這是世界醫療發展的趨勢，但台灣目前沒有口腔衛生師相關規定或條文限制，在臨床上只有牙醫助理擔任輔助性工作。如何有效地運用與控制現有人力資源來提昇牙科的醫療品質，實為刻不容緩的標題。此外國內、外相關文獻極少關於牙醫助理的輔助性介入對牙醫醫療效率之影響相關的研究發表，因此有必要調查牙醫助理相關的實際臨床工作情況並予以分析。研究目的：本研究旨在調查牙醫助理在牙周病科進行相關的輔助性介入醫療行為，藉以評估臨床上影響時間的多寡、品質及促進效率方面，進而增加牙醫師在醫療上的產值、經濟效益，及時間上的節省和相關的影響因素，以提出相關資料與建議供相關當局者參考。研究方法：對南部地區一家大型教學醫院中的牙周病科和1家牙周病專科診所的牙醫助理及牙醫師，於2005年11月至2006年8月之間，藉由發放調查表及由牙醫助理、牙醫師記錄填寫的方式進行調查;內容包括：病人的基本資料、治療項目、牙周狀況程度等級、治療時間起末及助手擔任工作等。本研究教學醫院共取樣526份調查表，牙周病專科診所共取樣184份調查表，並採用立意取樣法(purposive sampling)。資料庫設計使用Microsoft Office Excel 2003，資料分析使用JMP軟體（p＜0.05為有意義）。結果：教學醫院收集到526份問卷調查表，牙周病專科診所收集到184份問卷調查表。教學醫院中的病患性別以男性(60.08%)比率大於女性(39.92%)為多，診所以女性（60.33%）比率大於男性（39.67%）。病患年齡層方面，以41歲—50歲所佔的比率最高(40.68%)，40歲以下(14.26%)及61歲以上(19.39%)所佔的比率較低。治療項目方面，以全口洗牙所佔的比率最高(24.72%)，牙結石刮除術及齒根整平術次之(20.91%)，第三為口腔衛教(18.25%)。醫師資歷方面，主治醫師診療時間較短，住院醫師診療時間較長；其中教學醫院牙醫師進行口腔衛教所耗費時間之相關，顯示醫師資歷與進行口腔衛教所耗費時間無統計學上顯著差異（p值＝ 0.1318）。牙周狀況檢查評估表(charting)在無牙醫助理協助時；診療時間較長;為47.25±5.32分鐘，有牙醫助理協助時；診療時間明顯縮短，為21.15±7.74分鐘，具統計學上顯著差異(p值＝ 0.0011)。牙菌斑控制指數(check PI)在無牙醫助理協助時；診療時間較長;為 7.54±4.24分鐘，有牙醫助理協助時；診療時間明顯縮短，為4.19±1.70分鐘，具統計學上顯著差異(p值＝ 0.0003)。牙周程度方面，輕微程度者所花費的診療時間較短，中等次之，嚴重者花費最久。全口洗牙方面，教學醫院主治醫師所耗費的診療時間(7.50±3.53分鐘)較診所主治醫師短(10.79±2.69分鐘)。牙結石多寡方面，教學醫院耗費的診療時間較診所來的短。教學醫院在有牙醫助理（一位）協助下進行超音波全口洗牙時，所耗費的診療時間(11.30±4.72分鐘)較診所 (10.79±2.69分鐘) 長。結論與建議：無牙醫助理協助時；診療時間較長，有牙醫助理協助時；診療時間明顯縮短。教學醫院在有牙醫助理協助下進行超音波全口洗牙時，所耗費的診療時間較長，診所的診療時間較短。教學醫院基本社會人口學中皆發現無牙醫助理協助的樣本數皆大於有牙醫助理協助，但反觀診所的基本社會人口學所收集到的樣本數皆是有牙醫助理協助，推估這些是因為兩者的大環境及經營理念、型態不同所導致的結果。另外則需解決醫院、診所口腔衛生師、牙醫助理、牙醫師比例不均的問題，其經營績效、醫療品質及策略分析越顯得重要。國內法規尚未確立口腔衛生師與牙醫助理的工作範圍，這值得政府及牙醫界人士關注。關鍵字：牙醫助理、口腔衛生師、經營績效、策略分析

關鍵字

牙醫助理；口腔衛生師；經營績效；策略分析

並列摘要

Abstract Background: It is a worldwide trend that to improve the quality and efficiency of medical treatment, the implementation of dentists’ medical and health work must be aided by professionals. But there are no stipulations or clauses related to dental hygienists in Taiwan now. It is an urgent issue about how to raise the quality of dental medical service by utilizing and controlling the manpower efficiently. In addition there is insufficient literature mentioning the influence of dental efficiency during medical treatment in the dental assistants’ auxiliary intervening act. Consequently, we considered that it is necessary to investigate and analyze the clinical actual work of dental assistants. Purpose: The purpose of this study was to evaluate the related impact factors, including the duration, quality and economical efficiency of dental medical work influenced by the dental assistants’ auxiliary intervening act in dental treatment procedures, and we hope to provide information and suggestions to the related authorities. Methods: This investigation was utilized by a questionnaire completed by dentists and dental assistants during the period from November, 2005 to August 2006 in a teaching hospital and a periodontal clinic. The questionnaire content included：patient's fundamental data record、treatment items、periodontol status and its severity、their treatment time from the start to the finish in which assistants had worked。The study included 526 questionnaires and one hundred and eighty-four questionnaires were collected sampling from the teaching hospital and the periodontal clinics。Purposive database was designed using Microsoft Office Excel 2003 and the data were analyzed using JMP(p＜0.05 was statistically significant). Results: In this study，males occupied 60.08% of the hospital samples，females occupied 60.33% of the periodontal clinic samples. The majority of patients were between 41-50 years old(40.68%), and the lowest proportion was in patients below 40(14.26%) and over 61 years old(19.39%). From the survey of periodontal treatment items, the order from highest to lowest proportion was full-mouth scaling(24.72%), hand scaling and root planing(20.91%), and oral hygiene instruction(18.25%). Based on the classification of work experience of the dentists, the attending dentists spent less treatment time, whereas the residents spent more time. The relationship between the time of oral hygiene instruction and the qualification of the dentists revealed no statistical difference (p= 0.1318). Less time was used during charting (21.15±7.47mins)with the aid of the dental assistants, and there was a statistically significant difference in comparison to treatment without the dental assistants’ aid (p=0.0011). Less time was used during recording PI (4.19±1.70mins)with the aid of the dental assistants, and there was a statistically significant difference in comparison to treatment without the dental assistants’ aid (p= 0.0003). From the survey of periodontal disease severity, less time was used in patients with mild periodontitis, and more time was used in patients with severe periodontitis. From the aspect of amount of dental calculus, the treatment time in the teaching hospital was less than that in the clinic. More time was used during full-mouth scaling in the teaching hospital(11.30±4.72mins) compared with less time used in the dental clinic(10.79±2.69mins) when aided by an assistant (1 person). Conclusion and Suggestions: Less time was used for the periodontal therapy with the aid of a dental assistant. More time was used during full-mouth scaling in the teaching hospital compared with less time used in the dental clinic when aided by an assistant. There are few dental assistants working in the teaching hospital, and there is more than one dental assistant working in the periodontal clinics. This may be caused by the differences existing in the environment and operation and the difference between the hospital and periodontal clinics. Moreover, in order to promote the operation efficiency ，treatment quality and tactical analysis，the imbalance of the number between the dental hygienists 、assistants and dentists should be discussed and managed. The working scope of dental hygienists and dental assistants should be clarified and legislated. Key words：Dental Assistants﹐Dental Hygienists﹐Operation Efficiency﹐Tactical Analysis