牙醫師提供初診服務相關因素之研究

A Study of the Factors Associated with the Provision of Routine Oral Examinations by Dentists

謝其政(Chi-Jeng Hsieh) ； 林文德(Wen-Der Lin) ； 邱尚志(Shang-Jyh Chiou)

《Journal of Medical Education》 15卷1期 (2011/03) Pp. 1-9

https://doi.org/10.6145/jme.201103_15(1).0001

摘要

目的：牙醫初診服務自2004年納入健保給付至今，雖然使用人數逐年增加，但仍有牙醫師並未提供該項服務，本研究將分析牙醫師提供初診服務之情形以及牙醫師特質與是否提供初診間之關係。方法：採用國家衛生研究院「全民健康保險學術研究資料庫」中「牙醫門診處方及治療明細檔」2007年資料，並以邏吉斯迴歸方式探討牙醫師特質與初診服務之關係。結果：2007年整體牙醫師執行初診比例為72.3%，邏吉斯迴歸結果顯示女性、年齡較低、於診所執業、院所位於都市化程度較高地區、院所內牙醫師數多以及中報量高之牙醫師執行初診機率較高。結論：牙醫師提供初診機率的確與牙醫師特質有關，衛生機關可針對特定族群牙醫師擬定教育訓練或推廣措施以提高初診率。

關鍵字

牙醫初診 ； 預防保健 ； 牙醫師特質

並列摘要

Objectives: The routine oral examination program (ROE) was implemented in 2005. With this new policy, it is critical to know what factors are associated with the provision of ROE by dentists. However, such a comprehensive evaluation is not readily available. Based on prior research, it is believed that the characteristics of dentists are important factors. The purpose of this study was to explore the distribution of ROE provision by dentists and to analyze the relationship between the dentist's characteristics and the provision of ROE. Method: This research used the National Health Insurance research database from the National Health Research Institutes. All claim dental utilizations and dentists' characteristics for 2007 were retrieved from this database. A descriptive analysis of dentists' characteristics and the provision of ROE are presented and a logistic regression model was carried out to determine the relationship between dentist's characteristics and the probability of performing ROE. Results: In total. 10,548 dentists provided dental services as part of the National Health Insurance in 2007 and 72.3% of them perform ROE. In the logistic regression model, gender (OR=0.83 for males), age (references to under 29, OR=0.75 for 40 to 49, OR=0.46 for 50 to 59, OR=0.25 for 60 and above), institute level (OR=0.45 for hospital), urbanization (reference to city, OR=0.73 for town, OR=0.58 for country), the number of dentists at the institute (reference to 1, OR=1.95 for 2 to 3, OR=3.99 for 4 to 10, OR=7.08 for 10 and above), and claim volume (reference to first quartile, OR=2.11 for second quartile, OR=2.49 for third quartile, OR=2.59 for forth quartile) were found to be associated with the provision of ROE. Conclusions: More than 70% dentists provide ROE, which means that this policy is influential, but, nevertheless, the effect is not universal among dentists. The likelihood of performing ROE is associated with the dentist's characteristics. The authorities should consider conducting education courses or promotion programs that target specific groups of dentists in order to increase the provision of ROE. In addition, the association between ROE and population oral health also needs to be further investigated.

並列關鍵字

routine oral examination ROE ； prevention ； dentists' characteristics

參考文獻

Bureau of National Health Insurance: National health insurance fee schedule. Available at: [http://www.nhi.gov.tw/inquire/query2.asp?menu=1&menu_id=8&WD_ID=94] Accessed on 30th Sep, 2010. (In Chinese)

Bureau of National Health Insurance: Routineoral examination quality improvement program in National Health Insurance Dental Department Global Budget in 2006. Available at: [http://www.nhi.gov.tw/information/bulletin_file/815_w0950059352-A01.doc] Accessed on Sep 30th, 2010. (In Chinese)

(Beirne P, Clarkson JE, Worthington HV: Recall intervals for oral health in primary care patients, Cochrane Database Syst Rev 2007: CD004346.).

NHI Medical Expenditure Negotiation Committee: Bureau of National Health Insurance 2007: National Health Insurance global budget payment negotiation reference index. Available at: [http://www.doh.gov.tw/ufile/doc/96%e6%8c%87%e6%a8%99%e8%a6%81%e8%a6%bd09.pdf] Accessed on 30th Sep, 2010. (In Chinese)

Bureau of National Health Insurance: Point value in dental department global budget. Available at: [http://www.nhi.gov.tw/webdata/AttachFiles/Attach_10898_2_%E5%90%84%E7%B8%BD%E9%A1%8D%E5%90%84%E5%AD%A3%E6%B5%AE%E5%8B%95%E9%BB%9E%E5%80%BC-97Q4(980227)%E7%BD%AE%E5%85%A8%E7%90%83%E8%B3%87%E8%A8%8A%E7%B6%B2.pdf] Accessed on 30th Sep, 2010. (In Chinese)