Quality of care provided for young adults and adolescents in the Finnish public oral health service

Helminen SE. Quality of care provided for young adults and adolescents in the Finnish public oral health service. Institute of Dentistry, University of Helsinki, Finland, 2000. 55 pp. ISBN 952-91-1949-6. In this study, a model was designed to serve as a theoretical framework, with tools designed for assessing treatment practices in oral health care. The model and tools were applied in a real-life environment in order to assess dentists’ treatment selections and quality of treatment practices concerning oral health record-keeping, risk assessment, preventive and root canal treatment, and radiography. Cross-sectional data on actual clinical examinations and treatment courses performed by 56 dentists came from original individual oral health documents. In total, 559 treatment courses performed in 1994-1996, and 312 radiographs taken between 1990-1997 were scrutinized in randomly selected study populations of young adults and adolescents. Data on the dentists came from employee files. Dentists’ perceptions of their treatment practices were obtained through a questionnaire. The tools defining an individual score of quality points for each treatment case or for a radiograph employed assessment criteria conforming to good dental practice. Dentists’ treatment selections were evaluated in relation to patients’ oral health status and to dentist characteristics. As indicated by the quality points, treatment practices varied considerably. Independent of their year of graduation and gender, dentists fell short of actually following preferable treatment practices. In the majority of treatment cases, patient risk-factor assessment was insufficient, fewer than half of the dentists performing any kind of risk-assessment measures. Preventive treatment was not individualized according to each patient’s oral health status, adolescents receiving more prevention than did young adults, of whom, one-fourth received none. Lack of diagnostic procedures was evident also in radiography and root canal treatments. Overall, dentists' perception of the quality of their treatment practices exceeded that found in patient documents. With the shortcomings found in treatment practices in the present study, it was concluded, based on the relevant literature, that the quality of care was comparable to that found in similar assessments in other western countries. It was recommended that dentists should take an active role in assessing their processes of care as well as in improving them. The model and tools designed in this study may facilitate the assessment of actual practices and the follow-up of improvements made in any one oral health care setting. Author's address: Sari E Helminen, Institute of Dentistry, Department of Oral Public Health, University of Helsinki, P.O. Box 41, FIN-00014 Helsinki, Finland. E-mail: [email protected] List of original publications The thesis is based on the following original articles referred to in the text by their Roman numerals. In addition, the thesis includes unpublished data. I Helminen SE, Vehkalahti M, Murtomaa H, Kekki P, Ketomäki T-M. Quality evaluation of oral health record-keeping for Finnish young adults. Acta Odontologica Scandinavica 1998; 56: 288-292. II Helminen SE, Vehkalahti M, Ketomäki T-M, Murtomaa H. Dentists’ selection of measures for assessment of oral health risk factors for Finnish young adults. Acta Odontologica Scandinavica 1999; 57: 225-230. III Helminen SE, Vehkalahti M, Lammi R, Ketomäki T-M, Murtomaa H. Dentists’ decisions as to mode of preventive treatment in adolescents and young adults in Finland. Community Dental Health 1999; 16: 250-255. IV Helminen SE, Vehkalahti M, Kerosuo E, Murtomaa H. Quality evaluation of process of root canal treatments performed on young adults in Finnish public oral health service. Journal of Dentistry 2000; 28 (in press). V Helminen SE, Vehkalahti M, Wolf J, Murtomaa H. Quality evaluation of young adults’ radiographs in Finnish public oral health service. Submitted.