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An analysis of dental patient safety incidents in a patient complaint and healthcare supervisory database in Finland.

https://arctichealth.org/en/permalink/ahliterature275277
Source
Acta Odontol Scand. 2016;74(2):81-9
Publication Type
Article
Date
2016
Author
Nora Hiivala
Helena Mussalo-Rauhamaa
Hanna-Leena Tefke
Heikki Murtomaa
Source
Acta Odontol Scand. 2016;74(2):81-9
Date
2016
Language
English
Publication Type
Article
Keywords
Adult
Databases as Topic - statistics & numerical data
Dental Auxiliaries - statistics & numerical data
Dental Care - statistics & numerical data
Dental Hygienists - statistics & numerical data
Dental Technicians - statistics & numerical data
Dentists - statistics & numerical data
Dissent and Disputes
Expert Testimony
Female
Finland
Humans
Male
Malpractice - statistics & numerical data
Middle Aged
Patient Harm - classification - prevention & control - statistics & numerical data
Patient Safety - statistics & numerical data
Private Sector - statistics & numerical data
Public Sector - statistics & numerical data
Risk Management
Sex Factors
Abstract
Few studies of patient harm and harm-prevention methods in dentistry exist. This study aimed to identify and characterize dental patient safety incidents (PSIs) in a national sample of closed dental cases reported to the Regional State Administrative Agencies (AVIs) and the National Supervisory Authority for Welfare and Health (Valvira) in Finland.
The sample included all available fully resolved dental cases (n = 948) during 2000-2012 (initiated by the end of 2011). Cases included both patient and next of kin complaints and notifications from other authorities, employers, pharmacies, etc. The cases analyzed concerned both public and private dentistry and included incident reports lodged against dentists and other dental-care professionals. Data also include the most severe cases since these are reported to Valvira. PSIs were categorized according to common incident types and preventability and severity assessments were based on expert opinions in the decisions from closed cases.
Most alleged PSIs were proven valid and evaluated as potentially preventable. PSIs were most often related to different dental treatment procedures or diagnostics. More than half of all PSIs were assessed as severe, posing severe risk or as causing permanent or long-lasting harm to patients. The risk for PSI was highest among male general dental practitioners with recurring complaints and notifications.
Despite some limitations, this register-based study identifies new perspectives on improving safety in dental care. Many PSIs could be prevented through the proper and more systematic use of already available error-prevention methods.
PubMed ID
25967591 View in PubMed
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Assessing implementation difficulties in tobacco use prevention and cessation counselling among dental providers.

https://arctichealth.org/en/permalink/ahliterature134158
Source
Implement Sci. 2011;6:50
Publication Type
Article
Date
2011
Author
Masamitsu Amemori
Susan Michie
Tellervo Korhonen
Heikki Murtomaa
Taru H Kinnunen
Author Affiliation
Department of Oral Public Health, Institute of Dentistry, University of Helsinki, Helsinki, Finland. masamitsu.amemori@helsinki.fi
Source
Implement Sci. 2011;6:50
Date
2011
Language
English
Publication Type
Article
Keywords
Counseling
Dental Hygienists
Dentist's Practice Patterns
Factor Analysis, Statistical
Female
Finland
Guideline Adherence
Health Plan Implementation
Humans
Male
Models, Theoretical
Patient Education as Topic
Practice Guidelines as Topic
Questionnaires
Tobacco Use Cessation - methods
Abstract
Tobacco use adversely affects oral health. Clinical guidelines recommend that dental providers promote tobacco abstinence and provide patients who use tobacco with brief tobacco use cessation counselling. Research shows that these guidelines are seldom implemented, however. To improve guideline adherence and to develop effective interventions, it is essential to understand provider behaviour and challenges to implementation. This study aimed to develop a theoretically informed measure for assessing among dental providers implementation difficulties related to tobacco use prevention and cessation (TUPAC) counselling guidelines, to evaluate those difficulties among a sample of dental providers, and to investigate a possible underlying structure of applied theoretical domains.
A 35-item questionnaire was developed based on key theoretical domains relevant to the implementation behaviours of healthcare providers. Specific items were drawn mostly from the literature on TUPAC counselling studies of healthcare providers. The data were collected from dentists (n = 73) and dental hygienists (n = 22) in 36 dental clinics in Finland using a web-based survey. Of 95 providers, 73 participated (76.8%). We used Cronbach's alpha to ascertain the internal consistency of the questionnaire. Mean domain scores were calculated to assess different aspects of implementation difficulties and exploratory factor analysis to assess the theoretical domain structure. The authors agreed on the labels assigned to the factors on the basis of their component domains and the broader behavioural and theoretical literature.
Internal consistency values for theoretical domains varied from 0.50 ('emotion') to 0.71 ('environmental context and resources'). The domain environmental context and resources had the lowest mean score (21.3%; 95% confidence interval [CI], 17.2 to 25.4) and was identified as a potential implementation difficulty. The domain emotion provided the highest mean score (60%; 95% CI, 55.0 to 65.0). Three factors were extracted that explain 70.8% of the variance: motivation (47.6% of variance, a = 0.86), capability (13.3% of variance, a = 0.83), and opportunity (10.0% of variance, a = 0.71).
This study demonstrated a theoretically informed approach to identifying possible implementation difficulties in TUPAC counselling among dental providers. This approach provides a method for moving from diagnosing implementation difficulties to designing and evaluating interventions.
Notes
Cites: Med Princ Pract. 2003;12 Suppl 1:22-3212707498
Cites: Implement Sci. 2011;6:4221513547
Cites: Community Dent Oral Epidemiol. 2003 Oct;31(5):378-8514667009
Cites: Bull World Health Organ. 2004 Mar;82(3):213-815112010
Cites: J Mass Dent Soc. 1997 Spring;46(1):9-12, 149540724
Cites: Qual Saf Health Care. 2005 Feb;14(1):26-3315692000
Cites: Am J Public Health. 2005 Jun;95(6):950-515914815
Cites: Patient Educ Couns. 2006 Apr;61(1):152-6016533683
Cites: J Clin Periodontol. 2007 Jun;34(6):523-4417509093
Cites: Community Dent Health. 2007 Jun;24(2):70-417615820
Cites: Int J Cancer. 2008 Jan 1;122(1):155-6417893872
Cites: Int Dent J. 2008 Jun;58(3):115-2118630105
Cites: BMJ. 2008;337:a165518824488
Cites: J Eval Clin Pract. 2008 Aug;14(4):537-4418462288
Cites: Br Dent J. 2009 Apr 11;206(7):E13; discussion 376-719343033
Cites: Int Dent J. 2010 Feb;60(1):3-620361571
Cites: Implement Sci. 2011;6:1321320312
Cites: Aust Dent J. 2003 Sep;48(3):183-914640372
PubMed ID
21615948 View in PubMed
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Can patients detect hazardous dental practice? A patient complaint study.

https://arctichealth.org/en/permalink/ahliterature266043
Source
Int J Health Care Qual Assur. 2015;28(3):274-87
Publication Type
Article
Date
2015
Author
Nora Hiivala
Helena Mussalo-Rauhamaa
Heikki Murtomaa
Source
Int J Health Care Qual Assur. 2015;28(3):274-87
Date
2015
Language
English
Publication Type
Article
Keywords
Dental Health Services - standards
Finland
Humans
Malpractice - statistics & numerical data
Patient Safety
Patient satisfaction
Risk Management
Abstract
The purpose of this paper is to: determine the prevalence and distribution of patient/family-generated, dentistry-related complaints to Regional State Administrative Agencies (AVIs) and the National Supervisory Authority for Welfare and Health (Valvira) in Finland from 2000 to 2011, study patient/family safety incident experiences and other reasons for complaints, assess complaint validity and evaluate factors associated with disciplinary processes against dentists.
Data included closed cases handled by AVIs and Valvira (2000-2011) against dental practitioners or dental practice units (n=782). The authors analysed the complaints distribution and examined the antecedent factors and circumstances.
This study demonstrated that patients/families can detect many dental treatment hazards, substandard processes and even serious safety risks rather well. The investigation processes revealed some physical harm or potential patient safety (PS) risks in more than half the alleged cases. Many complaints accumulated against certain individuals and statistically significant positive correlations were found between some patient/family complaints, dentist-specific variables and disciplinary actions.
Patient/family-generated complaints must be taken seriously and seen as relatively good safety risk indicators. However, more knowledge on how patients might cooperate with dental care providers to prevent errors is needed.
This work provides a unique opportunity to learn from several dentistry-related patient complaints. Despite some limitations, patient complaints appear to be useful as a complementary source together with other PS study methods.
PubMed ID
25860924 View in PubMed
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Enhancing implementation of tobacco use prevention and cessation counselling guideline among dental providers: a cluster randomised controlled trial.

https://arctichealth.org/en/permalink/ahliterature137064
Source
Implement Sci. 2011;6:13
Publication Type
Article
Date
2011
Author
Masamitsu Amemori
Tellervo Korhonen
Taru Kinnunen
Susan Michie
Heikki Murtomaa
Author Affiliation
Department of Oral Public Health, Institute of Dentistry, University of Helsinki, Helsinki, Finland. masamitsu.amemori@helsinki.fi
Source
Implement Sci. 2011;6:13
Date
2011
Language
English
Publication Type
Article
Keywords
Adult
Dental Care - manpower - methods
Dental Hygienists
Dentists
Directive Counseling - methods
Female
Finland
Guideline Adherence
Humans
Male
Middle Aged
Practice Guidelines as Topic
Program Development
Questionnaires
Smoking Cessation - methods
Tobacco Use Disorder - prevention & control
Abstract
Tobacco use adversely affects oral health. Tobacco use prevention and cessation (TUPAC) counselling guidelines recommend that healthcare providers ask about each patient's tobacco use, assess the patient's readiness and willingness to stop, document tobacco use habits, advise the patient to stop, assist and help in quitting, and arrange monitoring of progress at follow-up appointments. Adherence to such guidelines, especially among dental providers, is poor. To improve guideline implementation, it is essential to understand factors influencing it and find effective ways to influence those factors. The aim of the present study protocol is to introduce a theory-based approach to diagnose implementation difficulties of TUPAC counselling guidelines among dental providers.
Theories of behaviour change have been used to identify key theoretical domains relevant to the behaviours of healthcare providers involved in implementing clinical guidelines. These theoretical domains will inform the development of a questionnaire aimed at assessing the implementation of the TUPAC counselling guidelines among Finnish municipal dental providers. Specific items will be drawn from the guidelines and the literature on TUPAC studies. After identifying potential implementation difficulties, we will design two interventions using theories of behaviour change to link them with relevant behaviour change techniques aiming to improve guideline adherence. For assessing the implementation of TUPAC guidelines, the electronic dental record audit and self-reported questionnaires will be used.
To improve guideline adherence, the theoretical-domains approach could provide a comprehensive basis for assessing implementation difficulties, as well as designing and evaluating interventions. After having identified implementation difficulties, we will design and test two interventions to enhance TUPAC guideline adherence. Using the cluster randomised controlled design, we aim to provide further evidence on intervention effects, as well as on the validity and feasibility of the theoretical-domain approach. The empirical data collected within this trial will be useful in testing whether this theoretical-domain approach can improve our understanding of the implementation of TUPAC guidelines among dental providers.
Current Controlled Trials ISRCTN15427433.
Notes
Cites: Int Dent J. 2008 Jun;58(3):115-2118630105
Cites: Eval Health Prof. 1997 Dec;20(4):407-2710183332
Cites: Int J Cancer. 2008 Jan 1;122(1):155-6417893872
Cites: JAMA. 2008 Mar 12;299(10):1182-418334694
Cites: Nebr Symp Motiv. 1980;27:195-2597242748
Cites: Qual Saf Health Care. 2005 Feb;14(1):26-3315692000
Cites: Oral Dis. 2005 Sep;11(5):268-7316120112
Cites: BMJ. 2008;337:a165518824488
Cites: J Eval Clin Pract. 2008 Aug;14(4):537-4418462288
Cites: Int Dent J. 2010 Feb;60(1):3-620361571
Cites: J Ir Dent Assoc. 2000;46(1):12-9, 2211323932
Cites: Med Princ Pract. 2003;12 Suppl 1:22-3212707498
Cites: Bull World Health Organ. 2004 Mar;82(3):213-815112010
Cites: J Clin Periodontol. 2007 Jun;34(6):523-4417509093
PubMed ID
21320312 View in PubMed
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[From the general health care law to guaranteed care-annual dental checkup].

https://arctichealth.org/en/permalink/ahliterature170842
Source
Duodecim. 2005;121(21):2325-31
Publication Type
Article
Date
2005
Author
Heikki Murtomaa
Pirkko Letto
Author Affiliation
Helsingin yliopiston hammaslääketieteen laitos, suuterveystiede. heikki.murtomaa@helsinki.fi
Source
Duodecim. 2005;121(21):2325-31
Date
2005
Language
Finnish
Publication Type
Article
Keywords
Adolescent
Adult
Age Factors
Child
Dental Care - organization & administration
Female
Finland
Humans
Male
Mass Screening - methods
Primary Prevention - organization & administration
Program Development
Risk assessment
Sex Factors
PubMed ID
16457117 View in PubMed
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Impact of educational intervention on implementation of tobacco counselling among oral health professionals: a cluster-randomized community trial.

https://arctichealth.org/en/permalink/ahliterature121141
Source
Community Dent Oral Epidemiol. 2013 Apr;41(2):120-9
Publication Type
Article
Date
Apr-2013
Author
Masamitsu Amemori
Jorma Virtanen
Tellervo Korhonen
Taru H Kinnunen
Heikki Murtomaa
Author Affiliation
Department of Oral Public Health, Institute of Dentistry, University of Helsinki, Helsinki, Finland. masamitsu.amemori@helsinki.fi
Source
Community Dent Oral Epidemiol. 2013 Apr;41(2):120-9
Date
Apr-2013
Language
English
Publication Type
Article
Keywords
Adult
Attitude to Health
Clinical Competence
Counseling - education
Dental Hygienists - economics - education
Dentists - economics
Education, Dental, Continuing
Electronic Health Records
Female
Finland
Follow-Up Studies
Humans
Intervention Studies
Male
Middle Aged
Motivation
Multimedia
Outcome Assessment (Health Care)
Reimbursement, Incentive
Role Playing
Self Efficacy
Smoking - prevention & control
Teaching - methods
Time Factors
Tobacco Use Cessation - statistics & numerical data
Abstract
Tobacco use adversely affects oral health. Clinical guidelines recommend that oral health professionals promote tobacco abstinence and provide patients who use tobacco with brief tobacco use cessation counselling. Research shows that these guidelines are seldom implemented successfully. This study aimed to evaluate two interventions to enhance tobacco use prevention and cessation (TUPAC) counselling among oral health professionals in Finland.
We used a cluster-randomized community trial to test educational and fee-for-service interventions in enhancing TUPAC counselling among a sample of dentists (n=73) and dental hygienists (n=22) in Finland. Educational intervention consisted of 1 day of training, including lectures, interactive sessions, multimedia demonstrations and a role play session with standard patient cases. Fee-for-service intervention consisted of monetary compensation for providing tobacco use prevention or cessation counselling. TUPAC counselling procedures provided were reported and measured using an electronic dental records system. In data analysis, intent-to-treat principles were followed at both individual and cluster levels. Descriptive analysis included chi-square and t-tests. A general linear model for repeated measures was used to compare the outcome measures by intervention group.
Of 95 providers, 73 participated (76.8%). In preventive counselling, there was no statistically significant time effect or group-by-time interaction. In cessation counselling, statistically significant group-by-time interaction was found after a 6-month follow-up (F=2.31; P=0.007), indicating that counselling activity increased significantly in intervention groups. On average, dental hygienists showed greater activity in tobacco prevention (F=12.13; P=0.001) and cessation counselling (F=30.19; P
PubMed ID
22934678 View in PubMed
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Implementation of tobacco use cessation counseling among oral health professionals in Finland.

https://arctichealth.org/en/permalink/ahliterature114666
Source
J Public Health Dent. 2013;73(3):230-6
Publication Type
Article
Date
2013
Author
Masamitsu Amemori
Tellervo Korhonen
Susan Michie
Heikki Murtomaa
Taru H Kinnunen
Author Affiliation
Department of Oral Public Health, Institute of Dentistry, University of Helsinki, Helsinki, Finland.
Source
J Public Health Dent. 2013;73(3):230-6
Date
2013
Language
English
Publication Type
Article
Keywords
Adult
Dental Health Services - organization & administration
Female
Finland
Health Personnel
Humans
Male
Middle Aged
Smoking Cessation
Tobacco
Abstract
Clinical guidelines for tobacco use cessation (TUC) counseling recommend that healthcare professionals should provide brief tobacco counseling for all tobacco users. Widespread implementation of these guidelines seems to be insufficient. To enhance adherence to TUC counseling guidelines, it is essential to identify provider behaviors related to a successful implementation. This study aims to assess adherence to TUC counseling guidelines and factors that are associated with counseling behaviors.
A 41-item questionnaire relevant to the implementation of TUC counseling guidelines among healthcare professionals was administered. This questionnaire included items used to evaluate TUC counseling behaviors as well Theoretical Domains Framework (TDF)-based behavior change items. Of the 95 oral health professionals invited from 34 community dental clinics in Finland, 73 professionals (76.8 percent) participated. The TDF factors and their associations to TUC counseling behaviors were analyzed using correlations and logistic regression analyses.
Adherence to TUC counseling guidelines, especially for providing advice to quit, assisting in quitting and arranging follow-up services, were low. In addition, only 15.1 percent of the providers reported asking about tobacco use and 8.2 percent assessed interest in quitting among the majority (>75 percent) of their patients. Of the behavior change domains, "Memory, Attention and Decision Processes" and "Professional Role and Identity" were found to be significantly associated with TUC counseling behavior among oral health professionals.
Regarding the adherence to TUC counseling guidelines, there is room for improvement. The identified TDF factors related to TUC behaviors provide an avenue for targeted interventions to improve guideline implementation.
PubMed ID
23594270 View in PubMed
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Influence of patient characteristics on Finnish dentists' decision-making in implant therapy.

https://arctichealth.org/en/permalink/ahliterature188449
Source
Implant Dent. 2002;11(3):301-7
Publication Type
Article
Date
2002
Author
Mia Heinikainen
Miira Vehkalahti
Heikki Murtomaa
Author Affiliation
Department of Oral Public Health, Institute of Dentistry, University of Helsinki, Helsinki, Finland. mia.heinikainen@clarinet.fi
Source
Implant Dent. 2002;11(3):301-7
Date
2002
Language
English
Publication Type
Article
Keywords
Adult
Decision Making
Dental Care for Chronically Ill - psychology
Dental caries
Dental Implantation, Endosseous - contraindications - psychology - utilization
Dental Implants - contraindications - psychology - utilization
Dentist's Practice Patterns - statistics & numerical data
Faculty, Dental
Female
Finland
Humans
Male
Middle Aged
Patient Selection
Periodontal Pocket
Private Sector
Public Sector
Questionnaires
Smoking
Abstract
The purpose of this survey was to evaluate the association of various patient characteristics or possible contraindications with dentists' treatment decisions in oral implantology among general practitioners (GPs) and dental teachers (DTs) in Finland. A questionnaire was mailed to 400 GPs, selected by stratified randomization by gender and main occupation (public vs private sector), and to all full-time DTs (n = 47) representing clinical disciplines other than surgery and orthodontics. The questionnaire included a clinical description of a situation optimal for implant therapy. The same situation was modified with 10 variations (cases) according to patient characteristics or possible contraindications, later classified into three categories: (1) oral factors, (2) medical factors, and (3) personal factors. Respondents were asked whether or not they would recommend implant therapy for each of the cases separately. For all 10 cases, the public sector dentists recommended implant therapy on average for 48%, the private sector dentists for 57% (P
PubMed ID
12271570 View in PubMed
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Oral health promotion among adults with diabetes in Finland.

https://arctichealth.org/en/permalink/ahliterature181352
Source
Community Dent Oral Epidemiol. 2003 Dec;31(6):447-53
Publication Type
Article
Date
Dec-2003
Author
Aija Karikoski
Pirjo Ilanne-Parikka
Heikki Murtomaa
Author Affiliation
Department of Oral Public Health, Institute of Dentistry, University of Helsinki, Finland. aijakarikoski@hotmail.com
Source
Community Dent Oral Epidemiol. 2003 Dec;31(6):447-53
Date
Dec-2003
Language
English
Publication Type
Article
Keywords
Adult
Dental Calculus - prevention & control
Dental Plaque - prevention & control
Dental Plaque Index
Diabetes Complications
Finland
Health Behavior
Health promotion
Humans
Intervention Studies
Nurse-Patient Relations
Oral Hygiene
Patient care team
Patient Education as Topic
Periodontal Diseases - prevention & control
Periodontal Index
Statistics, nonparametric
Treatment Outcome
Abstract
In the present community trial, changes in oral health among adults with diabetes in Finland were assessed in three differing intervention groups and in a control group. The goal of intervention was to promote periodontal health.
The study population comprised of 120 adults with diabetes, who were regular patients at the Salo Regional Hospital Diabetes Clinic in Salo, Finland. All underwent periodontal examination in 1999 and 2001. The percentage of dropouts was 4%. Outcome measures were visible plaque, presence of calculus, and the Community Periodontal Index of Treatment Needs (CPITN) index calculated for each tooth separately. Oral-health-related factors were determined by a questionnaire. Intervention based on the recommended treatment interval was carried out in the following groups: diabetes nurse-letter-reminder group (n = 26), diabetes nurse-reminder group (n = 31), letter-reminder group (n = 30), and a control group (n = 28).
A significant decrease occurred in the visible plaque index between 1999 and 2001 in all groups, and in calculus index in the diabetes-nurse-reminder group and in the letter-reminder group. During the study period, only in the control group, the CPITN index codes 3 and 4, calculated for each tooth separately, increased.
These positive results emphasize the potential of existing health-care actions for promoting periodontal health. With minimal recourse demands, it was possible to increase oral health behaviors and periodontal health among patients with diabetes.
PubMed ID
14986912 View in PubMed
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Oral self-care among adults with diabetes in Finland.

https://arctichealth.org/en/permalink/ahliterature190275
Source
Community Dent Oral Epidemiol. 2002 Jun;30(3):216-23
Publication Type
Article
Date
Jun-2002
Author
Aija Karikoski
Pirjo Ilanne-Parikka
Heikki Murtomaa
Author Affiliation
Department of Oral Public Health, Institute of Dentistry, University of Helsinki, Finland. aijakarikoski@hotmail.com
Source
Community Dent Oral Epidemiol. 2002 Jun;30(3):216-23
Date
Jun-2002
Language
English
Publication Type
Article
Keywords
Adult
Aged
Chi-Square Distribution
Dental Care - utilization
Diabetes Mellitus - psychology
Educational Status
Female
Finland
Health Knowledge, Attitudes, Practice
Humans
Logistic Models
Male
Middle Aged
Oral Hygiene - psychology - utilization
Periodontal Diseases - prevention & control - psychology
Questionnaires
Sex Factors
Abstract
The importance of maintenance and promotion of periodontal health is emphasized among people with diabetes because of their high risk for periodontal diseases. Our aim was to evaluate oral health behavior and its determinants among adults with diabetes in Finland.
The population of the questionnaire study consisted of 420 systematically selected adults with diabetes, who were members of a national diabetes register. The response rate was 80%. Questions focused on self-treatment, -prevention, and -diagnosis of oral diseases, utilization of dental services, and knowledge and attitudes toward oral health among adult people with diabetes. Oral self-care was evaluated in the framework of the New Century model of oral health promotion.
The proportion of edentulous subjects was 23%, and these were excluded from further analysis. Self-reported twice-a-day brushing among dentate participants was significantly more common among women and the highly educated, but was less common compared with earlier studies among Finnish adults. A quarter of those surveyed reported never cleaning interdental surfaces, with the number of daily cleaners being nearly equal (27%). Age 40 years or over and recent treatment by a private dentist were significant predictors for daily interdental cleaning. The proportion of those who had attended a dental appointment within the last year was 63%, and the main reason for the last dental visit was an emergency among almost one-fifth of those surveyed.
A need exists for further promotion of oral self-care among adults with diabetes. Support by dental and other health care professionals involved in diabetes care should be encouraged.
PubMed ID
12000345 View in PubMed
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17 records – page 1 of 2.