Monitoring patient satisfaction with university dental services under two fee-paying systems

Adult capped dental payment model applied within a university setting: an Australian reflective case study

Background

Capitation models of care in dentistry started around 1973 with varying degrees of success in meeting the needs of the individuals and expectations of the participating private practitioners. These studies mostly identified that capitation payments resulted in under treatment whilst fee-for-service models often led to over treatment. The objective of this study was to develop a new way of doing business using an outsourcing capitation model of care to meet population health needs and activity-based funding requirements of rural Local Health Districts with a local university dental school. This payment model is an alternate referral pathway for public oral health practitioners from the existing New South Wales Oral Health Fee-for-Service Scheme that focuses on urgent treatment to one that offers an all-inclusive preventive approach that concentrates on sustaining good long-term oral health for the individual.

Method

The reflective study analysed various adult age cohorts (18–24, 25–34, 35–44, 45–54, 55–64, 65–74 and 75 + years) based on 950 participants randomly selected from the Greater Southern adult public dental waiting lists. The study’s capitation formula was derived from NSW government adult treatment items (n = 447,625). Dental care was provided through the local university’s dental clinics utilising only dental students under clinical supervision. All data were sourced from NSW Oral Health Data Warehouse during 1 January 2012–30 June 2018 and analysed by using SAS 9.3 and Version 13 Microsoft Excel.

Results

There were 10,305 dental care items and 1129 capitation courses of care totalling A$599,026. This resulted in an average of 11 dental care items being provided to each participant. The capitation payment formula utilising the most provided dental care items of 100 individual patients proved to be economical and preventive focused.

Conclusion

The systematic reflection showed that this unique methodology in developing an adult capitation payment formula associated to diagnostic pathways that resulted in: (i) more efficient usage of government expenditure on public dental services, (ii) provision of person-centred courses of dental care, and (iii) utilisation of university dental education programs to best practice treatment and holistic care.

Satisfaction with healthcare services among refugees in Zaatari camp in Jordan

BACKGROUND

Feedback on satisfaction regarding healthcare services is vital for continuous improvement of the service delivery process and outcome.

AIMS AND METHODS

The objective of this study was to assess the satisfaction of refugees with the medical and dental services in Zaatari camp, under 3 domains with 20 key indicators (human and physical health resources, interaction and reactivity, and administration) using a self-administered questionnaire.

RESULTS

Of the 500 participants, the satisfaction rate was 72.5%. Young participants and participants with a shorter stay in the camp showed higher overall satisfaction rates (P ≤ 0.01). Within the domains, 'interaction and reactivity' achieved the highest satisfaction score, whereas 'administration efficiency' was ranked the lowest. As for elements within the domains, the most acceptable were the sufficient number of staff and the working hours, availability of radiological services and proper care for children, reasonable waiting time and asking for medical history in every visit. Whereas difficulty to access healthcare services, difficulty to be referred to hospitals, lack of follow up and lack of dental services were the least acceptable.

CONCLUSION

In conclusion, whereas refugees were generally satisfied with the provided services, this study indicates that there are areas for further service improvement. This study highlights a significant gaps in healthcare services which if not addressed have the potential to amplify oral/medical health problems.

Satisfaction with dental care among patients who receive invasive or non-invasive treatment for non-cavitated early dental caries: findings from one region of the National Dental PBRN

BACKGROUND

The objectives were to: (1) quantify patient satisfaction with treatment for early dental caries overall, and according to whether or not (2a) the patient received invasive treatment; (2b) was high-risk for dental caries, and had dental insurance; and (3) encourage practitioners to begin using non-invasive approaches to early caries management.

METHODS

Ten practitioners recorded patient, lesion, and treatment information about non-cavitated early caries lesions. Information on 276 consecutive patients with complete data was included, who received either non-invasive (no dental restoration) or invasive (dental restoration) treatment. Patients completed a patient satisfaction questionnaire and were classified as dissatisfied if they did not "agree" or "strongly agree" with any of 14 satisfaction items.

RESULTS

Patients had a mean (± SD) age of 41.8 (±15.8) years, 64% were female and 88% were white. Twenty-five percent (n = 68) were dissatisfied in at least one of the 14 satisfaction items. Satisfaction levels did not significantly vary by patient's gender, race, caries risk category, or affected tooth surface location. Overall, 11% (28 of 276) received invasive treatment; satisfaction did not differ between patients who had invasive or non-invasive treatment. Seven patients received invasive treatment at their request even though that was not what their practitioner recommended; 5 out of 6 were satisfied with their treatment nonetheless.

CONCLUSIONS

About one-fourth of patients treated for non-cavitated early caries were dissatisfied with at least some aspect of their dental care experience. Satisfaction of patients who received invasive treatment did not differ from those who received non-invasive treatment.

Treatment outcomes of single-visit versus multiple-visit non-surgical endodontic therapy: a randomised clinical trial

BACKGROUND

Clincians have been providing single-visit and multiple-visit endodontic treatments for their patients. This study aims to compare the success rate, prevalence of postoperative pain and chairside time of single-visit and multiple-visit endodontic treatments.

METHOD

Patients who required primary endodontic treatment in a university dental clinic were randomly allocated to two general dentists for single-visit or multiple-visit treatments using the same materials and procedures. Ni-Ti rotary files were used to prepare the root canals, which were subsequently obturated with a core-carrier technique. The chairside time was recorded. The treated teeth were followed up every 6 months on clinically signs and symptoms including pain, tenderness to percussion, sinus tract, mobility and abscess. Periapical radiographs were taken to assess periapical pathology. Successful treatments were neither clinical signs/symptoms noted nor radiographic periapical pathology found postoperatively.

RESULTS

A total of 220 teeth from patients aged 46.4 ± 14.1 were followed up for at least 18 months. The mean (±SD) follow-up period was 29.4 ± 9.3 months. The success rates of single-visit and multiple-visit treatments were 88.9 and 87.4 %, respectively (p = 0.729, effect size odds ratio = 1.156). Maxillary teeth had odds ratios of 3.16 (95 % CI: 1.33 to 7.46; p = 0.009) and absence of preoperative apical periodontitis had odds ratios of 4.35 (95 % CI: 1.43 to 13.24; p = 0.010) were identified from logistic regression as having a higher success rate. The average chairside times of single-visit and multiple-visit treatments were 62.0 and 92.9 min, respectively (mean difference = -30.9, 95 % CI: -39.4 to -22.4, p < 0.001, effect size odds ratio = -0.996). Single-visit and multiple-visit treatment had no significant difference in the prevalence of postoperative pain within 7 days (21 and 12 %, p = 0.055, effect size odds ratio = 2.061) and after at least 18 months (0.9 and 1.0 %, p > 0.999, effect size odds ratio = 0.879).

CONCLUSIONS

The success rate and prevalence of postoperative pain of single-visit or multiple-visit treatment had no significant difference. The chairside time for single-visit treatment was shorter than multiple-visit treatment.

TRIAL REGISTRATION

Clinical Trials (WHO) ChiCTR-IOR-15006117 registered on 20 March 2015.

Attitude and awareness of medical and dental students towards collaboration between medical and dental practice in Hong Kong

Background

Medical-dental collaboration is essential for improving resource efficiency and standards of care. However, few studies have been conducted on it. This study aimed to investigate the attitude and awareness of medical and dental students about collaboration between medical and dental practices in Hong Kong.

Methods

All medical and dental students in Hong Kong were invited to complete a questionnaire survey at their universities, hospitals and residential halls. It contained 8 questions designed to elicit their attitudes about the collaboration between medical and dental practice. Students were also asked about their awareness of the collaboration between dentistry and medicine. The questionnaires were directly distributed to medical and dental students. The finished questionnaires were immediately collected by research assistants on site.

Results

A total of 1,857 questionnaires were distributed and 809 (44%) were returned. Their mean attitude score (SD) towards medical-dental collaboration was 6.37 (1.44). Most students (77%) were aware of the collaboration between medical and dental practice in Hong Kong. They considered that Ear, Nose & Throat, General Surgery and Family Medicine were the 3 most common medical disciplines which entailed collaboration between medical and dental practice.

Conclusion

In this study, the medical and dental students in general demonstrated a good attitude and awareness of the collaboration between medical and dental practice in Hong Kong. This established an essential foundation for fostering medical-dental collaboration, which is vital to improving resource efficiency and standards of care.

Electronic supplementary material

The online version of this article (doi:10.1186/s12903-015-0038-2) contains supplementary material, which is available to authorized users.

Treatment time for non-surgical endodontic therapy with or without a magnifying loupe

BACKGROUND

Use of magnifying loupe may increase the efficiency of dental care. This clinical trial compared the time in performing non-surgical endodontic therapy with or without the use of a magnifying loupe.

METHODS

Patients who required primary endodontic treatment in clinical trial centres at the University of Hong Kong (HKU) in Hong Kong and Peking University (PKU) in Beijing were invited to participate in this study. Two HKU dentists and 2 PKU dentists, forming 2 pairs of dentists with similar years of clinical experience, performed endodontic treatments according to the same procedures and used the same materials, either in single or multiple visits. They had no prior experience with the use of a magnifying loupe. One dentist from each pair was trained to use a magnifying loupe (x2.5). The treatment time was recorded.

RESULTS

Eighty-four PKU patients with a mean age of 42.8 years and 98 HKU patients with a mean age of 46.0 years were recruited in this study. Ninety-six teeth were treated with a magnifying loupe and 86 teeth were treated without a magnifying loupe. The results showed that treatment time was not associated with age, gender, tooth vitality, or the presence of apical radiolucency or sinus tract. The results of ANCOVA revealed the treatment time was associated with the clinic (HKU or PKU), root canal system (single or multiple), presence of preoperative pain, treatment visit (single or multiple), the use of a magnifying loupe, and the experience of the operator.

CONCLUSION

In this study, the use of a magnifying loupe could significantly reduce the endodontic treatment time.

TRIAL REGISTRATION

Clinical Trials ChiCTR-IOR-15005988 registered 15 February 2015.

Oral health status of chinese paediatric and adolescent oncology patients with chemotherapy in Hong Kong: a pilot study

Aim:

To study the oral health status of Chinese children and adolescents undergoing chemotherapy in Hong Kong.

Method:

All Chinese children and adolescent oncology patients aged 18 or below attending the Children's Centre for Cancer and Blood Disease at a hospital for chemotherapy were invited and parental consent was sought before they were accepted into the study. The study comprised of 1) a parental questionnaire, 2) the collection of medical history and 3) a clinical examination for tooth decay (caries) and mucosal status.

Results:

A total of 69 patients were invited, and they all participated in this study. Their mean age was 9.2±5.0 and 44 (64%) were males. Twenty-six patients (38%) had no caries experience (DMFT and/or dmft = 0). Higher caries experience was detected in participants that were not born in Hong Kong, had completed active chemotherapy, participated in school dental care service and whose parents had low educational levels. There were 41 patients with active chemotherapy, 24 of whom were diagnosed with acute leukaemia, 5 with haematological malignancies other than leukaemia and 11 with solid tumours. Antimetabolites, cytotoxic antibiotics, alkylating agents and plant alkaloids were administered in 49%, 32%, 24% and 22% of them, respectively. Twenty-six (63%) patients showed no mucosal complications. The most common oral complication was oral mucositis (24%) followed by petechiae (10%).

Conclusion:

About two-thirds of paediatric and adolescent cancer patients had caries experience, which was more common among those who had completed chemotherapy. Oral mucositis followed by petechiae were the two most common complications of receiving chemotherapy.

Patients' satisfaction and prevalence of complications on surgical extraction of third molar

OBJECTIVES

To study patients' satisfaction and prevalence of complications in surgical extraction of impacted third molar by senior dentists and recently graduated dentists in a university dental clinic.

METHOD

Patients who had impacted third molar extraction in a university dental clinic by two associate dentists who had <2 years of experience and two senior dentists who had >15 years of experience were evaluated in this study. Patients' age, sex, history of pericoronitis, tooth extracted, and radiographic assessment of the impacted tooth were recorded. Immediately after suture removal, the patients were invited to indicate their satisfaction on a Likert scale of 1-5.

RESULTS

A total of 546 patients received extraction, and 251 patients were operated by associate dentists. Patient satisfaction was higher among those who had noncomplicated surgery (P=0.007), short treatment time (P<0.001), and had no postsurgical emergency appointments (P<0.001). The prevalence of seeking postsurgical emergency appointments was 9.2%. The reasons were severe pain (4.8%), swelling (2.6%), bleeding (2.4%), alveolar osteitis (0.9%), paresthesia (0.9), and trismus (0.5%). The prevalence of postsurgical complication(s) in associate dentists and senior dentists was 11.6% and 7.1%, respectively (P=0.050). The mean satisfaction scores for associate dentists and senior dentists were 4.17 and 3.95, respectively (P=0.002).

CONCLUSION

Although a higher rate of postsurgical complications was observed among the patients treated by the recently graduated dentists, their patients' satisfaction scores were higher than that of the senior dentists. Around 9% of patients attended postsurgical emergency appointments, and their common reason was severe pain.

Analysis of public dental service waiting lists in Queensland

Information on public dental service waiting lists is available as part of the Queensland Government open data policy. Data were summarised across the care categories and health districts to present the total number and percentage of people waiting for care and who have waited beyond the desirable period. As of 31 December 2012 there were 130 546 people on the dental waiting list; of these 85.8%, 8.5% and 2.2% were waiting for general care desirable within 24, 12 and 3 months, respectively. Across all care categories, almost 56% of those on the waiting list were beyond the desirable waiting period. The average number of people on the waiting list and the average number waiting beyond the desirable time differ substantially per clinic by district. Ongoing analysis of the Queensland public dental service waiting list database will determine the impact on patient waiting times of Federal Government initiatives announced in 2012 to treat an estimated 400 000 patients on waiting lists nationwide over the next 3 years and to expand services to assist low-income adults to receive dental services.

Impact of initiatives to reduce public dental waiting lists in Queensland, Australia

Information on public dental service waiting lists is available as part of the Queensland Government open data policy. Data were analysed for the period December 2012 to December 2013, to present the total number and percentage of people waiting for care and who have waited beyond the desirable period. Over the 1-year study period, the number of people on the waiting list decreased from 130 546 to 77 146, a difference of 40.9%. A decrease of 80.6% was found for those waiting beyond the desirable period for care. The largest decrease was for general care (44.9%). The initiatives to reduce the public dental waiting list appear to have been successful in significantly reducing the number of people waiting in general and especially those waiting beyond the desirable period. The initiatives to decrease waiting lists represent a downstream approach and are less likely to have any significant impact on the prevention of oral diseases. As waiting lists are reduced, more emphasis should be placed on upstream approaches such as health promotion, specific protection measures and targeting high-risk individuals for oral diseases.

A survey of practices of tunnel preparation among dentists who attended the 100th FDI Annual World Dental Congress

AIM

To study the practice of tunnel restoration (TR) among dentists who attended the 100th World Dental Federation (FDI) Annual World Dental Congress (AWDC).

METHODS

An anonymous questionnaire was administered to a sample of 150 dentists who attended the 100th FDI AWDC in 2012. The participants were asked about TR and their practice of TR. They were also asked to provide their years of dental practice and the countries in which they received their dental training.

RESULTS

Fifteen respondents were not performing restoration, and they were excluded from analysis. Most respondents (123/135) practiced general dentistry. Their basic dental training was from 46 countries and regions. Most of them (n = 117, 87%) knew about TR, and 53% (n = 71) practiced it. There were 12 dentists (9%) who had performed more than 10 TRs in the previous 12 months. Practice of TR among dentists who graduated more than 10 years previously was more common (odds ratio 5.87-5.98) than those who graduated <3 years previously.

CONCLUSIONS

The current study found that about half of the surveyed dentists practiced TR, although most of them knew about it. Tunnel restoration was performed more frequently among dentists who had more than 10 years of clinical experience.

Restoring proximal caries lesions conservatively with tunnel restorations

The tunnel restoration has been suggested as a conservative alternative to the conventional box preparation for treating proximal caries. The main advantage of tunnel restoration over the conventional box or slot preparation includes being more conservative and increasing tooth integrity and strength by preserving the marginal ridge. However, tunnel restoration is technique-sensitive and can be particularly challenging for inexperienced restorative dentists. Recent advances in technology, such as the contemporary design of dental handpieces with advanced light-emitting diode (LED) and handheld comfort, offer operative dentists better vision, illumination, and maneuverability. The use of magnifying loupes also enhances the visibility of the preparation. The advent of digital radiographic imaging has improved dental imaging and reduced radiation. The new generation of restorative materials has improved mechanical properties. Tunnel restoration can be an option to restore proximal caries if the dentist performs proper case selection and pays attention to the details of the restorative procedures. This paper describes the clinical technique of tunnel restoration and reviews the studies of tunnel restorations.

Components of patient satisfaction with a dental restorative visit: results from the Dental Practice-Based Research Network

BACKGROUND

The authors conducted a study to identify components of patient satisfaction with restorative dental care and to test the hypothesis that certain dentist, patient and procedure factors are associated with patient satisfaction.

METHODS

Practitioner-investigators (P-Is) from 197 practices in The Dental Practice-Based Research Network (DPBRN) recruited consecutively seen patients who had defective permanent-tooth restorations that were replaced or repaired. At the end of the treatment visit, P-Is asked each participant to complete a satisfaction survey and mail it directly to a DPBRN regional coordinator.

RESULTS

Analysis of the results of 5,879 satisfaction surveys revealed three satisfaction components: interpersonal relationship-comfort factors, material choice-value factors and sensory-evaluative factors. Satisfaction was highest among patients who received care in a private practice model, whose restorations were repaired rather than replaced and whose restored teeth were not molars.

CONCLUSION

These data suggest that a patient's judgments of a dentist's skills and quality of care are based on personal interactions with the dentist, the level of comfort the patient perceives while receiving care and any experience of posttreatment sensitivity in the treated tooth. These conclusions have direct implications for management of patient care before, during and after the procedure.

PRACTICE IMPLICATIONS

By taking a patient-centered approach, dentists should seek to understand how patients evaluate and rate the service provided, thereby enabling themselves to focus on what each patient values most.

Patient experiences during waiting time for dental treatment

OBJECTIVES

The aim of this study was to evaluate patient experiences of inconvenience and treatment need while waiting for dental treatment.

MATERIALS AND METHODS

A systematic sample of 210 patients with varying lengths of waiting time was drawn from the waiting list for non-emergency treatment in the City of Turku. A questionnaire covering socio-demographic background was mailed to the patients. The level of inconvenience caused by waiting was assessed by a linear visual analogue scale (0-100).

RESULTS

A total of 112 subjects (60%) completed and returned the questionnaire and 109 (58%) gave permission to collect data from their patient records. The average inconvenience score was 42.9, with those who had waited for 3 months or less reporting less inconvenience than those that had waited for 4 months or more. There was not a straightforward linear correlation between length of waiting time and level of inconvenience experienced. Experiences of inconvenience were independent of socio-demographic background. The patient-reported maximum acceptable waiting time for non-urgent dental treatment was 45.8 days. Fewer than half (42.0%) of the subjects had received treatment while waiting for comprehensive care; women (51.7%) significantly (p < 0.05) more often than men (31.5%). Fillings and unspecified emergency treatments were the most commonly needed treatment.

CONCLUSIONS

Waiting for dental treatment appears to be well-tolerated, as long as the waiting time remains reasonable. Treatment providers seem to have few means with which to rank dental patients into several queues with different urgencies.

Parental satisfaction with children's primary dental care in Valencia, Spain

AIM

To evaluate parents' satisfaction with the dental care that their children received in a primary dental care unit in Valencia, Spain.

METHODS

A cross-sectional study was designed. Parents were given a self-administered questionnaire with questions on accessibility, information received from the dentist and hygienist, staff interest in their child, dentist's and hygienist's apparent professional competence, handling of the child's behaviour, cleanliness of the office (surgery), overall parent satisfaction, parent's and child's age, and parental educational level. The chi-square test was used to assess overall parental satisfaction and the other study variables. For the multivariant study, CHAID (CHi-square Automatic Interaction Detection) analysis was used.

RESULTS

Out of a possible 400 respondents, 389 completed the questionnaire, of whom 384 completed it in full. The variables significantly associated with overall parental satisfaction were waiting time before the consultation, cleanliness of the surgery, the manner in which appointments were made, staff attitude with regard to helping, listening and understanding, the dentist's and hygienist's professionalism, handling of the child's behaviour, and information given by the dentist and hygienist. In logistic regression, the aspects that significantly explained parental satisfaction were the professionals' apparent competence, the information given by the dentist, staff interest in their child, and the handling of the child's behaviour.

CONCLUSION

The parents who took part in this study were satisfied with the care that their children received, mainly with aspects related to professional competence and information provided.

Factors affecting utilization of dental health services and satisfaction among adolescent females in Riyadh City

OBJECTIVES

This study was conducted to determine factors affecting utilization of dental health services among intermediate female school students in Riyadh. In addition to assessing their satisfaction with the dental care received during the last dental visit.

SUBJECTS AND METHODS

Self-administered questionnaires were distributed among students attending eight public and four private schools. These schools were selected randomly to represent the four different administrative zones in Riyadh.

RESULTS

Of 600 questionnaires distributed, 531 were complete and suitable for analysis. Nearly three quarters of the students visited the dentist more than once during the last 2 years. A bout 75% had their treatment in private dental clinics and 63% made their visits for routine treatment. The quality of dental care was found to be the most encouraging factor for utilization of dental services, whereas, far geographic location of the dental clinics was the most discouraging factor. For those who received treatment in the government clinics, the most discouraging factor was post operative complications (P < 0.0001), while the most encouraging factor was the availability of friendly staff (P < 0.0001). The high cost of dental care was the most discouraging factor for utilizing the dental services for those who visited private clinics (P < 0.0001), while the high quality of dental care was the most encouraging factor (P < 0.009). Students who made their visits because of pain highly considered modern clinics and those recommended by friends as highly encouraging factors (P < 0.002), while they considered the high cost of dental care as discouraging factor for using dental services (P < 0.038). Students who visited the dentist for routine treatment gave the quality of dental care as encouraging for the use of dental clinics (P < 0.0001). Satisfaction with dental care was found to be significantly associated with high quality of dental care, convenient appointment, friendly staff, modern dental clinics and clinics recommended by friends.

CONCLUSION

Quality of dental care, reasonable fees for dental services and close location of dental clinics to students' homes are encouraging factors for utilization of dental services.

Dental care utilization and satisfaction of residential university students

AIM

The objective of this study was to provide information on the level of utilization and satisfaction of residential university students with the dental services provided by the dental clinic of a teaching hospital. VOLUNTEERS AND MATERIAL: A stratified sampling technique was used to recruit volunteers from the outpatient clinic of the Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife, Nigeria. Information was collected by a self-administered questionnaire composed of questions that measure the level of utilization and satisfaction with the dental services provided. Questionnaires were provided to 650 randomly chosen students residing in the University hostels. There were 39 refusals, and 6 incomplete questionnaires were discarded. This left a sample size of 605 volunteers.

RESULTS

Forty seven students (7.8%) indicated that they visited the dental hospital within the last 12 months. Males and females utilized the dental services equally, and utilization increased with age and the number of years spent on campus. Anticipation of painful dental treatment, high dental charges, long waiting times and being too busy for a dental visit were cited as the most important impediments to seeking dental treatment. Females expressed greater satisfaction with the services.

CONCLUSION

Dental service utilization among the students was found to be low. Oral health awareness campaigns, improving the quality of the services, and shortening the waiting time are expected to increase service utilization and satisfaction.

Influence of perceived provider performance on satisfaction with oral health care among adolescents

OBJECTIVE

To investigate satisfaction with dental care received at the last dental appointment among adolescents and to analyse factors influencing their satisfaction scores.

METHOD

A total of 1146 subjects (mean age 15.8 years) attending secondary schools in Kampala (urban, n = 591) and Lira (rural, n = 555) completed structured questionnaires at school in 2001.

RESULTS

A total of 63% and 75% of Kampala and Lira students, respectively, reported attendance to dental clinics during the previous 2 years. The corresponding rates of students who confirmed satisfaction with oral health care services received were 73 and 77. In a logistic regression model, the students of Kampala who attended a dentist more than once, had no painful experience at the visit, evaluated their oral condition positively, were satisfied with the dentist's communication and dentist's information, were more likely to be satisfied with the oral health services received (OR = 1.7, 2.2, 4.1, 2.9 and 4.9, respectively). Regarding rural students, being satisfied with oral condition, dentist's communication and dentist's information were associated with higher odds of being satisfied with oral health care services (OR = 2.9, 1.9 and 2.3, respectively).

CONCLUSION

Inter-personal interaction with the dentist is a key determinant in establishing satisfaction with dental care among urban as well as rural adolescents.

Fee-paying systems and service patterns in a Hong Kong dental clinic

OBJECTIVE

This study aimed to describe and compare patients' consumption of dental services and dentists' productivity in a university campus clinic before and after changing from a time-based to an item-based fee-paying system.

METHOD

Data were collected from the University of Hong Kong dental clinic which serves all university students and staff. A time-based fee-paying system had been in use up to February 1999 when it was switched to an item-based system. Computerised records of all patients in two 1-year periods starting from February 1996 and February 1999 were analysed.

RESULTS

The percentages of eligible users who attended the University dental clinic were similar in the two study periods (30% in 96/97 vs 29% in 99/00). However, on average, patients consumed more dental service items in a year after the switch in fee-paying system (3.2 vs 4.1). There was also an increase in the mean number of dental service items provided by a dentist per working week after the change in fee-paying system (71.5 vs 99.4).

CONCLUSION

On switching from a time-based to an item-based fee-paying system, dentists in the UHS dental clinic became more productive and the consumption of dental services per patient also increased.