PubMed Health⌕ Search

Biomedical subjects

A C Mellor

Publications and source records attributed to A C Mellor.

36 records · Page 2Linked to original sources
PubMed1996

An assessment of capitation in the new General Dental Service contract.

A 2-year study has been completed to examine the dental health and patterns of treatment of samples of children registered under capitation in three areas of England. The opportunity was taken to compare some of these results with those reported in the same areas in 1989 when the dentists were remunerated under fee-for-service. In addition, the validity of the dental health information supplied by general dental practitioners on the FP17C form was assessed. The dental health of 14-15-year-old patients registered for more than a year was compared with that of similar patients in the same areas in 1989. There was a large reduction in the caries experience (mean DMFT) in these patients in all areas between 1989 and 1994 mainly due to a significant fall in the mean numbers of teeth filled. The mean number of teeth extracted for caries remained low in all areas. There was a small increase in the mean number of decayed, untreated teeth in all areas. There was a large increase in the proportion of patients with one or more fissure sealants present. The dental health of 7-8-year-old patients registered for more than a year was examined but, as this age group were not examined in 1989, no comparative data were available. Regularly attending child patients had, on average, one untreated decayed deciduous tooth, but few had more than two. Caries experience in first permanent molars was low in all areas. Data were collected from a sample of general dental practitioners in three areas on the treatment provided over a 12-month period for random samples of patients in two age groups: 6-12 and 13-15 years. There was an increase in two of the three areas in the provision of oral hygiene instruction and dietary advice. The level of fissure sealant use was maintained or increased. There was a reduction in the numbers of both deciduous and permanent teeth filled. Fewer children had teeth extracted. The proportions of patients having bitewing radiography reduced. The mean number of both visits and check-up examinations reduced. There validation of the dental health information on the FP17C was carried out by comparing the data collected for 7-8 and 14-15 year old patients during the dental health examinations with that submitted by general dental practitioners on FP17C forms to the Dental Practice Board for the same children. For the permanent dentition, agreement was good for missing and filled teeth but poor for decayed, untreated teeth. For deciduous teeth, levels of agreement were generally poor except for filled teeth where it was fair.

Adolescent↗
PubMed1996

Patients' perceptions of esthetics and technical quality in crowns and fixed partial dentures.

To assess patients' perceptions of different types of fixed anterior restorations, their responses to (1) metal-ceramic versus all-ceramic restorations; (2) National Health Service versus private-contract metal-ceramic restorations; and (3) normal versus overbuilt metal-ceramic restorations were compared. More people thought the all-ceramic crowns were more natural and preferred those restorations. More people thought the metal-ceramic fixed partial dentures were more natural, and those were also preferred. For both crowns and fixed partial dentures, respondents thought the private work was more natural looking, but the National Health Service work was preferred for the crowns. Respondents thought the crowns and fixed prostheses with normal margins were of a higher technical standard, and those restorations were preferred. The shade and color of the restorations were the most important factors in the patients' assessments.

Adult↗
PubMed1995

Prevalence of complaints by patients against general dental practitioners in greater Manchester.

A postal questionnaire regarding potential and official patient complaints was sent to all dentists on the Family Health Service Authority list of four health districts in Greater Manchester. From an eligible sample of 335 dentists, 306 responses were received (91%), 289 of them from general dental practitioners (GDPs). One hundred of the GDPs (35%) had reported at least one potential complaint to their defence organisation in the past 5 years (1989-1993) and 10 GDPs had reported three or more complaints. The majority of complaints were in the field of restorative dentistry (57%) with complaints about oral surgery accounting for another 20%. Dentists who worked longer hours contacted their defence organisation more often regarding potential complaints. Thirty-two dentists reported that their most recent potential complaint had resulted in an official complaint being filed against them. There was a significant relationship between the prevalence of official complaints and the dentists' reported level of unsatisfactory patient visits.

Adult↗
PubMed1995

Dentists' attitudes toward frustrating patient visits: relationship to satisfaction and malpractice complaints.

A 22-item questionnaire measuring physician frustration in communicating with patients was adapted to dentists, and its reliability and validity assessed, in a sample of 289 English dental surgeons in general practice in Greater Manchester. Subscales were derived assessing the concepts of unpleasant dentist feelings, lack of communication, patient non-compliance, patient control, and practice organization with Cronbach's alpha ranging from 0.59 to 0.77. Three of five subscale scores (unpleasant feelings, lack of communication, and practice organization) were significantly greater for dentists who had official malpractice complaints to insurers. Similarly, all five subscores were greater for dentists who reported larger numbers of unsatisfactory visits and expressed greater dissatisfaction with dental practice.

Adult↗
PubMed1994

Attitudes of dental students towards elderly people.

Questionnaires were distributed to first, third and fifth year dental students at two British dental schools, to assess their attitudes towards the elderly. A second follow-up questionnaire was given 1 year later to the five student years attending one of these dental schools, to compare attitudes and estimate how they affected their perceptions of treating this section of the community. In both questionnaire surveys, clinical dental students had a more positive attitude towards the elderly than did students in the non-clinical years of the course. In those students who had received both questionnaires on consecutive years, there was an improved attitude score. There were no significant differences in the attitudes of male and female students.

Adult↗
PubMed1994

Resource costs of capitation maintenance care in Britain.

The aims of this study were to examine variations in the resource cost of maintenance care for children under capitation by the area in which the dentist worked, the gender of the dentist, the number of years that the dentist had been qualified and the social class mix of the practice locality. Data were analysed from those collected during a clinical trial of capitation and fee-for-service payment systems that took place between 1986 and 1989. The costs of restorative/surgical treatment were over twice as high in Grampian than in Bromley. The costs of all treatment provided were 46 per cent higher in Salford than in Bromley. The date of qualification of the dentist was the only factor significantly associated with the cost of preventive treatment provided, with more recent graduates offering more preventive care than older dentists. The difficulties of using uniform national capitation rates are discussed.

Adolescent↗
PubMed1993

Frequency of examination of children by dentists working under different payment systems in the United Kingdom.

The aims of this study were, first, to determine the frequency of dental examination of child patients by general dental practitioners working under a fee-for-service or capitation payment system in eight areas of the United Kingdom and, secondly, to consider how the frequency of examination varied by dentist payment system, by area, by age of the child and by dentist. The number of examinations carried out by 198 general dental practitioners over a one-year period for 17,389 children aged 0-15 years was recorded. The mean number of examinations per year for children treated by dentists working under the fee-for-service system was 1.7, and for those treated under the capitation system 1.6; this difference, although small, was statistically significant. The dentist and the age of the child were also shown to be related to the number of examinations but not the area in which the dentist worked.

Adolescent↗
PubMed1993

A comparison of injectable local anesthesia and electronic dental anesthesia in restorative dentistry.

This study compares patient satisfaction and subjective pain levels with either electronic dental anesthesia (EDA) or injectable local anesthesia (LA) during the placement of direct restorations. Twenty-five patients (mean age 41 years), who each required two similar restorations in vital teeth, were selected. One restoration was placed using EDA and the other using LA. Preoperatively, all participants completed the Corah Dental Anxiety Scale, and postoperatively they completed a satisfaction questionnaire. Fifteen (60%) patients preferred EDA to LA, and 7 (28%) had no preference. Asked to rate their feelings on the prospect of having a filling placed with either EDA or LA (scale 1 to 5, very anxious to very relaxed), the patients rated LA as 3.0 and EDA as 3.6 (mean scores). Some pain or discomfort was felt by 12 patients with EDA and 14 patients with LA. On a scale of discomfort (1 to 5, very slight to very severe), the mean score was 1.0 for EDA and 1.2 for LA.

Adult↗
PubMed1992

Dental anxiety and attendance in the north-west of England.

The aim of this study was to record the level of anxiety and last recorded visit for a dental check-up of a random sample of 300 workers at three sites in the North-west of England. All subjects were asked to complete a short written questionnaire and 255 (85 per cent) usable forms were returned. The mean level of anxiety using the Corah Dental Anxiety Scale (DAS) (N.L. Corah, 1969, J. Dent. Res. 48, 596) was 9.1. Females had a statistically higher mean DAS than males but there was no correlation between DAS and either age or occupational status. Those subjects who claimed not to have had a check-up in the past year had a significantly higher mean DAS than those who claimed to have been in the past year. Multiple regression analysis showed that the reported time interval since the last check-up was the most important predictor of the DAS score. The implications of the results are considered for the future of restorative dentistry.

Adolescent↗
PubMed1990

The capitation study. 3. The views of participating dentists and the profession.

During the course of a 3-year parallel, controlled clinical trial comparing a capitation system of remuneration with fee-for-service for the dental care of children, the views of the dentists were gained through meetings, informal communication, and a structured questionnaire sent to every dentist in the study. The questionnaires completed by the dentists who had been in the study from the beginning were used in the analysis. The views of practice principals on practice administration were also gained. Dentists in capitation claimed to have greater clinical freedom than those in fee-for-service, but the system under test involved more practice administration. The trial allowed the two systems to be compared under limited, controlled conditions, thus benefiting any substantive scheme that might be developed from it.

Capitation Fee↗
PubMed1990

The Capitation Study. 2. Does capitation encourage more prevention?

The results of a 3-year parallel, controlled clinical trial comparing a capitation system of payment for the dental care of children with fee-for-service, showed that capitation offered dentists more clinical freedom. Dentists in capitation used this to provide more preventive care, particularly advice to parents on the control of dental disease in their children. In contrast, few fissure sealants were placed and few topical fluoride applications were made under either system. However, parents in both systems were satisfied with the preventive service their children received and were confident of their ability to control their children's dental disease. The effect of this increased preventive activity was not yet apparent within the period of the study.

Adolescent↗
PubMed1990

The capitation study. 1. Does capitation encourage "supervised neglect'?

Four matched pairs of geographically and socially contrasting areas of Britain were randomly allocated within pairs to either a capitation or fee-for-service payment system for the dental care of children in a 3-year clinical trial. Measurements were made on the dental health of randomly selected 5-6 and 14-15-year-old patients and the views of their parents elicited. Patterns of treatment were also gained from the clinical records of randomly selected patients. In addition, the views of the dentists taking part, of the profession's representatives, and of the administrators of the systems were obtained. No evidence of systematic neglect could be found among the children treated under capitation, but they had fewer fillings, more untreated diseased teeth and similar disease levels to their counterparts treated under fee-for-service. Dentists in capitation carried out fewer fillings, fewer extractions, took fewer radiographs and saw their patients less frequently than their fee-for-service colleagues.

Adolescent↗
PubMed1989

A trial of a capitation system of payment for the treatment of children in the General Dental Service. Final report. Dental Health Services Research Unit, University of Manchester. September, 1989.

A 3-year clinical trial comparing capitation and fee-for-service remuneration systems for general dental practitioners for the treatment of children has been successfully completed. Capitation dentists restored carious teeth at a later stage in the disease process than fee-for-service controls, and carried out more preventive treatment and advice. However, the disease experience of their patients was little different from that of patients treated under fee-for-service. Capitation dentists saw their patients less frequently and took fewer radiographs than their fee-for-service colleagues. The prevalence of both fissue sealants and arrested caries was low in both groups, as was the prevalence of teeth extracted as a result of caries. Levels of oral cleanliness were similar under both systems. Private treatment was rarely prescribed for children, but was more prevalent for patients of fee-for-service dentists. The profession felt that capitation offered greater clinical freedom and more financial stability to dentists, but a greater temptation to under-prescribe treatment. The profession lacked commitment to capitation as a method of remuneration for the treatment of children in the General Dental Service. Fee-for-service dentists appeared to be more innovative, expressed a greater allegiance to their patients and felt a greater temptation to over-prescribe than capitation dentists. The parents had a high opinion of the service for children, irrespective of the remuneration system, and the children found the service very acceptable. Parents had a stronger allegiance to the fee-for-service than the capitation dentists. The study revealed several short-comings in the capitation model tested, but solutions to all of these became apparent. A capitation agreement of more than 12 months would simplify administration and reduce costs, as would a reduction in the number of forms. The need to notify parents when a dentist was replaced in a practice created considerable difficulties and increased expense. The treatment of trauma and extractions for orthodontic purposes should have been items excluded from the capitation fee. The need for information on dentists' activity in capitation was accepted but should be kept simple and relevant. Monitoring quality of care under capitation can be carried out from the routine data collected for administrative purposes. Capitation does not appear to increase participation. Costs of administering capitation are little different from those for fee-for-service. More resources were spent per dentist and per patient under capitation than fee-for-service. In the clinical trial fee-for-service was more cost-effective than capitation.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
PubMedDate not supplied

Treatment planning for the problem patient: restorative, ethical, legal and psychological perspectives. Case 2: Jacqueline.

Jacqueline's is the second of a series of four articles that aims to look at some of the problems patients may present with when they visit their dentist. Each article starts with a brief scenario about the hypothetical patient and his/her clinical problems. As well as the clinical problem, each case also raises ethical, legal or psychological problems. All of these issues are discussed and possible management strategies and treatment options described.

Adult↗
PubMedDate not supplied

Capitation--an alternative payment system for the treatment of children in the general dental service.

The Health Departments' recent proposals for the new GDP contract include capitation payment for children's dental care. Manchester University's Dental Health Services Research Unit has been running a clinical trial of such a scheme for the last three years on behalf of the Departments and the BDA. The results of this scheme will be of major importance to the decision about any new payment system. This article describes the trial project, and reports some preliminary findings.

Adolescent↗