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Biomedical subjects

L Fiset

Publications and source records attributed to L Fiset.

At least 19 recordsLinked to original sources
PubMed2000

Third-party reimbursement and use of fluoride varnish in adults among general dentists in Washington State.

BACKGROUND: Studies have indicated that a minority of dentists regularly use fluoride varnish to control caries. To increase the use of this new technology, Washington Dental Service, or WDS, began reimbursing dentists for providing fluoride varnish in January 1996. The aim of the authors' study was to determine whether reimbursement increased dentists' use of fluoride varnish. METHODS: In the fall of 1995, the authors asked a random sample of 532 general dentists in Washington state to complete a mail questionnaire on their use of caries control services. The survey was conducted before the institution of payment for fluoride varnish use, and dentists were unaware that fluoride varnish use would be a paid service in January 1996. In the fall of 1997 the same dentists were asked to complete a second questionnaire on the same topic. RESULTS: About 32 percent of dentists used fluoride varnish regularly before WDS started reimbursement for the service. Two years after reimbursement began, about 44 percent of dentists regularly used fluoride varnish (P = .004). Dentists' rates of use of other caries-control services (chlorhexidine rinses for caries control and adult pit-and-fissure sealants) did not change. Dentists' reasons for not using fluoride varnish included lack of awareness, lack of convincing evidence of a favorable cost:benefit ratio, patients' rejection of the service and low caries risk among adult patients. CONCLUSIONS: After fluoride varnish became a covered benefit, the use of fluoride varnish among general dentists increased after two years, but a majority of dentists still had not adopted the technology. The increase in use may be due to reimbursement, as well as other factors. PRACTICE IMPLICATIONS: Reimbursement by itself cannot increase dentists' use of caries control services.

Adult↗
PubMed1998

The incentive effects of malpractice liability rules on dental practice behavior.

OBJECTIVES: The impact of malpractice liability rules on dental practice behavior was estimated using data from a 1992 nationwide survey of US general dentists. The study examined the premise that malpractice liability rules can affect quality of care and related resource allocation decisions by dentists, but that market features, such as relatively complete and "non-experience rated" malpractice insurance, are likely to weaken the incentive effects of malpractice liability. METHODS: General practice dentists in the United States were selected randomly, and 3,048 dentists were studied by mail survey. Secondary data on county-level characteristics were used to measure market area factors. Quality-of-care measures were derived from the survey about self-reported practice policies and behavior and participation in continuing education. Legal measures were assembled from state statutes and appellate court decisions. Ordinary least squares was used to assess the relation between legal variables and dependent variables of quality of care, continuing education, and the rate of dental output. RESULTS: Hypotheses about the effects of malpractice law on practice quality and participation in continuing education were not supported. The relation between pro-dentist law and output was supported. A number of legal provisions related to differences in practice behavior, but often in ways opposite to the expected direction. CONCLUSIONS: The direct effects of specific malpractice liability rules on dentist practice behavior often failed to point in the direction predicted by theory and were economically insignificant. It is possible that relatively complete malpractice liability insurance, coupled with "noisy" liability rules, substantially dulls the deterrent effect of malpractice liability. Other forces, such as the dentist's past malpractice claims experience, were more significant in shaping dentist behavior.

Education, Dental, Continuing↗
PubMed1997

Does fluoridation reduce the use of dental services among adults?

OBJECTIVES: The authors determine whether prevention influences the use of health services. Fluoridation's effect on restorative dental demand among 972 Washington state employees and spouses, aged 20 to 34 years, in two fluoridated communities and a nonfluoridated community was examined. METHODS: At baseline, adults were interviewed by telephone, and oral assessments were conducted to measure personal characteristics, lifetime exposure to fluoridated water, oral disease, and the quality of restorations. Adults were followed for 2 years to measure dental demand from dental claims. Each adult's baseline and claims data were linked with provider and practice variables collected from the dentist who provided treatment. RESULTS: Relative to adults with no lifetime exposure to fluoridated water, adults drinking fluoridated water for half or more of their lives had less disease at baseline and a lower but nonsignificant probability of receiving a restoration in the follow-up period. In the 2-year follow-up period, however, more than half of the restorations were performed to replace fillings of satisfactory or ideal quality at baseline. When only teeth with decay and unsatisfactory fillings at baseline were considered, adults with high fluoridation exposure had a lower probability of receiving a restoration than adults with no exposure. Market effects also were detected in demand equations; relative to adults in the nonfluoridated community, adults residing in the fluoridated community with a large dentist supply received a greater number of restorations, suggesting potential supplier-induced demand from less disease and fewer patients. CONCLUSIONS: Among adults aged 20 to 34 years with private dental insurance, fluoridation reduces oral disease but may or may not reduce use of restorative services, depending on dentists' clinical decisions.

Adult↗
PubMed1997

Factors influencing the appropriateness of restorative dental treatment: an epidemiologic perspective.

OBJECTIVES: An epidemiology analysis was performed to identify patient and dentist factors influencing over- and undertreatment of restorative services in a sample of insured adults. METHODS: At baseline, 681 Washington State employees and their spouses, aged 20 to 34 years and residing in the Olympia or Pullman areas, were interviewed by telephone. Oral assessments were conducted to measure personal characteristics, oral disease, and restoration quality. Adults were followed for two years to measure use of restorative services from dental insurance claims. Each adult's baseline and claims data were linked with provider and practice variables collected from the dentist who provided treatment. RESULTS: For overtreatment, 39 percent of adults received one or more replacement restorations in nondecayed teeth with satisfactory fillings at baseline, while 18 percent of adults had one or more restorations placed in teeth with no decay and fillings. An adult's probability of overtreatment was higher if the adult had more fillings at baseline, or if an adult's dentist was younger, had a busy practice, advertised, charged higher fees, had less continuing education, or had a solo practice. For undertreatment, about 16 percent of adults either received no replacement restorations in teeth with unsatisfactory fillings at baseline, or had decayed teeth at baseline that were not filled or crowned. An adult's probability of undertreatment was higher if an adult had less decayed or more missing surfaces at baseline, or if an adult's dentist believed in sharing information with patients, had a busy practice, or reported not placing fillings when radiographic evidence of new caries was present. CONCLUSIONS: A minority of adults aged 20 to 34 experienced potential over- or undertreatment of restorative services, which are influenced by both patient and dentist factors.

Adult↗
PubMed1997

Adoption of innovative caries-control services in dental practice: a survey of Washington State dentists.

To assess the adoptability of the medical model for caries control, the authors surveyed general dentists about their use of four caries-control services among adult patients: salivary functioning tests, fluoride varnishes, chlorhexidine rinses, and pit-and-fissure sealants. Responses indicated that leaders in the dental community and those with a wider network of professional colleagues were likely to adopt new services more quickly than other dentists. Earlier adopters also had more correct information about these services than later or nonadopters. Overall, the knowledge base of the services studied in this survey was not uniform, making adoption of the medical model for caries control premature.

Adult↗
PubMed1997

Pain control in recovering alcoholics: effects of local anesthesia.

OBJECTIVE: The medical literature suggests that alcoholics may present greater challenges to achieving clinical pain control than nonalcoholics. This study was undertaken to test the hypotheses that: (1) significant differences exist between alcoholics and nonalcoholics on detection and pain thresholds during electric tooth stimulation; (2) group differences exist in the depth and time course of pulpal anesthesia; and (3) responses to tooth stimulation are associated with severity of alcoholism and/or other psychological factors. METHOD: Male alcoholics (n = 22) in aftercare treatment (mean length of sobriety = 113 days) and age-matched nonalcoholics (n = 22) received 1.0 ml of 3% mepivicaine at the apex of a maxillary lateral incisor and saline placebo at the apex of the contralateral incisor. RESULTS: At baseline no group differences were found on sensory thresholds. During drug intervention significant drug and time effects for both detection threshold (p < .0001) and pain threshold (p < .0001) were found, but group differences and interactive effects were not significant. By exploratory regression analysis of alcoholic subjects, history of depression/unhappiness was significantly associated with shallower pulpal anesthesia, whereas high need for control/low actual control and frequency of treatment for detoxification were associated with deeper anesthesia. CONCLUSIONS: Our findings suggest alcoholics in recovery are not at increased risk for inadequate pain control with local anesthesia.

Adult↗
PubMed1997

The relationship between price of services, quality of care, and patient time costs for general dental practice.

OBJECTIVE: To examine the relationships between price of services, quality of care, and patient time costs in private practices of general dentists. DATA SOURCE/STUDY SETTING: In October 1992, a 3.7 percent sample of eligible general dentists in part-time or full-time private practice in 1991 was randomly drawn from a sampling frame tailored from data gathered by the 1991-1992 American Dental Association Distribution of Dentists census of all United States dentists. DATA COLLECTION: A mail survey was used to collect data on dentist demographic characteristics, dental practice characteristics practice finances, and insurance. The survey was completed and returned by 3,048 general dentists (77 percent response rate). Local area population characteristics were obtained from secondary sources. STUDY DESIGN: Two-stage least squares regression was used to evaluate the structural relationships between price of services, quality of care, and time costs to patients. Structural equations were estimated for four different quality of care measures and two time costs. PRINCIPAL FINDINGS: Price of services and quality of care were significantly related to each other. Higher quality of care was associated with higher price of services and, reciprocally, higher price of services was associated with higher quality of care. Shorter waits for a new patient appointment were associated with higher prices. Higher price of services, lower quality of care, and longer waits for a new patient appointment were related to shorter in-office waiting time. CONCLUSIONS: The implication of these findings is that if price of services is constrained, then the quality of care provided by the dentist may also be reduced.

Fees, Dental↗
PubMed1996

Frustrating patient visits.

OBJECTIVES: This study, part of a national mail survey of dentist malpractice liability claims, reports the reliability and validity of a new 22-item instrument measuring frustrating patient visits. METHODS: The items were subjected to factor analysis and subscales constructed. Reliability was assessed using Cronbach's alpha. Validity was assessed by comparing subscale scores to self-reports of satisfaction and liability claims. RESULTS: Factor analysis revealed four subscales representing unpleasant feelings, lack of communication, compliance, and practice organization (alpha = 0.60-0.86). Compliance was the most important factor. Subscale scores were related to satisfaction with practice and the proportion of patient visits in the practice that were frustrating to the dentist. Dentists who reported frustrating patient visits as quite typical of their practices were more likely to have had a malpractice liability claim within the last five years. CONCLUSION: This instrument may be of value in detecting patient-dentist communication difficulties that are the precursor to liability claims.

Communication↗
PubMed1995

Tort reform and malpractice liability insurance.

Legal factors related to the malpractice liability insurance purchased by general dentists in the United States were investigated using a comprehensive multivariate model that assessed the contribution of legal provisions affecting the probability of a malpractice claim, the probability of a payment, and the average size of the payment. General practice dentists in the United States were selected randomly, and 3,048 dentists were studied by mail survey. A number of legal statutes (periodic payment allowed, percentage fault liability informed consent limits, limits on res ipsa loquitor, attorney fee control, some statute of limitations provisions) had the intended effect of reducing the malpractice insurance sought by dentists. Other provisions, such as binding arbitration, may have unintended cost-raising effects. Previous malpractice claims were associated with purchasing greater amounts of insurance. These findings have implications for future changes in the legal system as part of health care reform.

Dentistry↗
PubMed1995

Malpractice premiums in 1992: results of a national survey of dentists.

According to a 1992 national survey, more than 95 percent of general dentists in the United States purchased malpractice insurance. The authors evaluated the survey findings to identify factors that had the greatest effect on dentists' insurance premium costs. Premiums were higher for dentists who had been the subject of previous complaints or claims, as well as for those who owned their practices. States with fewer lawyers had lower premiums. Finally, state limits on use of dental hygienists, number of offices and the extent of water fluoridation also affected premium levels.

Fees and Charges↗
PubMed1994

The anxiolytic effects of intravenous sedation using midazolam alone or in multiple drug techniques.

This study examines four drug combinations (midazolam, midazolam-midazolam, fentanyl-midazolam, and fentanyl-midazolam-methohexital) in a placebo-controlled double-blind clinical trial of intravenous sedation. It tests the hypothesis that there is no difference between the anxiolytic effect of the four combinations when compared with a saline placebo. Subjects were 207 mildly anxious young adults having their third molars removed. Cognitive measures of anxiety increased from preoperative levels in the placebo and both midazolam groups (P < .05). The anxiety response remained the same in the fentanyl-midazolam and fentanyl-midazolam-methohexital groups (P > .05). The level of successful anxiolysis ranged from 24% in the placebo group to 74% in the barbiturate group. Using the log likelihood method, comparisons suggest that the drug groups (from midazolam alone to the methohexital combination) have increasingly positive anxiolytic effects even when controlling for the effects of dental fear and intraoperative pain. The fentanyl-midazolam group is 8.1 and the methohexital group is 9.0 times more likely to have had a favorable outcome than the placebo group. Additional analyses of behavioral measures of anxiety yielded parallel results. Global evaluations after surgery were related to the success of anxiolysis for subjects in the active drug conditions (P < .05).

Adult↗
PubMed1994

Dentists' response to financial incentives in a mail survey of malpractice liability experience.

This two-part methodologic research was designed to evaluate the effects of a financial incentive on questionnaire response rate and response bias for general dentists surveyed by mail. Subjects were 517 clinicians randomly selected from a two-state population of practitioners insured by a single malpractice liability carrier. Subjects received a check for either $5 or $10 in the original mailing. In Study 1, a single mailing and postcard follow-up resulted in a 57.8 percent (111/192) response rate. In Study 2, employing Dillman's Total Design Method, a 69.6 percent (208/299) response was obtained after a third mailing. Analysis of response rate by incentive level in each study revealed no significant differences. In contrast, early responders (first mailing and follow-up postcard) differed from late responders (second and third mailings) on age (41.4 vs 37.0 years; T = 2.17; P = .032), non-Caucasians (27.7% vs 63.9%; chi 2 = 17.3; df = 4; P < .002), females (13.9% vs 27.8%; chi 2 = 3.9; df = 1; P < .05), foreign-trained (7.0% vs 19.4%; chi 2 = 16.5; df = 2; P < .001), and dissatisfaction with practice (31% vs 51%; chi 2 = 7.8; df = 4; P = .10). Thus, the magnitude of the financial incentive in this experiment had no differential effect on response rate. But differences in responses from late responders (proxies for nonresponders) on demographic characteristics and key study variables suggest the persistence of response bias despite an acceptable response rate. Future dental health survey research should employ tests for response bias on both sets of variables.

Adult↗
PubMed1994

Review of 40 cases of lung abscesses in foals and adult horses.

A retrospective study of 40 horses with primary lung abscesses without pleuropneumonia showed that lung abscesses occurred predominantly in young horses, usually in foals aged < or = 6 months. Hyperfibrinogenaemia was present in all but 2 horses, and other common clinical and haematological findings were hyperthermia, tachycardia, polypnoea, and neutrophilic leucocytosis. The most common bacterial species isolated from transtracheal aspirates were Streptococcus zooepidemicus (20/34) and Rhodococcus equi (13/34). Most horses (23/27) discharged from the hospital were long term survivors. Of the 19 horses for which a follow up was available, 12 raced or performed the task for which they were intended. None of the indicators evaluated in this study could reliably predict the bacterial species involved or the outcome.

Actinomycetales Infections↗
PubMed1994

Malpractice claims during 1988-1992: a national survey of dentists.

Between 1988 and 1992, almost a quarter of surveyed dentists reported at least one patient complaint to malpractice insurance carriers. The incidence of claims more than doubled in that time and payment size increased nearly five times between 1988 and 1991. These and other trends in professional liability are examined in this national survey of general dentists.

Age Factors↗
PubMed1994

Dental malpractice liability insurance market: surveys of insurers and insurance commissioners.

Surveys of malpractice insurers and state insurance commissioners in 1992 show a highly concentrated market with opportunities for greater competition. Fewer than 50 firms write coverage nationally. Weighted premiums for $1 million/$3 million coverage vary across U.S. census divisions from $1,700 in the South to $3,000 in the Northeast. These data may be of interest to practitioners who purchase insurance and will aid dental associations in effectively participating in revisions of malpractice liability statutes as part of overall health care reform.

Data Collection↗
PubMed1994

Topical anesthesia: differentiating the pharmacological and psychological contributions to efficacy.

Pain can be influenced by both pharmacologic and psychologic factors. The purpose of this study was to investigate the pharmacologic and psychologic factors. The purpose of this study was to investigate the pharmacologic and psychologic processes that may play a role when topical anesthesia is used to reduce the pain of dental injections. Subjects were assigned to one of two belief manipulation conditions: one-half of the subjects were led to believe they would receive a placebo, while the remaining subjects were told they would receive the active agent. In reality, all subjects received two separate injections at contralateral sites, one preceded by a placebo and the other by a 20% benzocaine gel. The order in which injections were given was associated with differences in pain report. Second injections were more painful than first injections. Whether injections were preceded by an active or placebo agent did not alter subjects' experienced pain. Likewise, the belief manipulation did not affect the pain report. However, subjects who believed they would receive the active agent anticipated significantly less pain than subjects who thought they would receive placebo. The widespread belief that topical anesthetics are effective at reducing injection pain may serve to reduce the anticipatory anxiety associated with an impending dental injection, thus making the injection experience less aversive.

Administration, Topical↗