Η δημόσια οδοντιατρική φροντίδα στην Ελλάδα: μελέτη των παρεχόμενων υπηρεσιών Πρωτοβάθμιας Οδοντιατρικής Φροντίδας των Κέντρων Υγείας του Εθνικού Συστήματος Υγείας της Ελλάδας και αξιολόγησή τους

Doctoral Dissertation uoadl:1308573 350 Read counter

Unit:
Κατεύθυνση Κοινωνική Οδοντιατρική (Βασικές Οδοντιατρικές Επιστήμες)
Βιβλιοθήκη Οδοντιατρικής
Deposit date:
2015-04-24
Year:
2014
Author:
Συγγελάκης Αριστομένης
Dissertation committee:
Χαριτίνη Κωλέτση – Κουνάρη, Αναπληρώτρια Καθηγήτρια Προληπτικής και Κοινωνικής Οδοντιατρικής, Τμήμα Οδοντιατρικής, ΕΚΠΑ – Επιβλέπουσα της διατριβής, Αργυρώ Πολυχρονοπούλου,Αναπληρώτρια Καθηγήτρια Προληπτικής και Κοινωνικής Οδοντιατρικής, Τμήμα Οδοντιατρικής, ΕΚΠΑ, Χρήστος Λιονής, Καθηγητής, Τμήμα Ιατρικής, Πανεπιστήμιο Κρήτης
Original Title:
Η δημόσια οδοντιατρική φροντίδα στην Ελλάδα: μελέτη των παρεχόμενων υπηρεσιών Πρωτοβάθμιας Οδοντιατρικής Φροντίδας των Κέντρων Υγείας του Εθνικού Συστήματος Υγείας της Ελλάδας και αξιολόγησή τους
Languages:
Greek
Summary:
The purpose of this PhD thesis is the mapping and evaluation of the Primary
Dental Care services offered by the Dental Departments (DD) of Health Centers
(HC) of the National Health System (ESY), in Greece; moreover it aims to assess
the professional satisfaction, job security and stress of employed dentists.
Methodology: All of the 192 dentists who are, in real terms, employed in HC in
the 7 Health Administrative Regions of the country were invited to participate
in the study; 135 of them agreed (70.3% participation); 68 (50.4%) of them were
men (55.3 ± 6.6 years) and 67 (49.6%) were women (54.3 ± 4.5 years). A
semi-quantitative tool of two parts was mailed to dentists; the first, general,
part included 69 basic questions. The second part of the research tool included
the Greek version of Effort – Reward Imbalance (ERI) questionnaire with 23
basic questions. The following factors were studied: demographics, staffing,
organization and operation of DD, oral health promotion and chronic disease
management activity, educational and scientific activity, stress, job security
and professional satisfaction.
Results: The DD of the HCs were found to be seriously understaffed in dental as
much as nursing and other specialized health personnel were concerned. The
Dental personnel were reported as having a quite high percentage of
postgraduate education; despite that, its scientific activities was not found
to be consistent to their qualifications. On organizational issues the
situation was assessed as not quite satisfactory as there was observed a
significant amount of ineptitude in records’ keeping, sterilization conditions,
safe and environmentally responsible waste disposal and appropriate equipment
maintenance. On the contrary, the attention given by the dentists to issues
such as adhering to clinical protocols and safe storage of medication and other
medical materials was assessed as quite satisfactory. The level of available
infrastructure and equipment was also rated negatively; similarly wanting was
found the degree of collaboration and coordination with other secondary and
tertiary dental health services. Despite all these issues, a large percentage
of the participant dentists rated positively the overall organization structure
of the D.D. as well as its ability to meet the population needs.
Regarding the development of prevention and oral health promotion activities,
the overall assessment was positive, especially as far as clinical examination
and assessment of primary school students as well as communication with their
parents and local fluorine application are concerned. Contrary to that, as far
as in adults are concerned, the findings were quite disappointing regarding
health promotion activities, screening programs’ implementation for early
detection of mouth cancer in high risk populations (smokers, alcoholics etc) or
chronic mental health patients or persons with disabilities. The only exception
to this rule, was the rising awareness for smoking’s harmful implications. In
overall an increased number of treated cases were reported during the last
years and they can be attributed to the current economic crisis; moreover the
unobstructed access of uninsured to services provided by D.D.s was also
verified.
As to the working conditions, salaries and professional perspectives for
development in Greek NHS, a general sense of disillusion was reported among
dentists along with a rising feeling of professional insecurity. An assessment
using the ERI questionnaire revealed that the dentists had a rather neutral
attitude on their professional post’s social recognition, support and security
but they experience an imbalance between efforts dedicated and rewards
perceived. This results in increased psychosocial stress which in turn puts
them at greater risk of negative health implications.
As far as the dental care determinants are concerned, the grade of the dentist
seems to bear significant relation with his/hers professional satisfaction; the
degree of DD’s staffing with level of its correspondence to dental primary care
needs of its reference population; the possession of post graduate certificate
or second graduate one by the dentist with keeping electronic records for
patients; the relatively lower age of the dentist with higher level of
organization of the DD. Additionally, the overall volume of workload as well as
the general assessment of the DD’s meeting population’s needs were correlated
with the size of the DD in terms of number of dentists in service; scientific
activities with initiation of prevention programs. The self-reported
professional satisfaction was correlated with level of functional and
operational organization of the DD and its overall meting population’s needs’
assessment. On the contrary, professional stress seemed to be concerning males,
relatively of higher age with several years in service the Greek NHS, which
often possess also post graduate studies degrees that regularly have to deal
with increased numbers of first-line clinical practice cases. Factor analysis
revealed three main profiles of dentists’ responses: (a) one pattern, combining
intense time stress, physical fatigue, stress and feeling of decreased esteem
and respect by the others, which was mostly found in male dentists, with
postgraduate studies, increased scientific activity and oral health promotion
activities concerning children and adolescents; at the same time this profile
of dentists is related negatively to the existence of factors such as the
organization of the D.D. and the increased oral health promotion activities for
adults, (b) one other pattern comprising by time stress, physical fatigue, job
security and stability which was mostly found in dentists that who worked in
well-organized D.D., with oral health promotion activities for adults, male,
with extensive working experience in the Greek NHS; this profile of dentists is
related negatively to the existence of factors, increased oral health promotion
activities for children and adolescents, consistent performance in safety
issues and scientific activities and finally (c) one pattern exhibiting intense
daily –relentless working stress, which was mostly found in dentists with
relatively lower research and scientific record, lack of postgraduate education
occupied by D.D.s with lower levels of organization but with feeling of job
security.
Conclusions: The Dental Departments of the HC, despite their problems and
weaknesses, accomplish great feats in the sectors of public health and social
cohesion. However there is still scepticism about the causes of temporal
deficits and weaknesses of Primary Dental Care services within the Greek NHS.
Nevertheless, there is need for immediate intervention by public health
authorities, in order to fully staff, improve infrastructure and organization
of Dental Departments of the HC, as well as to restore within the Greek NHS
conditions of job security, recognition and fair reward of the effort provided
by the dental human resource. The aforementioned references are absolutely
vital conditions for the improvement of the Primary Dental Care services
provided by the Greek NHS and necessary preconditions so as to improve
efficiency and equity in access and to ensure the sustainability and the
safeguarding of their social nature character, all of which are key objectives
for the NHS, especially during periods of the implementation of austerity state
policies and socio-economic crisis.
Keywords:
Primary Dental Care, Economic crisis, Evaluation of health services, Access to dental care, ERI
Index:
No
Number of index pages:
0
Contains images:
Yes
Number of references:
468
Number of pages:
266

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