Study of reason for low OPD at SMBT Dental college: An Open ended questionnaire survey

Transcription

1 American Journal of Advances in Medical Science eissn: Original Research Article Study of reason for low OPD at SMBT Dental college: An Open ended Priyanka Bhushan 1*, Maj Kundan Kumar 2, Prasant MC 3 1 Public Health Dentistry, Rajasthan Dental College, Jaipur , Rajasthan, India 2 Army Dental Corps, Ministry of Defence, Govt of India. 3Dept of Oral and Maxillofacial Surgery, RKDF Dental College, Sangamner, Maharashtra, India Abstract The aim of the present study was to investigate reasons for low patient flow at the OPD of SMBT dental college. Study sample consisted of three hundred patients reporting to OPD of the dental hospital, one hundred fifty students and fifty faculties. An open ended was conducted and patient, students and doctors were asked about there views for low OPD at the college hospital % of the patients were of view that increased treatment/waiting time was the main reason for low OPD, 63.33% of the students blamed the patient attitude being the main reason for low OPD, while majority of the faculty blamed the patient and student behaviour as the main reason. The outcome of the study indicates that there is need of improving the relationship between patients, initiatives like use of information technology or digitalization of system so as to reduce the treatment time. Keywords: Out patient department, waiting/treatment time, digitalization Cite this article as: Priyanka Bhushan, Maj Kundan Kumar, Prasant MC. Study of reason for low OPD at SMBT Dental college: An Open ended.. A rare case report of Amlodipine induced gingival enlargement. American Journal of Advances in Medical Science. 2014; 2(3): Source of Support: Nil, Conflict of Interest: None declared 26

2 1.0 Introduction Oral health and related diseases affect one s quality of life. The most basic human needs like eating, drinking, swallowing, smiling and communication are dependent on sound oral health. One should realize that oral health not only affects the quality of life, but also an individual s self- esteem, performance at school or work. Poor oral health reflects social inequalities; hence the prevention of oral diseases should be of priority in underdeveloped countries around the world. Oral cavity is as important as any other structures in a human body. It s an integral part of a human body. Health is incomplete without good oral health. In order to achieve the objective of health for all, it s important to consider oral health as an integral part of general health. Oral health includes much more than just healthy teeth. Nearly every human will experience poor oral health in their lifetime [1]. Of these, dental caries are the most common noncommunicable disease in the world [1]; periodontal disease and dental caries are the two dominant disease burdens in oral health [2]. Adequate knowledge of oral diseases and its manifestations is crucial to medical practice as: (a) Periodontal disease is associated with multiple systemic conditions of medical interest, (b) A large number of systemic diseases have oral manifestations, and (c) Many drugs are associated with oral adverse drug reactions. In developing countries like India only 2% to 3% of the total GDP is allocated to health care with no specific or separate allocation for oral health. In order to achieve the desired health care goals it is necessary to involve private sector, trusts and NGO s to provide effective health care. WHO recommends dentist to population ratio of 1:7500. In 1960 s the dentist to population ratio in India was 1:300,000[3]. Dental Council of India (DCI regulatory body of dental education in India) granted permission to private entities and trust to start dental colleges for improving the dentist to population ratio and to provide specialized dental treatment to large section of people. The result is that at present there are about 294 dental colleges [Figure-1] producing more than 30,000 graduates every year and the dentist to population ratio in India now stands at 1:10,000 [3], although still below WHO standards. In order to be economically viable and attract large number of students to their college, most of the colleges were opened in the urban areas or their outskirts. DCI s National survey was conducted to determine the prevalence of dental diseases in Indian states. The figures showed disturbing trends like prevalence of dental caries is 40%-80% (Very high in Northern states 85%-90%), oral cancer and precancerous conditions are 3%-10% [highest being in Orissa 7% (world s highest)] [3]. Inspite of improved dentist to population ratio and large number of dental colleges, there is less progress to bring down the incidence and prevalence of dental diseases as problem lies with distribution rather than number of dental surgeons as majority of the dentist (80%) work in big cities despite of the fact that larger proportion of Indian population (70%) still resides in rural areas [3]. 27

3 SMBT Dental College (OPD) As per the 2001 India census, Sangamner Taluk has a population of 439,806 with an urban population of 61,958. Males constituted around 51% of the population and females 49%. Sangamner has an average literacy rate of 76%. Table-1: Difficulties as reported by patients while undergoing treatment leading to low OPD at college (300 Subjects) Reasons Number % Increased Appointments/ Waiting Time % OPD Procedures % Distance % Trainee Doctors Working % Sangamner, being a semi-urban area consist of both rural as well as urban population. Table-2: Reasons for the Low OPD Problems as perceived by the students/interns (150 Subjects) Reasons Number % Patient % Attitude (Low Priority) Academics 39 26% OPD Procedures % General population are mostly from labour and agricultural labour class belonging to lower socio-economic status with poverty, poor sanitation, high density of population, lack of health consciousness, poor health care facilities being major factors leading to poor health in general and poor oral health in particular. In terms of health facilities there are no hospital or dental facility in Sangamner. There are two government run PHC without dental facility. Oral health care is provided by the only trust owned dental college Sau Mathurabai Bhausaheb Thorat Dental College ( SMBT Dental college) and few numbers of private practitioners. *Including both New and Old Appointment Cases Graph-1: Consolidated OPD visits of Last 3 year OPD timings in the college was from morning 9 o clock to afternoon 3 o clock. Daily OPD is around 30 to 40 patients (new registration). Graph-1 shows an OPD increased by 4.2% every year as per the data accessed from the college authority. However the increase in OPD is not so significant and almost stagnant since last 3 year. Being the only dental college in the region the OPD of the college should have increased at a greater percentage. Keeping all the above mentioned points in view, an epidemiological titled reasons for low OPD at SMBT dental college and hospital was undertaken to figure out the reasons for low 28

4 patient flow at the OPD of the dental college and hospital. A was done on a total of 500 subjects out of which 300 were patients reporting to college for treatment, 150 students and interns and 50 clinical staff of the college so as to ascertain their views on the problems faced by them in obtaining and in providing treatment which may lead to low OPD patient turnout at college hospital. It was open ended questionnaire and patient, students and doctors were asked about their views about the reasons for low OPD at the college hospital. Depending upon their response the reasons as viewed by each of the group was tabulated. 2.0 Materials and methods Inclusion Criterion The patients visiting the out patient department of the college hospital. The students from 3 rd year onwards including interns. The teaching faculty of the college. Exclusion Criterion Subjects not willing to participate in the survey. Subjects who refused to answer after persuasion. Official Permission: All necessary permission were obtained from concerned authorities to carry out the study. Informed Consent Before collection of data, the purpose and the methodology of the survey was explained to each of the subject and informed consent was obtained. 3.0 Results and discussion Out of 500 samples selected 265 (53%) were male and 235 (47%) were female. Table-3: Reasons for the low OPD Problems as perceived by the teaching faculty (50 Subjects) Reasons Number % Students & % Patients Attitude Appointment / % Waiting Time Out of the 300 patients elected for survey, majority of the patients (38.33%) belonged to the low socioeconomic strata [Figure-2]. Figure-1: Distribution of dental college in India (State wise) Data in Table-1 shows the response of the patients about the problems faced by them or the reasons leading to low OPD. The majority of them (43.66%) responded that the waiting time and the number of appointments was the major reason for low OPD of the college % of the patients stated that lot of time was wasted in locating the department and the procedure involved before a patient is seen by a doctor % of respondents cited distance of the college from the city as the reason for low OPD. Only 7.33% of the patients felt that low OPD can be attributed to trainee doctor. Patient attitude and behaviour was the main reason 29

5 cited by the students and interns for delayed treatment and thereby resulting in Low OPD as shown in Table-2. Figure-2: Patient distribution according to occupation 63.33% of the students and interns cited patient attitude i.e oral health being low on the priority list of the patient, loss of appointment card, not reporting on time for treatment as the main reason for low OPD. 26% of the students were of the view that academics also results in increased waiting or treatment timeleading to low OPD. Table-4: Difference in treatment time at private clinic and dental college and hospital Time ** Treatment * In college Private clinic Restoration 2 hrs 45 min Root Canal Treatment 15 days/ hr sitting 3-4 sitting / sitting half an hour Complete denture days (5 5-8 days (3-4 sittings) sittings) Fixed Partial Denture 1 month (On Appointment) Ceramic 4-5 days, metal 2-3 days Removable Partial 10 days 2 days Denture Scaling 2-3 days (3 4 Sittings) Half an hour (Single Sittings) Extraction 1 hr Half an hour Fixed Appliances 3-3 ½ half year (On Appointment) 1 1 ½ half year * Depending on case to case and severity of case ** Rough Estimate However, only 10.66% of the students were of view that location of department or the procedure followed was responsible for low OPD. Response of the faculty as shown in table-3 cites the attitude of the patients and students as the main reason for low OPD (72%). Faculty cited the irresponsibility and lack of 30

6 seriousness among the students and oral health being of low priority among the population as the main reason for low OPD. 28% felt that increased appointment and waiting time was also responsible for low OPD. OPD of any hospital is a very important section especially in a teaching college and hospital. It is the first point of contact between patient and the hospital staff. So the present study was conducted to assess the reason for low OPD patient flow. The amount of time a patient has to wait for his/her turn to be seen or treated by the doctor seems to be the most important factor. About 43.66% of the patients and 28% of the faculty involved in private practice were of view that appointment or waiting time was the major reason for low OPD. However being treated by trainee doctor was of least important reason for low OPD to the visiting patient. Similar views were expressed by patients in a study conducted by Hayat at el [4]. The reasons given for low OPD include: Waiting Time/ Appointment Patients' waiting time has been defined as "the length of time from when the patient entered the outpatient clinic to the time the patient actually leaves the OPD" [5]. Increased waiting or appointment time was the main reason cited by the respondent for low OPD. Waiting time was considered to be the most important factor for patient satisfaction [4,6]. Most of the patients visiting college for treatment belonged to low socioeconomic status and dependant on daily wage for earning. As the average time taken for treatment for any dental ailment is very high at college [Table-4,]which means loss of wage of that day for the patient. The results clearly indicate there is a need for efforts to reduce the waiting time as much possible. Many methods like use of information technology, provision for evening OPD and emergency services may be some of them. OPD Procedure The difficulty in locating the various departments was cited the second highest reason for low OPD. This was in comparison with the study conducted by Asghar S et al [7] wherein 32.65% of the patient cited difficulty in locating the departments of the college hospital. After initial examination they were referred to various departments depending upon their dental problem and that is when their problem starts as they have difficulty in locating the departments as some of them are located at 2 nd or 3 rd floor. Before the commencement of treatment, they have to make entries and undergo oral examination again at the respective departments and thereafter the patient have to deposit the requisite fees for which the patient has to again go back to reception counter there by making treatment process very lengthy. It further gets complicated if any diagnostic treatment like radiograph or blood investigation has to be performed. Behavioural Attitude Majority of the students and teachers were of the view that the behaviour of patients was the main reason for low OPD of the college. Most of the population of the city belonged to low socio-economic status for whom oral health was of least priority. Together with this, majority of the patient would lose 31

7 their OPD card and would seldom arrive for treatment at schedule appointment time. Once a patient gets relief from pain they seldom return for subsequent treatment. Absence of any form of insurance scheme or national scheme for dental treatment means 80-85% people spend from their pocket for dental treatment [3] which may explain the low priority accorded to dental health. Distance In the present study, 19.33% patients said that the distance of the dental clinic affected their choice of dental clinic. Similar findings were obtained in the study conducted by Moshkelgosha et al at School of Dentistry, Iran [8]. However in a study conducted by Johara and Hussyeen at Riyadh City, a slightly higher, 36.5% respondents said the distance of dental clinic from their home is the major consideration while selecting a clinic for treatment [9]. The college is located on National Highway but on the outskirts of the city. There is no dedicated bus stop for the hospital and neither any public transport services are available from the city to college hospital. Majority of the patients have to use private or personal mode of transportation leading to increase in treatment cost. Academics 26% of the student felt that the pressures of academics affect the waiting time and may be responsible for low OPD. Students have great difficulty in balancing both the academics along with patient treatment. Most of the dental treatment procedure are time consuming and involves lot of laboratory work which the students have to do alone resulting in increased treatment time. Probably this may explain the reason for the difference in the time taken for any treatment at college and at private clinic [Table-4]. At times, internal exams and lecturers are scheduled during OPD timings leading to lot of inconvenience to the patient. 4.0 Conclusion Although India has more number of dental colleges than and more favourable dentist to population ratio, yet a lot has to be achieved to attain the Oral Health Goal Our approach towards dental treatment is still curative in nature although emphasis should be on prevention. Most of the dental college are following old and primitive method of functioning. Information Technology services are hardly utilized. Results from the present study indicate that novel techniques like use of computers and information technology would be of greater help bring in efficiency and reduce treatment or waiting time. Digitalization of patient data and diagnostic investigation would also be greatly helpful. There is urgent need of reorientation of the OPD according to the need of the patient rather than the space available. Clinical departments which are widely used should be located preferably on ground floor and the non clinical department at other floors. More number of satellite clinics should be opened especially in Govt owned PHC s and CHC s. To boost college OPD turnout, the authorities may introduce some form of dental insurance scheme for the local population of the city. Dental insurance provides an 32

8 effective way to manage the rising costs of dental care, and it may encourage people come up with, for, why not to see a dentist [10]. DCI along with government agencies will have to devise plan or regulation to reduce the significant geographic imbalance in the distribution of dental colleges and dentist to population ratio in the rural and the urban areas. There are about more than one million unqualified dental health-care providers, or 'quacks', practicing in India [11].They are mostly responsible for spreading unnecessary rumours about dental treatment and misdiagnosis and mistreatment causing unnecessary financial burden and behavioural change among the population. References 1. Beaglehole R, Benzian H, Crail J, Mackay J. The oral health atlas. FDI World Dental Federation; (2009): Retrieved from: 2. PetersenPE, OgawaH. Strengthening the prevention of periodontal disease: The WHO Approach. J Periodontol. 2005; 76 (12): Ahuja NK, Parmar R. Demographics and current scenario with respect to dentists, dental institutions and dental practices in India. Ind J Den Sci. 2011; 3(2): Hayat H, Rehman B, Din Q. Factors affecting patient satisfaction and delay In urgent care in patients reporting to Khyber college of Dentistry. Ind J Den Sci. 2012; 3 (1): Dinesh TA, Singh S, Nair P, Remya TR. Reducing waiting time in outpatient services of large university teaching hospital - A Six sigma spproach. Manag Heal. 2013; 17(1): Patel JY. A Study on evaluation of patient satisfaction with dental health care Services. Int J Scie Res Pub. 2014; 4 (8): Asghar S, Farheen F, Asghar A, Amana N. Assessment of patient's satisfaction about dental treatment/ facilities provided by Bahria dental college hospital, Karachi. Pak Oral Den J. 2013; 33 (3): MoshkelgoshaV, Mehrzadi M, Golkari A. The Public attitude towards selecting dental health centers. J Dent Shiraz Univ Med Sci. 2014; 15(3): Johara A, Hussyeen A. Factor s affecting utilization of dental health services and satisfaction among adolescent females in Riyadh City. Saudi Den J. 2010; 22: Raju HG. Oral health insurance in India. Ann Ess Den. 2010; 2 (4): Nagarajapa S, Mohapatra AK. Street dentistry: Time to tackle quackery. Ind J Dent Res. 2009; 20: