Quality of care for special patients with general anesthesia

Article

Doctor Carmen Martín-Sanjuán. Doctor in Dentistry. Pediatric Dentist of the Oral Health Unit for children with disabilities. (USBD-D) of the Madrid Health Service. (Sermas). Specialist in dental care for children with special needs. / Doctor E. Selle-Malagola. Graduate in Dentistry. Specialist in dental care for children with special needs / Doctor M.ª Cristina Moreno-Martín. Graduate in Dentistry. Master in Implant-Supported Oral Rehabilitation / Don JM de los Ríos de la Peña. Diploma in Nursing. USBD-D from Sermas / Doctor Maitena Urberuaga-Erce. Doctor-Dentist. Basque Health Service. Osakidetza / Doña Rosa Domingo-Malvadí. Diploma in Nursing. Osakidetza.

Summary
Foundation. Satisfaction is one of the dimensions of healthcare quality and can be measured through surveys.

Material and method. 501 surveys of caregivers of patients with special needs who underwent oral treatment with general anesthesia were reviewed.

Results. The evaluation of the services provided is high and 99% of those surveyed would recommend the services of the Oral Health Unit.

Introduction
The progress of the concepts that characterize Primary Care has allowed progress in the implementation of preventive and health promotion activities (1). The different aspects related to the quality of care in the provision of health services arouse increasing interest among professionals, managers and those responsible for health policy, and among users of the system. This interest is framed within the need to optimize available resources, and the emergence of a new business culture to guarantee and improve quality in all the products offered to customers. The dimensions of healthcare quality are: scientific-technical quality; effectiveness, efficiency, accessibility and satisfaction or the extent to which health care and the resulting health state meet the user's expectations. It can be studied through surveys and therefore measured (1).

Satisfaction includes the term acceptability that encompasses the degree of adherence or collaboration of the patient to the extent that he or she accepts and complies with the treatment plan and the prescribed care. These terms can refer to various aspects such as organizational aspects, for example the physical environment or waiting times; the effect of care on the state of health and the manner or treatment received during the care process by the personnel involved. It is accepted that satisfaction is very directly related to personal treatment, what is called the “art” of health care, and that even the differences between user expectations and what is scientifically correct can be minimized to the extent that professionals are able to establish an effective relationship with users (1, 2).

Surveys can measure this satisfaction and help corroborate that there is a deep interest in patients and/or caregivers in receiving information about their process and its evolution, including the different procedures they will require due to their pathology. By reducing uncertainty, their anxiety decreases, which is why they consider it key to insist on professional-patient/caregiver communication, reinforcing personal and direct treatment. Therefore, questions such as knowing the names of the staff who have treated them mean closeness and proximity of the professionals to the patient. There is a “halo” effect or dependency generated towards healthcare personnel that can cause the patient to magnify both the positive and negative aspects after their hospital stay (2). It would be included within the art of practicing medicine.

Citizens trust their doctors in the National Health System (SNS), according to a study of “Trust in the SNS”, with the Primary Care doctor being the best rated with 61%, followed by nurses, pharmacists, public hospital doctors and dentists. In the same work, they indicate that 81% know the name of the family doctor who treats them at their health center and that waiting lists are the most important SNS problem detected by citizens (3). The quality of the assistance received is the most important factor for the user.

The objective of this work is to know the satisfaction of caregivers with the oral treatment of a sample of non-cooperative patients with special needs in an Oral Health Unit for children with disabilities (USBD-D).

Material and methods
501 satisfaction surveys received from the caregivers of special patients, who underwent oral treatment in the operating room and with general anesthesia, were evaluated in the weekly review carried out after the treatment and during the period between July 2003 and March 2008. The survey was prepared following care quality criteria and was validated by the Area Health Technician.

The results were processed and stored in a Microsoft Excel database and statistically exploited using the SPSS package for Windows 12.0, performing descriptive statistics where the available data are summarized and organized with frequencies and percentages for the categorical variables.

Results
13.9% of the children cared for at the USBD-D are immigrants and 16.6% belong to Autonomous Communities (CCAA) outside the Community of Madrid.

The average age of the respondents, who are the parents of said children with special needs (since the children are non-cooperative), is 47 years. Regarding sex, 75.25% are women and 24.7% are men. 35% have primary education, 19% have an elementary school degree, 16.5% have a high school degree, 14% are intermediate university students and 10.6% have a higher degree.

85% know the name of the pediatric dentist and 77% know the name of the nurse. To which they give a value of 83.55 and 80.16 respectively. 93.22% of those surveyed claim to have been informed about the procedure to be carried out, 93.1% understood the information received and 92.14% reported that what was reported coincided with what was carried out.

91.5% respond that they have not had to wait to be treated at the USBD-D. 95.23% indicate that they were explained what the treatment to be performed would consist of, the risks and benefits of performing it with general anesthesia. The evaluation of the services provided is 94.24.

99.01% of the caregivers surveyed would recommend the services of the Oral Health Unit for children with disabilities due to the high satisfaction with the care and treatment provided, giving a value of 9.7 to the care received at the Unit.

Oral treatment with general anesthesia had to be repeated in 8.8% of the patients.

Discussion
Oral care for approximately 14% of immigrant children with disabilities is a true reflection of Madrid society today where there is a high immigration rate. Likewise, almost 17% of children belong to other Autonomous Communities other than Madrid and this is due in part to the location of the USBD-D in the Niño Jesús hospital in Madrid where there are specialties that are not found in their hospitals and Autonomous Communities being for these specialists a Reference Unit.

It is found, as in a previous work carried out in 2003 on oral care with general anesthesia for a population of 62 children with disabilities and/or non-cooperators (4) and another study carried out in 2005 on a sample of 206 children with special needs (5), a high degree of satisfaction with the treatment and care received, valuing the personalized and humane treatment, hence the relative importance of the questions about the names of the professionals involved (2,3). (Table 1). When discussing both the foreseeable risks and benefits of the procedure, the goal is empathy with primary and secondary clients/users. Regarding the increase in waiting time for treatment in relation to previous years, it is due to the fact that the Oral Health Unit for children with disabilities serves children from the Community of Madrid and neighboring Autonomous Communities and to a continuously growing demand for care activity.

Once informed of the benefits and risks, the majority of parents accept the procedure, but a significant number refuse it, as indicated by Havelka et al (6). Other authors also carry out surveys, such as Anderson et al (7), obtaining the following results: when asked if patients received enough information, 94.7% affirmed yes; 80% considered the experience positive, and 98.9% would repeat the dental treatment with general anesthesia. Likewise, Enever et al (8) achieved 67% satisfaction among respondents. Other authors such as Rueda et al (9) also found a high degree of satisfaction, thus demonstrating that this care model provides highly personalized treatment and reduces the drama of conventional surgery while facilitating rapid incorporation into normal life.

The need to repeat oral treatment with general anesthesia is an undesirable but inevitable event, which does not reduce the quality of care.

These patients, due to their underlying pathologies and other factors such as very difficult oral hygiene, a diet that is often cariogenic or types of enteral feeding such as through gastrostomy or crushed foods, accumulate tartar and have a high risk of cavities. In a high percentage of cases it is the only solution that exists so that they can be treated appropriately and therefore they must be subjected to this treatment repeatedly.

In Table 2 there are similarities with other authors (10-12), although it must be taken into account that the sample provided in the present work is the largest of those compared, so our levels of repetition of the treatment would be significantly lower than the rest of the authors compared.

Conclusion
Dental treatment with general anesthesia is a procedure that has a high degree of satisfaction for caregivers of patients with special needs. It solves a gap in oral care for patients who do not cooperate with conventional dental treatment, as it is the only way to carry out satisfactory treatment.

Author responsible for the correspondence
Dr. Carmen Martín-Sanjuán.

Bibliography

1. Martín-Zurro A, Cano JF. Primary Health Care. In: Martín-Zurro A, Cano JF. Primary Care. Concepts, organization and clinical practice. 3rd ed. Ed, Mosby/Doyma books. Barcelona, ​​1994. 1: 3-13.

2. Gracia-San Román FJ, Valencia-Martín R, Monteagudo-Piqueras O, Alonso-Vigil P, Díez-Sebastián J, García-Caballero J et al. Monitoring of perceived quality after the implementation of a clinical pathway. Rev Healthcare Quality. 2004; 19: 75-82.

3. Barberá JM. The primary care doctor, the professional most valued by the citizen. Seven Medical Days.2006; 671: 7-11.

4. Martín-Sanjuán C, Carracedo-Cabaleiro E, Mourelle- Martínez R, de Nova- García J. Children's dental care integrated with general anesthesia. Arch Odontostomatol. 2005; 21: 399-406.

5. Martín-Sanjuán C. Integration of general anesthesia in the dental treatment of children with special needs (doctoral thesis). Madrid: Univ. Complutense. Faculty of Dentistry; 2006.

6. Havelka C, McTigue D, Wilson S, Odom J. The influence of social status and prior explanation on parental attitudes toward behavioral management techniques. Pediatr Dent. 1992; 14: 376-381.

7. Anderson H, Drummond B, Thomson W. Changes in aspects of children's oralhealth-related quality of life following dental treatment under general anesthesia. Int J Paed Dent. 2004; 14: 317-325.

8. Enever G, Nunn J, Sheehan J. A comparison of post-operative morbidity following outpatient dental care under general anesthesia in pediatric patients with and without disabilities. Int J Paed Dent. 2000; 10: 120-125.

9. Rueda J, Sanguino D, Daviu JC, Alfonso F, Melado A. Perceived quality in a hospital odontostomatology service. Arch Odontoestomatolol Community Prev. 2005; 21:84.

10. O'Sullivan E, Carson M. The efficacy of comprehensive dental care for children under general anesthesia. Br Dent J. 1991; 171: 56-8.

11. Eidelman E, Faibis S, Peretz B. A comparison of restorations for children with early childhood caries treated under general anesthesia or conscious sedation. Pediatr Dent. 2000; 22(1): 33-7.

12. Barbería E, Arenas M, Gómez B, Saavedra-Ontiveros D. An audit of pediatric dental treatments carried out under general anesthesia in a sample of Spanish patients. Community Dent Health. 2007; 24:55-8.

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