Abstract
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 d ...
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.
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