The role of insurance and training in dental decision making.

By Aminoshariae A, Teich S, Heima M, Kulild JC.

Date: 06/2015
Journal: JOE

Purpose: to evaluate:

1) the differences in treatment planning decisions between dental general practitioners and specialists.

2) the role of patients’ insurance and/or type of treatment in decision making.

Methodology:

•A computerized retrieval system was used to retrieve records from Jan 2011 to Dec 2012 were reviewed and filtered

•N = 1740 (contained 1  NSRCT, RETX, or EXT-implant), (n=180)

•60 charts selected for each treatment option, divided into 20 for each tooth category (anterior, cuspids, molars) Fig.1

•Two specialists examined radiographs and reviewed the charts and then independently generated treatment plans blinded to patients’ insurance status. 

Most highlighted Results:

1.A statistically significant difference was found between treatment plans designed by GPs and those designed by specialists. The overall agreement for NSRCT (93%), RETX (82.8%), and EXT-Implant (72.9%)

2.Patients’ insurance status did not influence the degree of agreement between specialists and GPs but it was influenced by treatment type. Logistic regression analysis shows that the type of treatment plan designed by GPs (NSRCT, RETX, and EXT-Implant) is significantly related to the degree of disagreement with the specialists; if GPs decided to plan for extraction and implants, the odds ratio (OR) of disagreement with the specialists’ treatment plans is 4.5 times more than when NSRCT is planned.

Conclusion:

1. There were significant differences in treatment planning decisions between GPs and specialists.

2. The disagreement in treatment planning between GPs and specialists was not influenced by patients’ insurance status, but it was influenced by treatment type. GPs planned significantly more toward extraction and implant placement compared with specialists.

Limitation: it’s a retrospective study, specialists did not have the opportunity to clinically examine the patients before selecting treatment plan for that patient