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Biomedical subjects

P Milgrom

Publications and source records attributed to P Milgrom.

At least 55 records · Page 3Linked to original sources
PubMed1996

Frustrating patient visits.

OBJECTIVES: This study, part of a national mail survey of dentist malpractice liability claims, reports the reliability and validity of a new 22-item instrument measuring frustrating patient visits. METHODS: The items were subjected to factor analysis and subscales constructed. Reliability was assessed using Cronbach's alpha. Validity was assessed by comparing subscale scores to self-reports of satisfaction and liability claims. RESULTS: Factor analysis revealed four subscales representing unpleasant feelings, lack of communication, compliance, and practice organization (alpha = 0.60-0.86). Compliance was the most important factor. Subscale scores were related to satisfaction with practice and the proportion of patient visits in the practice that were frustrating to the dentist. Dentists who reported frustrating patient visits as quite typical of their practices were more likely to have had a malpractice liability claim within the last five years. CONCLUSION: This instrument may be of value in detecting patient-dentist communication difficulties that are the precursor to liability claims.

Communication↗
PubMed1996

The estimation of caries prevalence in small areas.

National surveys have been effective for the estimation of caries prevalence in broad regions of the US. However, it is unclear if data from such surveys can be used to estimate prevalences in small areas such as states or counties because of small sample sizes within individual areas. In this study, we applied specialized statistical methods to the estimation of small-area caries measures using data from an oral health survey conducted in the State of Washington. Dental exams to assess caries and the presence of sealants and fluorosis were performed on 2921 third-grade students in 84 public schools selected by a stratified random sample from all 39 counties in the state. Statistical methods for small-area estimation were used to estimate disease and sealant utilization measures for each of the counties. Adjustment was made for covariates measured at the school level, including ethnicity and the proportion of children in the Federally sponsored school lunch program. Substantial variability in disease and sealant utilization between counties was found. The estimated number of decayed and filled surfaces per child was 4.7 (inter-county range, 2.4 to 7.4). The estimated number of surfaces of untreated decay was 1.2 per child overall (range, 0.5 to 3.1). Thirty percent of the children had restorative treatment needs (range, 15 to 54%). The prevalence of sealants on one or more permanent molars was estimated to be 34% (range, 19 to 46%). Overall, only 8% of children showed evidence of fluorosis. The results demonstrate the usefulness of small-area estimation methods for oral health surveys.

Child↗
PubMed1995

Prevalence of complaints by patients against general dental practitioners in greater Manchester.

A postal questionnaire regarding potential and official patient complaints was sent to all dentists on the Family Health Service Authority list of four health districts in Greater Manchester. From an eligible sample of 335 dentists, 306 responses were received (91%), 289 of them from general dental practitioners (GDPs). One hundred of the GDPs (35%) had reported at least one potential complaint to their defence organisation in the past 5 years (1989-1993) and 10 GDPs had reported three or more complaints. The majority of complaints were in the field of restorative dentistry (57%) with complaints about oral surgery accounting for another 20%. Dentists who worked longer hours contacted their defence organisation more often regarding potential complaints. Thirty-two dentists reported that their most recent potential complaint had resulted in an official complaint being filed against them. There was a significant relationship between the prevalence of official complaints and the dentists' reported level of unsatisfactory patient visits.

Adult↗
PubMed1995

Origins of childhood dental fear.

This study explored Rachman's theory of fear acquisition applied to fear of the dentist in a large sample of low income American primary school children. Children and their mother/guardians were interviewed or completed questionnaires in the home about fear acquisition and related concerns. A multivariate logistic regression model was evaluated in order to explore the relationship of direct conditioning and modeling variables to fear levels. Both direct conditioning and parent modeling factors were significant independent predictors of fear level even when controlling for gender, age and other sociodemographic and attitudinal factors.

Attitude to Health↗
PubMed1995

Tort reform and malpractice liability insurance.

Legal factors related to the malpractice liability insurance purchased by general dentists in the United States were investigated using a comprehensive multivariate model that assessed the contribution of legal provisions affecting the probability of a malpractice claim, the probability of a payment, and the average size of the payment. General practice dentists in the United States were selected randomly, and 3,048 dentists were studied by mail survey. A number of legal statutes (periodic payment allowed, percentage fault liability informed consent limits, limits on res ipsa loquitor, attorney fee control, some statute of limitations provisions) had the intended effect of reducing the malpractice insurance sought by dentists. Other provisions, such as binding arbitration, may have unintended cost-raising effects. Previous malpractice claims were associated with purchasing greater amounts of insurance. These findings have implications for future changes in the legal system as part of health care reform.

Dentistry↗
PubMed1995

Dentists' attitudes toward frustrating patient visits: relationship to satisfaction and malpractice complaints.

A 22-item questionnaire measuring physician frustration in communicating with patients was adapted to dentists, and its reliability and validity assessed, in a sample of 289 English dental surgeons in general practice in Greater Manchester. Subscales were derived assessing the concepts of unpleasant dentist feelings, lack of communication, patient non-compliance, patient control, and practice organization with Cronbach's alpha ranging from 0.59 to 0.77. Three of five subscale scores (unpleasant feelings, lack of communication, and practice organization) were significantly greater for dentists who had official malpractice complaints to insurers. Similarly, all five subscores were greater for dentists who reported larger numbers of unsatisfactory visits and expressed greater dissatisfaction with dental practice.

Adult↗
PubMed1995

Dental care satisfaction: the reliability and validity of the DSQ in a low-income population.

OBJECTIVES: Studies examining satisfaction with dental health care among the poor are quite rare. This study was done to confirm the internal structure and reliability of the Dental Satisfaction Questionnaire (DSQ), a measure of dental care satisfaction, among a low-income population, and provide normative data regarding dental satisfaction among low-income people. METHODS: Subjects were 895 mothers of school-aged children who were administered the DSQ as part of a larger study of dental utilization and dental fears in Seattle. RESULTS: Factor analysis largely confirmed the factor structure of the DSQ. Results also suggested subjects in this sample were less satisfied with pain management than nonpoor people. Self-reported dental health and dental appearance were associated with satisfaction with pain management, quality of care, access to care, and overall satisfaction. Race/ethnicity, education level, marital status, nation of origin, and type of insurance predicted differences in satisfaction with pain management and access. CONCLUSIONS: Barriers to dental care and quality of care among low-income populations are discussed. Uses and research with the DSQ are suggested.

Attitude to Health↗
PubMed1995

The prevalence of dental anxiety in children from low-income families and its relationship to personality traits.

The prevalence of dental anxiety and the association between dental anxiety and personality traits were examined in a population-based sample of 895 US urban children, from 5 to 11 years of age, from low-income families. Dental anxiety was reported by the child using the Dental Subscale (DS) of the Children's Fear Survey Schedule, and behavioral problems and personality traits were evaluated by parent report on the Child Behavior Checklist (CBCL). Mean DS scores were 31.1 (SD = 10.3) for boys and 34.3 (SD = 11.0) for girls. CBCL score means were 33.3 (SD = 23.2) for boys and 28.5 (SD = 19.1) for girls. The hypothesized relationship between DS and CBCL scores in this population was not demonstrated.

Child↗
PubMed1995

Malpractice premiums in 1992: results of a national survey of dentists.

According to a 1992 national survey, more than 95 percent of general dentists in the United States purchased malpractice insurance. The authors evaluated the survey findings to identify factors that had the greatest effect on dentists' insurance premium costs. Premiums were higher for dentists who had been the subject of previous complaints or claims, as well as for those who owned their practices. States with fewer lawyers had lower premiums. Finally, state limits on use of dental hygienists, number of offices and the extent of water fluoridation also affected premium levels.

Fees and Charges↗
PubMed1994

Cross-cultural validity of a parent's version of the Dental Fear Survey Schedule for children in Chinese.

The cross-cultural validity of a parent's version of the Dental Fear Survey Schedule (DFSS) for children was assessed by examining the relationship between the parent's report of child fear in Chinese (DFSS) and actual child behavior (CB) in the dental environment for two samples: 70 Chinese children ages 5-15 yr, residing in Canada, and 99 mainland Chinese children ages 2.5-7.0 yr residing in Kunming, Yunnan, PRC Canadian DFSS score M = 31.9 (SD = 9.5) with no differences by age or sex. PRC DFSS score M = 35.7 (SD = 8.9) with girls reported more fearful than boys. No age difference was detected. Higher DFSS scores were associated with more CB in both samples. Factor analyses yielded similar solutions and internal consistency was high. Control and potential victimization were identified as important constructs. The results suggest the Chinese version of the DFSS is a reliable and valid parental measure of child dental fear.

Adult↗
PubMed1994

The anxiolytic effects of intravenous sedation using midazolam alone or in multiple drug techniques.

This study examines four drug combinations (midazolam, midazolam-midazolam, fentanyl-midazolam, and fentanyl-midazolam-methohexital) in a placebo-controlled double-blind clinical trial of intravenous sedation. It tests the hypothesis that there is no difference between the anxiolytic effect of the four combinations when compared with a saline placebo. Subjects were 207 mildly anxious young adults having their third molars removed. Cognitive measures of anxiety increased from preoperative levels in the placebo and both midazolam groups (P < .05). The anxiety response remained the same in the fentanyl-midazolam and fentanyl-midazolam-methohexital groups (P > .05). The level of successful anxiolysis ranged from 24% in the placebo group to 74% in the barbiturate group. Using the log likelihood method, comparisons suggest that the drug groups (from midazolam alone to the methohexital combination) have increasingly positive anxiolytic effects even when controlling for the effects of dental fear and intraoperative pain. The fentanyl-midazolam group is 8.1 and the methohexital group is 9.0 times more likely to have had a favorable outcome than the placebo group. Additional analyses of behavioral measures of anxiety yielded parallel results. Global evaluations after surgery were related to the success of anxiolysis for subjects in the active drug conditions (P < .05).

Adult↗
PubMed1994

Behavior problems in 5- to 11-year-old children from low-income families.

OBJECTIVE: The aims of the present study were to survey the Child Behavior Checklist (CBCL) scores (behavioral section) in a nonclinical population of US urban children from low-income families and to compare the distribution and pattern of scores with the normative data in the CBCL manual (1991). METHOD: The sample consisted of 890 low-income children and a mother or female guardian selected randomly from among Seattle public school students aged 5 to 11 years. RESULTS: In this sample the total CBCL score as well as all subscale scores were significantly higher than the norms. The proportion of children who scored in the clinical/borderline range was also higher than the norm. CONCLUSIONS: These findings support previous work showing that poverty is a risk factor for mental distress in children. They also raise questions about the validity of the CBCL norms for screening or research purpose for low-income families.

Child↗
PubMed1994

Dentists' response to financial incentives in a mail survey of malpractice liability experience.

This two-part methodologic research was designed to evaluate the effects of a financial incentive on questionnaire response rate and response bias for general dentists surveyed by mail. Subjects were 517 clinicians randomly selected from a two-state population of practitioners insured by a single malpractice liability carrier. Subjects received a check for either $5 or $10 in the original mailing. In Study 1, a single mailing and postcard follow-up resulted in a 57.8 percent (111/192) response rate. In Study 2, employing Dillman's Total Design Method, a 69.6 percent (208/299) response was obtained after a third mailing. Analysis of response rate by incentive level in each study revealed no significant differences. In contrast, early responders (first mailing and follow-up postcard) differed from late responders (second and third mailings) on age (41.4 vs 37.0 years; T = 2.17; P = .032), non-Caucasians (27.7% vs 63.9%; chi 2 = 17.3; df = 4; P < .002), females (13.9% vs 27.8%; chi 2 = 3.9; df = 1; P < .05), foreign-trained (7.0% vs 19.4%; chi 2 = 16.5; df = 2; P < .001), and dissatisfaction with practice (31% vs 51%; chi 2 = 7.8; df = 4; P = .10). Thus, the magnitude of the financial incentive in this experiment had no differential effect on response rate. But differences in responses from late responders (proxies for nonresponders) on demographic characteristics and key study variables suggest the persistence of response bias despite an acceptable response rate. Future dental health survey research should employ tests for response bias on both sets of variables.

Adult↗
PubMed1994

Malpractice claims during 1988-1992: a national survey of dentists.

Between 1988 and 1992, almost a quarter of surveyed dentists reported at least one patient complaint to malpractice insurance carriers. The incidence of claims more than doubled in that time and payment size increased nearly five times between 1988 and 1991. These and other trends in professional liability are examined in this national survey of general dentists.

Age Factors↗
PubMed1994

Dental malpractice liability insurance market: surveys of insurers and insurance commissioners.

Surveys of malpractice insurers and state insurance commissioners in 1992 show a highly concentrated market with opportunities for greater competition. Fewer than 50 firms write coverage nationally. Weighted premiums for $1 million/$3 million coverage vary across U.S. census divisions from $1,700 in the South to $3,000 in the Northeast. These data may be of interest to practitioners who purchase insurance and will aid dental associations in effectively participating in revisions of malpractice liability statutes as part of overall health care reform.

Data Collection↗
PubMed1994

The efficacy and memory effects of oral triazolam premedication in highly anxious dental patients.

Triazolam (0.375 or 0.50 mg) or placebo was administered orally to 31 highly anxious dental patients in a double-blind clinical trial 1 hr before treatment. The drug was safe and highly effective, in comparison to placebo, in reducing both anxious cognitions and disruptive movement during oral injections of local anesthetic and drilling. Episodic memory and implicit memory were both adversely affected by the active drug but not the placebo.

Administration, Oral↗