A Study on Promotion of Dental Care Provision Services for Children and Persons with Disabilities:Factual Investigation of Dental Treatment for Special Needs Patients at Oral Health Centers
Objective:The purpose of this study was to grasp the actual status of dental care for persons with disabilities at oral (dental) health centers (oral health centers) and to identify and organize problems in order to establish a system in which children and adults with disabilities can receive higher...
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| Published in | Journal of the Japanese Society for Disability and Oral Health Vol. 45; no. 2; pp. 117 - 127 |
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| Main Authors | , , , , , , , , , , , , , , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
The Japanese Society for Disability and Oral Health
30.06.2024
一般社団法人 日本障害者歯科学会 |
| Subjects | |
| Online Access | Get full text |
| ISSN | 0913-1663 2188-9708 |
| DOI | 10.14958/jjsdh.45.117 |
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| Abstract | Objective:The purpose of this study was to grasp the actual status of dental care for persons with disabilities at oral (dental) health centers (oral health centers) and to identify and organize problems in order to establish a system in which children and adults with disabilities can receive higher quality dental care in their familiar communities at any time.Subjects and Methods:After obtaining approval from the Japanese Association for Dental Science, we mailed an explanation of the purpose of the survey, the questions, and the URL and a two-dimensional barcode of Google forms with which to answer the questions, to 343 oral health centers.Results:Responses were obtained from 215 centers that agreed to participate in the survey. Of these, 142 (66.0%) were facilities that accepted dental care for children and persons with disabilities (intellectual disability, physical disability, mental disorder, children with medical complexity, and intractable disease), so these 142 facilities were included in the analysis. Most of the facilities were staffed by part-time dentists on a rotating basis, and outpatient care was the main service provided in 134 (94.4%) of the cases. Despite collaboration with other medical institutions, the referral rate was 21.1 (28.5%), while the reverse referral rate was 8.7 (14.8%). 105 (73.9%) and 89 (62.7%) of the respondents answered that they had “current or anticipated medical and managerial difficulties/problems,” respectively. The most common medical problem was “Insufficient personnel,” followed by “Lack of expertise to accept special cases considering the characteristics of the disabled,” and “Few dental clinics that can make a reverse referral.”Conclusion:The results suggest that it is necessary to provide dental health counseling and home-visit dental care, secure highly specialized personnel, and establish a system for smooth cooperation among dental care institutions, to improve the provision of dental care for children and adults with disabilities in the community. |
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| AbstractList | Objective:The purpose of this study was to grasp the actual status of dental care for persons with disabilities at oral (dental) health centers (oral health centers) and to identify and organize problems in order to establish a system in which children and adults with disabilities can receive higher quality dental care in their familiar communities at any time.Subjects and Methods:After obtaining approval from the Japanese Association for Dental Science, we mailed an explanation of the purpose of the survey, the questions, and the URL and a two-dimensional barcode of Google forms with which to answer the questions, to 343 oral health centers.Results:Responses were obtained from 215 centers that agreed to participate in the survey. Of these, 142 (66.0%) were facilities that accepted dental care for children and persons with disabilities (intellectual disability, physical disability, mental disorder, children with medical complexity, and intractable disease), so these 142 facilities were included in the analysis. Most of the facilities were staffed by part-time dentists on a rotating basis, and outpatient care was the main service provided in 134 (94.4%) of the cases. Despite collaboration with other medical institutions, the referral rate was 21.1 (28.5%), while the reverse referral rate was 8.7 (14.8%). 105 (73.9%) and 89 (62.7%) of the respondents answered that they had “current or anticipated medical and managerial difficulties/problems,” respectively. The most common medical problem was “Insufficient personnel,” followed by “Lack of expertise to accept special cases considering the characteristics of the disabled,” and “Few dental clinics that can make a reverse referral.”Conclusion:The results suggest that it is necessary to provide dental health counseling and home-visit dental care, secure highly specialized personnel, and establish a system for smooth cooperation among dental care institutions, to improve the provision of dental care for children and adults with disabilities in the community. Objective:The purpose of this study was to grasp the actual status of dental care for persons with disabilities at oral (dental) health centers (oral health centers) and to identify and organize problems in order to establish a system in which children and adults with disabilities can receive higher quality dental care in their familiar communities at any time.Subjects and Methods:After obtaining approval from the Japanese Association for Dental Science, we mailed an explanation of the purpose of the survey, the questions, and the URL and a two-dimensional barcode of Google forms with which to answer the questions, to 343 oral health centers.Results:Responses were obtained from 215 centers that agreed to participate in the survey. Of these, 142 (66.0%) were facilities that accepted dental care for children and persons with disabilities (intellectual disability, physical disability, mental disorder, children with medical complexity, and intractable disease), so these 142 facilities were included in the analysis. Most of the facilities were staffed by part-time dentists on a rotating basis, and outpatient care was the main service provided in 134 (94.4%) of the cases. Despite collaboration with other medical institutions, the referral rate was 21.1 (28.5%), while the reverse referral rate was 8.7 (14.8%). 105 (73.9%) and 89 (62.7%) of the respondents answered that they had “current or anticipated medical and managerial difficulties/problems,” respectively. The most common medical problem was “Insufficient personnel,” followed by “Lack of expertise to accept special cases considering the characteristics of the disabled,” and “Few dental clinics that can make a reverse referral.”Conclusion:The results suggest that it is necessary to provide dental health counseling and home-visit dental care, secure highly specialized personnel, and establish a system for smooth cooperation among dental care institutions, to improve the provision of dental care for children and adults with disabilities in the community. 目的:障害児・者が身近な地域でより質の高い歯科医療がいつでも受けられる体制を整備するために,口腔(歯科)保健センター等(口腔保健センター)での障害者歯科診療の実態を把握し,問題点を抽出・整理することを目的とした.方法および対象:調査は日本歯科医学会の承認を得たうえで,本調査の趣旨説明と質問内容および回答先Google formのURLと二次元バーコードを343件の口腔保健センターへ郵送して実施した.結果:調査に同意が得られた215件より回答を得たが,対象に該当する障害児・者の歯科診療を受け入れている施設は142件(66.0%)であったため,これら142件を分析対象とした.非常勤歯科医師による輪番制で対応している施設が多く,業務内容は,外来診療が134件(94.4%)と主体であった.他の医療機関等との連携はあるにもかかわらず,患者の紹介率の平均(SD)が21.1(28.5)%に対して,逆紹介率は8.7(14.8)%であった.「現在あるいは今後予想される医療上および経営管理上で困っている点/問題点」があるとの回答が,それぞれ105件(73.9%),89件(62.7%)であった.医療上の問題点としては,「人員の不足」が最も多く,「障害者の特性を考慮した特殊なケースを受け入れる専門性の不足」「逆紹介できる歯科診療所が少ない」の順となった.結論:地域における障害児・者の歯科医療提供を充実するためには,歯科保健相談,歯科訪問診療への対応や専門性の高い人材の確保や歯科医療機関の円滑な連携がとれる体制を整備する必要があると考えられた. |
| Author | KOMATSU, Tomoko KONDO, Takanari ITOH, Tatsuhiko KUBOTA, Tomohiko KADOTA, Aya KAWASE, Souichirou AMANO, Ikuko KATSUREN, Yoshiyuki SONG, Wenqun TACHINAMI, Yasuharu NAKAGAMI, Masahiro OGATA, Katsuya KIKUCHI, Kazuko HIRATSUKA, Masao ASAHINA, Yoshiaki EZURA, Yoko SAIRENJI, Nakayasu TAKAMANN, Kougi TAKANO, Tomoko |
| Author_FL | 門田 綾 久保田 智彦 高野 知子 天野 郁子 高満 幸宜 河瀬 聡一朗 西連寺 央康 立浪 康晴 平塚 正雄 江面 陽子 宋 文群 今渡 隆成 菊池 和子 中神 正博 勝連 義之 小松 知子 朝比奈 義明 井東 竜彦 緒方 克也 |
| Author_FL_xml | – sequence: 1 fullname: 小松 知子 – sequence: 2 fullname: 久保田 智彦 – sequence: 3 fullname: 朝比奈 義明 – sequence: 4 fullname: 天野 郁子 – sequence: 5 fullname: 井東 竜彦 – sequence: 6 fullname: 江面 陽子 – sequence: 7 fullname: 勝連 義之 – sequence: 8 fullname: 菊池 和子 – sequence: 9 fullname: 門田 綾 – sequence: 10 fullname: 河瀬 聡一朗 – sequence: 11 fullname: 今渡 隆成 – sequence: 12 fullname: 西連寺 央康 – sequence: 13 fullname: 高野 知子 – sequence: 14 fullname: 高満 幸宜 – sequence: 15 fullname: 立浪 康晴 – sequence: 16 fullname: 中神 正博 – sequence: 17 fullname: 緒方 克也 – sequence: 18 fullname: 平塚 正雄 – sequence: 19 fullname: 宋 文群 |
| Author_xml | – sequence: 1 fullname: EZURA, Yoko organization: Medical Corporation Ezura Clinic Ezura Dental Clinic – sequence: 1 fullname: OGATA, Katsuya organization: Social Welfare Corporation, Breath to Tomorrow – sequence: 1 fullname: KONDO, Takanari organization: Hinode Makomanai Dental Hospital – sequence: 1 fullname: NAKAGAMI, Masahiro organization: Kakogawa Dental Health Center – sequence: 1 fullname: SONG, Wenqun organization: Department of Preventive Dentistry and Dental Public Health, Kanagawa Dental University – sequence: 1 fullname: KOMATSU, Tomoko organization: Department of Dentistry for the Special Patient, Kanagawa Dental University – sequence: 1 fullname: KADOTA, Aya organization: Kochi Dental Association Dental Health Center – sequence: 1 fullname: TAKAMANN, Kougi organization: Takamann Dental Clinic – sequence: 1 fullname: AMANO, Ikuko organization: Section of Dentistry for the Disabled, Department of Growth and Development, Fukuoka Dental College/Oita Oral Health Center – sequence: 1 fullname: HIRATSUKA, Masao organization: Okinawa Oral Health Medical Center, Okinawa Dental Association – sequence: 1 fullname: KAWASE, Souichirou organization: Ishinomaki City Ogatsu Dental Clinic – sequence: 1 fullname: ASAHINA, Yoshiaki organization: Asahina Dental Clinic – sequence: 1 fullname: KUBOTA, Tomohiko organization: Wakakusu Ryoikuen Rehabilitation and Medical Center – sequence: 1 fullname: SAIRENJI, Nakayasu organization: Sairenji Dental Clinic/Shiga Dental Association – sequence: 1 fullname: TAKANO, Tomoko organization: Department of Dentistry for the Special Patient, Kanagawa Dental University – sequence: 1 fullname: KIKUCHI, Kazuko organization: Division of Pediatric and Special Care Dentistry, Department of Oral Health Science, School of Dentistry, Iwate Medical University – sequence: 1 fullname: KATSUREN, Yoshiyuki organization: Naha-Makabi Dental Clinic – sequence: 1 fullname: TACHINAMI, Yasuharu organization: Tachinami Dental Clinic – sequence: 1 fullname: ITOH, Tatsuhiko organization: Himawari Dental Clinic |
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| References | 6) 西条清隆.川崎市歯科医師会心身障害児(者)歯科診療の評価.障歯誌1992;13:48-57 10) 令和2年度厚生労働省委託事業.歯科医療提供体制推進等事業等一式報告書.令和3年3月.https://www.mhlw.go.jp/content/10800000/000817555.pdf(アクセス日:2023.11.19) 1) 障害者基本法の一部を改正する法律案新旧対照表.https://www8.cao.go.jp/shougai/suishin/kihonhou/pdf/shinkyu.pdf(アクセス日:2023.11.19) 19) 日本歯科医学会.新歯科医療提供検討委員会.これからの歯科医療提供体制の新機軸として期待される地域支援型多機能歯科診療所(医療機関).令和5年5月30日 3) Hogarth J. Glossary of Health Care Terminology. Public Health in Europe 4. Copenhagen:Regional Office for Europe World Health Organization;1978. 7) 嘉ノ海秀昭,杉岡伸悟,大村 舞,他.口腔保健センター障害者歯科協力医制度に関する諸因子の検討.障歯誌2009;30:91-5 13) 総務省統計局.日本の統計2023.第2章 人口・世帯.2-2都道府県別人口と人口増減率.https://www.stat.go.jp/data/nihon/pdf/23nihon.pdf(アクセス日:2024.1.8) 12) 弘中祥司.障害者等への歯科保健医療サービスの提供状況の把握及びその提供体制構築のための調査研究.https://mhlw-grants.niph.go.jp/system/files/report_pdf(アクセス日:2023.12.2) 16) 緒方克也,俣野哲成,新崎祐一,他.わが国の歯科医師会口腔保健センターにおける障害者への歯科サービスの実態.障歯誌1999;20:255-67 9) 野島靖子,森 貴幸,大前(薬師寺)紀子,他.地方の口腔保健センターにおける近年の初診患者に関する実態調査―2005年報告と比較して―.障歯誌2019;40:59-66 14) 池田正一.障害者歯科医療に連携医療を!―身近なところで受けられる歯科医療を:神奈川県の対応から―.障歯誌2018;39:81-8 22) 令和5年版障害者白書全文(PDF版).https://www8.cao.go.jp/shougai/whitepaper/r05hakusho/zenbun/pdf/ref.pdf(アクセス日:2024.1.8) 4) 日本歯科医師会.心身障害者歯科医療対策について(日本歯科医師会心身障害者対策臨時委員会答申書).1978.19 21) 厚生労働省社会・援護局障害保健福祉部障害福祉課障害児・発達障害者支援室.医療的ケア児等の支援に係る施策の動向.第17回医療計画の見直し等に関する検討会.令和2年1月15日.https://www.mhlw.go.jp/content/10800000/000584473.pdf(アクセス日:2024.1.8) 5) 野本たかと,白橋知幸,原田 昇,他.某歯科医師会附属歯科診療所の障害者歯科診療システムおよび患者動態:開設30年を経過して.障歯誌2012;33:206-12 8) 日本歯科医師会日本歯科総合研究機構.口腔(歯科)保健センター等業務内容調査報告書(速報版).平成29(2007)年10月1日現在.平成30(2008)年3月 11) 歯科医療提供体制等に関する検討会中間とりまとめ(案).第8回歯科医療提供体制等に関する検討会.https://www.mhlw.go.jp/content/10804000/001102337.pdf(アクセス日:2023.12.2) 2) 恒石美登里,石井拓男.口腔(歯科)保健センター等の業務内容等についての変化(H21およびH24年調査).口腔衛生会誌2014;64:163 17) 日本歯科医師会.2040年を見据えた歯科ビジョン―令和における歯科医療の姿―.令和2年10月.54,71 15) 大東道治,五十嵐清治,小椋 正,他.障害児(者)歯科診療の実態調査.小児歯誌1998;36:453-66 18) 島田路征,青柳真紀子,竹田まゆ.自閉症児に対する歯科的対応.歯学2008;95:125-31 20) 嚥下障害診療ガイドライン作成委員会.嚥下障害診療ガイドライン2018年版.日本耳鼻咽喉科学会編.東京:金原出版;2018.9-60 |
| References_xml | – reference: 19) 日本歯科医学会.新歯科医療提供検討委員会.これからの歯科医療提供体制の新機軸として期待される地域支援型多機能歯科診療所(医療機関).令和5年5月30日. – reference: 15) 大東道治,五十嵐清治,小椋 正,他.障害児(者)歯科診療の実態調査.小児歯誌1998;36:453-66. – reference: 22) 令和5年版障害者白書全文(PDF版).https://www8.cao.go.jp/shougai/whitepaper/r05hakusho/zenbun/pdf/ref.pdf(アクセス日:2024.1.8) – reference: 11) 歯科医療提供体制等に関する検討会中間とりまとめ(案).第8回歯科医療提供体制等に関する検討会.https://www.mhlw.go.jp/content/10804000/001102337.pdf(アクセス日:2023.12.2) – reference: 1) 障害者基本法の一部を改正する法律案新旧対照表.https://www8.cao.go.jp/shougai/suishin/kihonhou/pdf/shinkyu.pdf(アクセス日:2023.11.19) – reference: 2) 恒石美登里,石井拓男.口腔(歯科)保健センター等の業務内容等についての変化(H21およびH24年調査).口腔衛生会誌2014;64:163. – reference: 5) 野本たかと,白橋知幸,原田 昇,他.某歯科医師会附属歯科診療所の障害者歯科診療システムおよび患者動態:開設30年を経過して.障歯誌2012;33:206-12. – reference: 13) 総務省統計局.日本の統計2023.第2章 人口・世帯.2-2都道府県別人口と人口増減率.https://www.stat.go.jp/data/nihon/pdf/23nihon.pdf(アクセス日:2024.1.8) – reference: 20) 嚥下障害診療ガイドライン作成委員会.嚥下障害診療ガイドライン2018年版.日本耳鼻咽喉科学会編.東京:金原出版;2018.9-60. – reference: 21) 厚生労働省社会・援護局障害保健福祉部障害福祉課障害児・発達障害者支援室.医療的ケア児等の支援に係る施策の動向.第17回医療計画の見直し等に関する検討会.令和2年1月15日.https://www.mhlw.go.jp/content/10800000/000584473.pdf(アクセス日:2024.1.8) – reference: 12) 弘中祥司.障害者等への歯科保健医療サービスの提供状況の把握及びその提供体制構築のための調査研究.https://mhlw-grants.niph.go.jp/system/files/report_pdf(アクセス日:2023.12.2) – reference: 16) 緒方克也,俣野哲成,新崎祐一,他.わが国の歯科医師会口腔保健センターにおける障害者への歯科サービスの実態.障歯誌1999;20:255-67. – reference: 17) 日本歯科医師会.2040年を見据えた歯科ビジョン―令和における歯科医療の姿―.令和2年10月.54,71. – reference: 18) 島田路征,青柳真紀子,竹田まゆ.自閉症児に対する歯科的対応.歯学2008;95:125-31. – reference: 8) 日本歯科医師会日本歯科総合研究機構.口腔(歯科)保健センター等業務内容調査報告書(速報版).平成29(2007)年10月1日現在.平成30(2008)年3月. – reference: 4) 日本歯科医師会.心身障害者歯科医療対策について(日本歯科医師会心身障害者対策臨時委員会答申書).1978.19. – reference: 9) 野島靖子,森 貴幸,大前(薬師寺)紀子,他.地方の口腔保健センターにおける近年の初診患者に関する実態調査―2005年報告と比較して―.障歯誌2019;40:59-66. – reference: 14) 池田正一.障害者歯科医療に連携医療を!―身近なところで受けられる歯科医療を:神奈川県の対応から―.障歯誌2018;39:81-8. – reference: 10) 令和2年度厚生労働省委託事業.歯科医療提供体制推進等事業等一式報告書.令和3年3月.https://www.mhlw.go.jp/content/10800000/000817555.pdf(アクセス日:2023.11.19) – reference: 6) 西条清隆.川崎市歯科医師会心身障害児(者)歯科診療の評価.障歯誌1992;13:48-57. – reference: 7) 嘉ノ海秀昭,杉岡伸悟,大村 舞,他.口腔保健センター障害者歯科協力医制度に関する諸因子の検討.障歯誌2009;30:91-5. – reference: 3) Hogarth J. Glossary of Health Care Terminology. Public Health in Europe 4. Copenhagen:Regional Office for Europe World Health Organization;1978. |
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| Title | A Study on Promotion of Dental Care Provision Services for Children and Persons with Disabilities:Factual Investigation of Dental Treatment for Special Needs Patients at Oral Health Centers |
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