Joachim Krois1, Aleksander Krasowski1,2, Jesus Gomez Rossi1, Sebastian Paris3, Adelheid Kuhlmey4, Hendrik Meyer-Lückel2, Falk Schwendicke5. 1. Department of Oral Diagnostics, Digital Health and Health Services Research, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Aßmannshauser Str. 4-6, 14197, Berlin, Germany. 2. Department of Restorative, Preventive and Pediatric Dentistry, zmk Bern, University of Bern, Bern, Switzerland. 3. Department of Operative and Preventive Dentistry, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany. 4. Institute of Medical Sociology and Rehabilitation Science, Charité - Universitätsmedizin, Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany. 5. Department of Oral Diagnostics, Digital Health and Health Services Research, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Aßmannshauser Str. 4-6, 14197, Berlin, Germany. falk.schwendicke@charite.de.
Abstract
OBJECTIVES: We aimed to assess periodontal services utilization in very old Germans. METHODS: A comprehensive sample of very old (≥ 75 years), insured at a large Northeastern statutory insurer was followed over 6 years (2012-2017). We assessed periodontal service provision, entailing (1) periodontal screening index (PSI), (2) periodontal status/treatment planning, (3) periodontal therapy (scaling and root planning with or without access surgery), (4) postoperative reevaluation, and (5) any of these four services groups. Association of utilization with (1) sex, (2) age, (3) region, (4) social hardship status, (5) ICD-10 diagnoses, and (6) diagnoses-related groups was explored. RESULTS: 404.610 individuals were followed; 173,733 did not survive follow-up. The mean (SD) age was 81.9 (5.4) years. 29.4% (119,103 individuals) utilized any periodontal service, nearly all of them the PSI. Periodontal status/treatment planning, treatment provision, and reevaluation were provided to only a small fraction (1.54-1.57%, or 6224-6345) of individuals. The utilization of the PSI increased between 2012 and 2017; no such increase was observed for treatment-related services. Utilization decreased with age; those aged > 85 years received nearly no services at all. Decreases were more pronounced for treatment-related services. Utilization was lower in rural than urban areas, those with hardship status, and those severely ill (e.g., dementia, heart insufficiency). In multivariable analysis, a previous PSI measurement tripled the odds of receiving treatment-related services (OR: 3.2; 95% CI: 3.0-3.4). CONCLUSIONS: Periodontal services utilization was low. Screening for periodontal disease significantly increased therapy provision. Social, demographic, regional, and general health aspects were associated with utilization. CLINICAL SIGNIFICANCE: The utilization of periodontal services in the very old in Northeast Germany was low, and even screening was only performed in a minority of individuals. Policies to increase identification and management of periodontitis especially in the most vulnerable individuals are needed.
OBJECTIVES: We aimed to assess periodontal services utilization in very old Germans. METHODS: A comprehensive sample of very old (≥ 75 years), insured at a large Northeastern statutory insurer was followed over 6 years (2012-2017). We assessed periodontal service provision, entailing (1) periodontal screening index (PSI), (2) periodontal status/treatment planning, (3) periodontal therapy (scaling and root planning with or without access surgery), (4) postoperative reevaluation, and (5) any of these four services groups. Association of utilization with (1) sex, (2) age, (3) region, (4) social hardship status, (5) ICD-10 diagnoses, and (6) diagnoses-related groups was explored. RESULTS: 404.610 individuals were followed; 173,733 did not survive follow-up. The mean (SD) age was 81.9 (5.4) years. 29.4% (119,103 individuals) utilized any periodontal service, nearly all of them the PSI. Periodontal status/treatment planning, treatment provision, and reevaluation were provided to only a small fraction (1.54-1.57%, or 6224-6345) of individuals. The utilization of the PSI increased between 2012 and 2017; no such increase was observed for treatment-related services. Utilization decreased with age; those aged > 85 years received nearly no services at all. Decreases were more pronounced for treatment-related services. Utilization was lower in rural than urban areas, those with hardship status, and those severely ill (e.g., dementia, heart insufficiency). In multivariable analysis, a previous PSI measurement tripled the odds of receiving treatment-related services (OR: 3.2; 95% CI: 3.0-3.4). CONCLUSIONS: Periodontal services utilization was low. Screening for periodontal disease significantly increased therapy provision. Social, demographic, regional, and general health aspects were associated with utilization. CLINICAL SIGNIFICANCE: The utilization of periodontal services in the very old in Northeast Germany was low, and even screening was only performed in a minority of individuals. Policies to increase identification and management of periodontitis especially in the most vulnerable individuals are needed.
Authors: Aleksander Krasowski; Joachim Krois; Sebastian Paris; Adelheid Kuhlmey; Hendrik Meyer-Lueckel; Falk Schwendicke Journal: Int J Environ Res Public Health Date: 2021-06-21 Impact factor: 3.390