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國(guó)民醫(yī)療體系人滿為患 英國(guó)頻現(xiàn)“看牙難”

Can't get to see the dentist?

中國(guó)日?qǐng)?bào)網(wǎng) 2014-04-14 16:30

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國(guó)民醫(yī)療體系人滿為患 英國(guó)頻現(xiàn)“看牙難”
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Under new system, dentists must spend longer assessing each patient

In a bid to reduce waiting times, patients could see therapists, who have studied for three years, instead of dentists, who trained for five

Dentists would concentrate on more complex procedures

Dental therapists should stand in routinely for dentists and start drilling and filling patients’ teeth to tackle growing NHS waiting lists, the Government’s tooth tsar has said.

Patients are waiting weeks longer for an appointment at many surgeries piloting a new NHS system of check-ups, which could be rolled out across the country within two years.

The new check-ups require dentists to spend longer assessing each patient, and now Barry Cockcroft, the chief dental officer, has recommended that, to avoid delays, junior staff should take on some tasks traditionally carried out by dentists.

This could see therapists – who study for three years, compared with five years for dentists – drilling and filling adults’ teeth, and extracting children’s milk teeth. Dental nurses should also play a bigger role, doing procedures such as fluoride varnishes, he said. Speaking to The Mail on Sunday at the British Dental Conference in Manchester, Dr Cockcroft said: ‘A dentist is very highly trained and can carry out complex work such as crowns and bridges. Therapists can do extractions and fillings.’

Health Minister Earl Howe said patients needed to accept that dentists would do less work on their teeth in the future, and that nurses, hygienists and therapists would do more. He said: ‘Sometimes in GP practices you see a nurse and sometimes a GP. People are used to that.’

The pilot of the new dental system involves a traffic-light rating where patients are given a ‘green’, ‘a(chǎn)mber’ or ‘red’ notice on the condition of their teeth and gums. Patients flagged as ‘red’ can be refused advanced treatment until they have improved their oral health – by cleaning their teeth more and cutting down on sugary foods.

Dentists largely welcome the scheme, which has been running for two-and-a-half years, because it focuses on preventing problems as well as treating them. But the initial check-ups take up to half an hour per patient rather than 15 minutes, meaning that waiting times for an appointment have increased.

Dr Len D’Cruz, of Woodford Dental Care in North-East London, who has been on the pilot since 2011, said: ‘It’s halved the number of patients we can see and increased waiting times which has been frustrating for the practice and patients.’

Dentist Dr Tony Kilcoyne, from Haworth, West Yorkshire, said he had no problem with therapists doing fillings but warned the move could be a ‘false economy’ as they tended to take longer. And dentist Dr Suzanne Baker, from Dewsbury, said. ‘People are going to lose the family-dentist feel patients appreciate.’

Earl Howe said no new scheme would be rolled out before 2016.

A DoH spokesman said: ‘Our pilots are exploring how we prevent people needing treatment in the first place, but will not be a blueprint for a new system.’

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據(jù)《每日郵報(bào)》4月13日?qǐng)?bào)道,在新醫(yī)療制度下,牙醫(yī)必須花更長(zhǎng)時(shí)間為每個(gè)患者診斷。

為了縮減等待時(shí)間,患者可以向理療師就診,他們畢業(yè)時(shí)間為3年,而牙醫(yī)則是5年,牙醫(yī)將專注于更復(fù)雜的病例。

政府的“牙齒沙皇” (tooth tsar)說(shuō),牙科理療師應(yīng)該接替牙醫(yī),開(kāi)始進(jìn)行患者牙齒修補(bǔ)工作,從而滿足日益增長(zhǎng)的英國(guó)國(guó)民保健服務(wù)(NHS)的等待名單。

新NHS診斷系統(tǒng)正在試行并可能在兩年內(nèi)正式推行。在新系統(tǒng)下,患者需要多等待數(shù)周才能通過(guò)預(yù)約。

新的檢查系統(tǒng)要求牙醫(yī)花費(fèi)更長(zhǎng)時(shí)間來(lái)診斷每位患者,而現(xiàn)任首席牙科官員巴里·科克羅夫特曾提醒,為免耽誤醫(yī)療,初級(jí)人員應(yīng)當(dāng)代替牙醫(yī)處理一些傳統(tǒng)項(xiàng)目。

對(duì)于這種情況,理療師——相比牙醫(yī)學(xué)習(xí)5年,他們畢業(yè)只需要3年時(shí)間——可以修補(bǔ)成人的牙齒以及拔出兒童的乳牙。牙科護(hù)士應(yīng)當(dāng)擔(dān)任更重要的角色,例如進(jìn)行涂氟防齲理療,他說(shuō)。在周日曼徹斯特舉行的英國(guó)牙科會(huì)議上,科克羅夫特對(duì)每日郵報(bào)說(shuō):“一名牙醫(yī)經(jīng)歷過(guò)非常高端的培訓(xùn),可以完成諸如鑲牙冠或搭橋等復(fù)雜任務(wù)。理療師可以進(jìn)行拔牙和補(bǔ)牙?!?/p>

衛(wèi)生部長(zhǎng)厄爾·豪說(shuō),患者需要接受,未來(lái)牙醫(yī)對(duì)他們牙齒的治療將會(huì)減少,而護(hù)士、保健師和理療師的工作會(huì)增加。他說(shuō):“有時(shí)候,你在普通診所會(huì)見(jiàn)到護(hù)士和全科醫(yī)生已經(jīng)這樣做了?!?/p>

試行新牙科系統(tǒng),涉及到一個(gè)“紅綠燈等級(jí)”,即根據(jù)病人牙齒和牙齦的情況,會(huì)分成“綠色”、“黃色”或“紅色”警示。標(biāo)記為“紅色”的病人可能會(huì)拒絕進(jìn)行進(jìn)一步治療,直到他們改善其口腔健康——通過(guò)多清潔牙齒和少吃糖果類食物。

很大程度上,這個(gè)已經(jīng)推行了兩年半的計(jì)劃受到牙醫(yī)歡迎,因?yàn)樵撚?jì)劃在治療牙齒疾病的同時(shí),也專注于預(yù)防牙齒問(wèn)題。但初期檢查每位病人要花費(fèi)大約半個(gè)小時(shí),而不是以前的15分鐘,這意味著等待預(yù)約的時(shí)間提高。

在倫敦東北部的伍德福德牙科護(hù)理中心工作的倫恩·D·科魯茲從2011年開(kāi)始已經(jīng)試行該計(jì)劃,他說(shuō):“這計(jì)劃讓我們可以診斷的病人數(shù)量減半,而更長(zhǎng)的等待時(shí)間使得診所和患者都感到沮喪?!?/p>

來(lái)自西約克郡霍爾斯的牙醫(yī)托尼·基爾科因博士稱他對(duì)于理療師補(bǔ)牙沒(méi)有問(wèn)題,但提醒這個(gè)改變可能是“錯(cuò)誤的經(jīng)濟(jì)決定”,因?yàn)樗麄円ǜL(zhǎng)時(shí)間。來(lái)自迪尤斯伯里的牙科博士蘇珊娜·貝克則稱:“以前患者喜愛(ài)的家庭牙醫(yī)的感覺(jué)將會(huì)失去了。”

厄爾·豪說(shuō)在2016年之前不會(huì)有新的計(jì)劃再推行。

一名衛(wèi)生部發(fā)言人說(shuō):“我們?cè)囆械挠?jì)劃為的是找出我們?nèi)绾文軌蛟谠搭^預(yù)防人們的疾病,但這不會(huì)成為新系統(tǒng)的藍(lán)本。”

(譯者 imnapple 編輯 齊磊)

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國(guó)民醫(yī)療體系人滿為患 英國(guó)頻現(xiàn)“看牙難” 國(guó)民醫(yī)療體系人滿為患 英國(guó)頻現(xiàn)“看牙難”

 

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