Unregistered Patients Research Articles

The development and use of a triage protocol for patients with dental problems contacting an out-of-hours general medical practitioner cooperative.

The number of patients contacting general medical practitioner (GMP) out-of-hours services with dental problems is perceived to be a significant problem by the medical profession. This study was undertaken to design and pilot a triage protocol that could be used by non-dental staff to refer callers with dental complaints for appropriate treatment. A triage protocol was designed to address the patient conditions considered to be relevant to emergency dental care. The triage protocol was piloted for three months at a GMP cooperative in North Wales, which provided an out-of-hours service for 61 GMPs. Baseline data were collected for three months prior to the introduction of the triage protocol. The study showed that the number of dental callers contacting the out-of-hours service was not as great as GMPs imagined, and was similar to other studies. The introduction of the triage protocol resulted in a rise in the number of callers asked to call the general dental practitioner (GDP) support line. The number of unregistered patients given the name of a dentist also increased. The need to make a second telephone call seemed not to affect patient satisfaction since when patients were later questioned on their experience, those who had used the service since the introduction of the triage protocol were more likely to be satisfied with the service. This study provides some evidence that a triage protocol can be used successfully by non-dental staff to sift requests for out-of-hours emergency dental care.

Socioeconomic and geographical influences on primary dental care preferences in a population of young children

To compare the socioeconomic profiles of children registered in the GDS, with those using the CDS services and unregistered children. Secondly to examine the effects of socioeconomic status on travelling to access primary dental care, and finally to map out the location of unregistered children in relation to primary dental care services. The study was carried out in 1998 in Ellesmere Port in the North West of England. The study population was all children younger than 6 years who used primary dental care services in, or were residents of, Ellesmere Port. The study population was categorized into those registered with a GDS dentist, those using CDS services and those unregistered by matching GDS and CDS data to the HA population register. Socioeconomic status was measured using the Super Profiles geodemographic classification. The relationship between service preferences and travelling to access primary dental care with socioeconomic status were compared using cross-tabulations and chi square tests. There was a significant socioeconomic trend evident in the use of dental services. Two thirds of those using CDS services came from the most deprived area types. Of those who were unregistered half lived in the most deprived area types compared with one third of those registered with the GDS. Those who travelled into Ellesmere Port to access primary dental care were significantly more likely to live in an affluent area. Unregistered patients were homogeneously spread across the town. The ability to match GDS and CDS data to the HA population register is essential to understand how dental services are used by the local population. Children from deprived areas are more likely to use the CDS and a service local to their homes, therefore primary dental care services for deprived communities have to be provided locally.

A study of primary dental care provision in young children with special reference to deprived communities

Objective To compare the socioeconomic profiles of children registered in the GDS, with those using the CDS services and unregistered children. Secondly to examine the effects of socioeconomic status on travelling to access primary dental care, and finally to map out the location of unregistered children in relation to primary dental care services. Setting The study was carried out in 1998 in Ellesmere Port in the North West of England. Subjects and materials The study population was all children younger than 6 years who used primary dental care services in, or were residents of, Ellesmere Port. The study population was categorised into those registered with a GDS dentist, those using CDS services and those unregistered by matching GDS and CDS data to the HA population register. Socioeconomic status was measured using the Super Profiles geodemographic classification. The relationship between service preferences and travelling to access primary dental care with socioeconomic status were compared using cross-tabulations and chi square tests. Results There was a significant socioeconomic trend evident in the use of dental services. Two thirds of those using CDS services came from the most deprived area types. Of those who were unregistered half lived in the most deprived area types compared with one third of those registered with the GDS. Those who travelled into Ellesmere Port to access primary dental care were significantly more likely to live in an affluent area. Unregistered patients were homogeneously spread across the town. Conclusions The ability to match GDS and CDS data to the HA population register is essential to understand how dental services are used by the local population. Children from deprived areas are more likely to use the CDS and a service local to their homes, therefore primary dental care services for deprived communities have to be provided locally.

Do we provide dental treatment out-of-hours?

Objective To describe the variety of arrangements for providing out-of-hours dental care in the UK. Design A telephone interview survey of health authorities and health boards. Setting United Kingdom. Subjects 104 health authority contacts, usually consultants in dental public health, dental advisers or others in a position to describe the local dental service arrangements. Results At weekends, 25 authorities have no formal dental care arrangements for unregistered patients, 55 have separate arrangements for registered and unregistered patients, and 44 have 'universal access' arrangements – for anyone in an area, regardless of their registration status. On weekday nights over two-thirds (82/124) of UK health authorities have no formal arrangements for unregistered patients. Where there are separate 'safety-net' services intended for unregistered patients only they are usually (in 48 of 55 authorities) emergency treatment sessions. A fifth of authorities reported planned changes to their local out-of-hours arrangements, including the introduction of telephone triage, and moves to make care available at more times, to more people or from centralised premises. Conclusions There is extremely wide geographical variation in the organisation of out-of-hours dental services provided in the United Kingdom. In many parts of the UK there are no formal out-of-hours care arrangements for unregistered patients, even at weekends. This unequal provision will mean inequitable access for many unregistered patients. With increasing demands from a growing unregistered population, and various government initiatives to make primary care services more integrated and accessible, the highly fragmented pattern of provision in many areas may no longer be acceptable.

Do we provide dental treatment out-of-hours?

Objective To describe the variety of arrangements for providing out-of-hours dental care in the UK. Design A telephone interview survey of health authorities and health boards. Setting United Kingdom. Subjects 104 health authority contacts, usually consultants in dental public health, dental advisers or others in a position to describe the local dental service arrangements. Results At weekends, 25 authorities have no formal dental care arrangements for unregistered patients, 55 have separate arrangements for registered and unregistered patients, and 44 have 'universal access' arrangements – for anyone in an area, regardless of their registration status. On weekday nights over two-thirds (82/124) of UK health authorities have no formal arrangements for unregistered patients. Where there are separate 'safety-net' services intended for unregistered patients only they are usually (in 48 of 55 authorities) emergency treatment sessions. A fifth of authorities reported planned changes to their local out-of-hours arrangements, including the introduction of telephone triage, and moves to make care available at more times, to more people or from centralised premises. Conclusions There is extremely wide geographical variation in the organisation of out-of-hours dental services provided in the United Kingdom. In many parts of the UK there are no formal out-of-hours care arrangements for unregistered patients, even at weekends. This unequal provision will mean inequitable access for many unregistered patients. With increasing demands from a growing unregistered population, and various government initiatives to make primary care services more integrated and accessible, the highly fragmented pattern of provision in many areas may no longer be acceptable.

Out-of-hours dental services: a survey of current provision in the United Kingdom.

To describe the variety of arrangements for providing out-of-hours dental care in the UK. A telephone interview survey of health authorities and health boards. United Kingdom. 104 health authority contacts, usually consultants in dental public health, dental advisers or others in a position to describe the local dental service arrangements. At weekends, 25 authorities have no formal dental care arrangements for unregistered patients, 55 have separate arrangements for registered and unregistered patients, and 44 have 'universal access' arrangements--for anyone in an area, regardless of their registration status. On weekday nights over two-thirds (82/124) of UK health authorities have no formal arrangements for unregistered patients. Where there are separate 'safety-net' services intended for unregistered patients only they are usually (in 48 of 55 authorities) emergency treatment sessions. A fifth of authorities reported planned changes to their local out-of-hours arrangements, including the introduction of telephone triage, and moves to make care available at more times, to more people or from centralised premises. There is extremely wide geographical variation in the organisation of out-of-hours dental services provided in the United Kingdom. In many parts of the UK there are no formal out-of-hours care arrangements for unregistered patients, even at weekends. This unequal provision will mean inequitable access for many unregistered patients. With increasing demands from a growing unregistered population, and various government initiatives to make primary care services more integrated and accessible, the highly fragmented pattern of provision in many areas may no longer be acceptable.

Completeness of cancer registration: a new method for routine use.

We report a new method of estimating the completeness of cancer registration, in which the proportions of unregistered patients are derived from the time distributions of three probabilities, each of which can be directly estimated from the registry's own data – the probabilities of survival, of registration of the cancer during the patient's life, and of the mention of cancer on the death certificate of a cancer patient who dies. This method allows completeness to be assessed routinely by factors such as age, sex, geographical area and tumour type. © 2000 Cancer Research Campaign

Limitations of the death certificate only index as a measure of incompleteness of cancer registration.

The death certificate only (DCO) index, which quantifies the proportion of patients for whom the death certificate provides the only notification to the registry, is a widely used measure of incompleteness of population-based cancer registration. This paper provides an algebraic assessment and a quantitative illustration of the relationship between the DCO index and incompleteness of cancer registration. It is shown that the relationship between the DCO index and incompleteness of registration is strongly dependent on the case fatality rate and the misclassification rates of cancer deaths among unregistered patients. Therefore, the DCO index is a very poor indicator of incompleteness. Similar limitations apply to the DCN index (proportion of cases first notified by death certificate), which has been proposed as an alternative measure of incompleteness.

Hepatitis B in a Prenatal Population

<h3>To the Editor.</h3> —We read with interest the article by Silverman et al¹in the November 27, 1991, issue of<i>JAMA</i>. The authors found a high rate of hepatitis B surface antigen (HBsAg) positivity (6.7%) among their unregistered prenatal population. Positivity was highly correlated with positive urine drug test results. They recommended initiating hepatitis B virus (HBV) prophylaxis to neonates born of unregistered mothers, especially those with positive drug-test results. At the University of California San Diego Medical Center, with an average of about of 4000 deliveries per year, 25% to 30% of women present with no prenatal care. Included in the battery of tests for these women are HBsAg and urine drug screening. In order to compare our population with that of Silverman et al, we reviewed similar demographic, laboratory, and clinical data from our unregistered patients for one calendar year. In 1990 there were 3981 deliveries of

Hepatitis B Prevalence in an Unregistered Prenatal Population

To evaluate the risk and associated cofactors for hepatitis B infection in inner-city pregnant women not registered for prenatal care. Fifteen-month survey of 208 patients not registered for prenatal care, compared with 1555 women registered for prenatal care during the same period. An urban university hospital prenatal clinic and labor unit. Unregistered patients had a significantly higher rate of hepatitis B surface antigen positivity than patients who had registered with the clinic (6.7% vs 0.8%; P less than .0001). Unregistered patients with positive results of urine drug screening (46%) had a relative risk for seropositivity of 29.2%, compared with registered patients who did not have histories of illicit drug use (95% confidence interval, 25.9% to 32.4%), while registered patients with past histories of drug use had a relative risk of 6.7%, compared with the reference group that did not have histories of drug use (95% confidence interval, 1.8% to 24.0%). Among inner-city pregnant women not registered for prenatal care, a positive result of urine drug screening is a rapidly available marker for increased risk of hepatitis B surface antigen positivity. Infants born to unregistered women with positive results of urine drug screening before maternal hepatitis B surface antigen results are available may warrant empiric initiation of hepatitis B virus-specific prophylaxis.

A review of perinatal mortality in an urban situation in a developing country.

Perinatal deaths occurring within the City of Harare, Zimbabwe, during 1983 were studied. Data were collected from all known deliveries within the city. This included exact numbers from three central maternity hospitals, and from referring midwife-run maternity clinics. An estimate was made of the number of births and perinatal deaths occurring within the city, but outside these official maternity facilities. All perinatal deaths were reviewed. The birthweight, the cause of death, and the antenatal care registration status of the mother were established. There were 2103 perinatal deaths from an estimated 53,665 total births. Deliveries include 50,138 (93.4%) in hospitals or clinics, 972 (1.8%) before arrival to the maternity service, and an estimated 2555 (4.8%) outside the city maternity services. One thousand seven hundred and fourteen (81.5%) perinatal deaths occurred in hospital or clinic delivered babies, and 134 (6.4%) from babies delivered before arrival at medical services. An estimated 255 (12.1%) of deaths occurred elsewhere. A total of 6380 (12%) patients did not register for antenatal care. There were 909 (43.2%) perinatal deaths in this unregistered group of patients. The overall perinatal mortality rate (PNMR) for infants weighing 500 g or more was 39.2/1000. For registered patients the PNMR was 25.3/1000 and for unregistered patients, 142.5/1000. For infants weighing 1000 grams or more the PNMR was 31.6/1000. The causes of death in the 2103 perinatal deaths were established and classified by clinical cause and by a simple pathological grouping with breakdown by birthweight.(ABSTRACT TRUNCATED AT 250 WORDS)

Patients perceived as having psychosocial problems in a general hospital emergency room: A study of registered and unregistered patients.

Patients perceived as having psychosocial problems in a general hospital emergency room: A study of registered and unregistered patients.

Urinary beta-2-microglobulin does not serve as diagnostic tool for Minamata disease.

"Minamata disease" (methylmercury poisoning), originally found in Minamata, Japan 3 decades ago, still poses a medico-socio-legal problem mostly resulting from difficulty in drawing diagnostic demarcation. To examine the efficacy of urinary beta-2-microglobulin (BMG) in identifying patients with Minamata disease, the authors studied 115 patients (63 males and 52 females) who were officially registered for compensation (registered patients); 114 patients (54 males, 60 females) currently undergoing medical evaluations for compensation (unregistered patients); and 82 control subjects (40 males, 42 females) matched for sex and age. There was no significant difference with regard to urinary BMG (corrected by creatinine) among the above three groups, although there was a parallel increase in urinary BMG and neurological scores of male patients which suggested the presence of a dose-effect relationship. Although renal tubular dysfunction manifesting hyper-beta-2-microglobulinuria has been reported in patients with Minamata disease, our findings indicate that excessive excretion of BMG is not a satisfactory diagnostic parameter for Minamata disease.

Adolescent pregnancy: The Jackson, Mississippi, experience

An adolescent pregnancy center combining the educational, medical, and social needs was operational in Jackson, Mississippi, from September, 1971, to July, 1976. Administrative responsibilities were shared by the University of Mississippi and the Jackson Separate School District. From 1971 to 1975, 763 students were enrolled. The mean age was 16 and ages ranged from 11 to 18 years. Ninety-nine per cent were black and a majority were poor and from a single-parent home. There was a 78 per cent school retention rate, but the center did not reduce dependence upon welfare assistance. When center, noncenter, faculty, and unregistered patients were compared, no difference could be detected in the incidence of medical complications, low birth weight, hypertension, and hematocrit. When compared for age only hypertension and difficult deliveries appeared to be age related.

Perinatal mortality in the North Carolina Memorial Hospital, 1952-1958.

An audit of perinatal deaths (from birth through the 28th day) was made by reviewing the mother's and infant's charts and the autopsy records for a series of 2,728 deliveries in a university hospital. During the period of the study, the perinatal mortality was reduced from 38.67 to 23.39 deaths per 1,000 births for infants weighing 1,000 Gm. or more. This was partly explained by a progressive decrease in the proportion of indigent patients during the period of study, for striking contrasts were found between the causes of death reported for private patients and those for unregistered patients. Possible errors in obstetric and pediatric management were sought for. The most frequent errors in obstetrics leading to perinatal deaths related to the management of fetal distress and of toxemia of pregnancy. The major problems of the neonatal period, as judged from autopsy findings or clinical diagnoses in 63 cases of neonatal death, were prematurity (26 cases), birth injury (13 cases), and infection (9 cases).