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      Complaints about dental practitioners: an analysis of 6 years of complaints about dentists, dental prosthetists, oral health therapists, dental therapists and dental hygienists in Australia

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          Abstract

          Background

          Previous research has found dental practitioners at elevated risk of complaint compared with other health professions. This study aimed to describe the frequency, nature and risk factors for complaints involving dental practitioners.

          Methods

          We assembled a national dataset of complaints about registered health practitioners in Australia between January 2011 and December 2016. We classified complaints into 23 issues across three domains: health, performance and conduct. We compared rates of complaints about dental practitioners and other health practitioners. We used negative binomial regression analysis to identify factors associated with complaints.

          Results

          Dental practitioners made up 3.5% of health practitioners, yet accounted for approximately 10% of complaints. Dental practitioners had the highest rate of complaints among fourteen health professions (42.7 per 1000 practitioners per year) with higher rates among dentists and dental prosthetists than allied dental practitioners. Male practitioners were at a higher risk of complaints. Most complaints about dentists related to treatments and procedures (59%). Around 4% of dentists received more than one complaint, accounting for 49% of complaints about dentists. In 60% of closed cases no regulatory action was required. Around 13% of complaints resulted in restrictive actions, such as conditions on practice.

          Conclusion

          Improved understanding of patterns may assist regulatory boards and professional associations to ensure competent practice and protect patient safety.

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          Most cited references21

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          Relationship between complaints and quality of care in New Zealand: a descriptive analysis of complainants and non-complainants following adverse events.

          To estimate the proportion and characteristics of patients injured by medical care in New Zealand public hospitals who complain to an independent health ombudsman, the Health and Disability Commissioner ("the Commissioner"). The percentage of injured patients who lodge complaints was estimated by linking the Commissioner's complaints database to records reviewed in the New Zealand Quality of Healthcare Study (NZQHS). Bivariate and multivariate analyses investigated sociodemographic and socioeconomic differences between complainants and non-complainants. New Zealand public hospitals and the Office of the Commissioner in 1998. Patients who lodged claims with the Commissioner (n = 398) and patients identified by the NZQHS as having suffered an adverse event who did not lodge a complaint with the Commissioner (n = 847). Adverse events, preventable adverse events, and complaints lodged with the Commissioner. Among adverse events identified by the NZQHS, 0.4% (3/850) resulted in complaints; among serious, preventable adverse events 4% (2/48) resulted in complaints. The propensity of injured patients to complain increased steeply with the severity of the injury: odds of complaint were 11 times greater after serious permanent injuries than after temporary injuries, and 18 times greater after deaths. Odds of complaining were significantly lower for patients who were elderly (odds ratio (OR) 0.2, 95% confidence interval (CI) 0.1 to 0.4), of Pacific ethnicity (OR 0.3, 95% CI 0.1 to 0.9), or lived in the most deprived areas (OR 0.3, 95% CI 0.2 to 0.6). Most medical injuries never trigger a complaint to the Commissioner. Among complaints that are brought, severe and preventable injuries are common, offering a potentially valuable "window" on serious threats to patient safety. The relatively low propensity to complain among patients who are elderly, socioeconomically deprived, or of Pacific ethnicity suggests troubling disparities in access to and utilisation of complaints processes.
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            Prevalence and Characteristics of Physicians Prone to Malpractice Claims

            The distribution of malpractice claims among physicians is not well understood. If claim-prone physicians account for a substantial share of all claims, the ability to reliably identify them at an early stage could guide efforts to improve care.
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              The PRONE score: an algorithm for predicting doctors’ risks of formal patient complaints using routinely collected administrative data

              Background Medicolegal agencies—such as malpractice insurers, medical boards and complaints bodies—are mostly passive regulators; they react to episodes of substandard care, rather than intervening to prevent them. At least part of the explanation for this reactive role lies in the widely recognised difficulty of making robust predictions about medicolegal risk at the individual clinician level. We aimed to develop a simple, reliable scoring system for predicting Australian doctors’ risks of becoming the subject of repeated patient complaints. Methods Using routinely collected administrative data, we constructed a national sample of 13 849 formal complaints against 8424 doctors. The complaints were lodged by patients with state health service commissions in Australia over a 12-year period. We used multivariate logistic regression analysis to identify predictors of subsequent complaints, defined as another complaint occurring within 2 years of an index complaint. Model estimates were then used to derive a simple predictive algorithm, designed for application at the doctor level. Results The PRONE (Predicted Risk Of New Event) score is a 22-point scoring system that indicates a doctor's future complaint risk based on four variables: a doctor's specialty and sex, the number of previous complaints and the time since the last complaint. The PRONE score performed well in predicting subsequent complaints, exhibiting strong validity and reliability and reasonable goodness of fit (c-statistic=0.70). Conclusions The PRONE score appears to be a valid method for assessing individual doctors’ risks of attracting recurrent complaints. Regulators could harness such information to target quality improvement interventions, and prevent substandard care and patient dissatisfaction. The approach we describe should be replicable in other agencies that handle large numbers of patient complaints or malpractice claims.
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                Author and article information

                Contributors
                mbismark@unimelb.edu.au
                Journal
                Aust Dent J
                Aust Dent J
                10.1111/(ISSN)1834-7819
                ADJ
                Australian Dental Journal
                John Wiley and Sons Inc. (Hoboken )
                0045-0421
                1834-7819
                16 July 2018
                September 2018
                : 63
                : 3 ( doiID: 10.1111/adj.2018.63.issue-3 )
                : 285-293
                Affiliations
                [ 1 ] Law and Public Health Unit Melbourne School of Population and Global Health Centre for Health Policy University of Melbourne Parkville Victoria Australia
                [ 2 ] Melbourne Dental School University of Melbourne Parkville Victoria Australia
                Author notes
                [*] [* ] Address for Correspondence:

                Associate Professor Marie Bismark

                Law and Public Health Unit

                Centre for Health Policy

                Melbourne School of Population and Global Health

                University of Melbourne

                Level 4, Room 442, 207‐221 Bouverie Street

                Parkville, Vic. 3010

                Australia

                Email: mbismark@ 123456unimelb.edu.au

                Author information
                http://orcid.org/0000-0002-0941-6155
                http://orcid.org/0000-0001-7169-4087
                http://orcid.org/0000-0003-3549-9860
                http://orcid.org/0000-0001-6891-4819
                Article
                ADJ12625
                10.1111/adj.12625
                6635754
                29862517
                c3142110-8d6b-4f94-8d9c-6a7707249334
                © 2018 The Authors. Australian Dental Journal published by John Wiley & Sons Australia, Ltd on behalf of Australian Dental Association.

                This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

                History
                : 30 May 2018
                Page count
                Figures: 0, Tables: 4, Pages: 9, Words: 7096
                Funding
                Funded by: National Health and Medical Research Council
                Award ID: 1092933
                Funded by: Australian Health Practitioner Regulatory Agency
                Categories
                Scientific Article
                Scientific Articles
                Custom metadata
                2.0
                adj12625
                September 2018
                Converter:WILEY_ML3GV2_TO_NLMPMC version:5.6.5 mode:remove_FC converted:17.07.2019

                complaints,dental practitioners,dentists,disciplinary action,regulation,risk regulation

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