Dental Satisfaction Survey at an Expeditionary Dental Clinic in Support of Operations Enduring Freedom and Iraqi Freedom

Military Medicine, Oct 2004 by Dunn, William J, Langsten, Robert E

This study used a survey to gather information about soldiers' perceptions of the quality of dental treatment delivered at a deployed clinic. An ordinal scale of 1 through 5 scored access, dental facility and equipment, pain control, technical skill, and interpersonal skills of the provider. Four additional items identified whether the respondent was new to military or deployment dentistry, was in pain before arriving at the clinic, or had any concerns about being treated at a deployed dental clinic. Percentages for each type of response were recorded. Data were further analyzed by the Mann-Whitney U test to investigate the relationship between respondent variables and how they rated the attributes of quality. Deployed service members reported a high degree of satisfaction with the quality of care they received. Ninety-seven percent of respondents believed that the care they received was as good as the care they would have received at their regular stateside military dental facility.

Introduction

Dental readiness is an important component in the nation's military readiness posture and can play a vital role in the successful mobilization of our deployed forces. It has been demonstrated that dental emergencies can significantly affect the mission of a deployed unit.1 Dental emergency rates for field exercises and various military conflicts have been previously reported in the literature.2-11 In Bosnia, these rates ranged from 156 to 170 dental emergencies per 1,000 soldiers per year.3,5 In addition, these studies investigated the distribution of causes of dental emergencies. The expected number and different types of dental emergencies are used in determining the package size of the deploying dental team.

To deploy units more efficiently and rapidly, the Air Force developed a new concept of force organization known as the Expeditionary Air Force. In August 1998, the Air Force Chief of Staff directed the transition to an Expeditionary Air Force.12 Under this concept, the Air Force was divided into several Air Expeditionary Forces, each with similar capabilities. Deployment responsibilities were more equitably rotated among the different Air Expeditionary Forces. The expeditionary concept embodied in the Air Force medical services is known as Expeditionary Medical Support (EMEDS).

Deployed expeditionary medical units are lighter, leaner, and more readily deployable than the former Air Transportable Hospitals. Expeditionary forces leave a smaller footprint and are self-sustaining. Very little is known about how deployed soldiers perceive the quality and capability of these expeditionary hospitals to deliver care. Chisick13,14 performed dental satisfaction studies of active duty military personnel and demonstrated that the satisfaction level with military dentistry is high. However, these studies were performed at full-service Continental United States dental facilities and did not address the satisfaction of soldiers receiving care at a deployed location. It is possible that some soldiers may avoid necessary dental treatment at a deployed location because they may perceive the facility as being an inferior substitute to a full-service dental clinic stateside. Although much of the equipment at an expeditionary clinic is mobile, the capability of the clinic to provide modern, comfortable care is not questioned by the senior medical and dental leadership. However, patients may have a strong opinion about being treated in a mobile dental chair and unit powered by a noisy generator. Their confidence in mobilized equipment and the technology of mobile field units may not be high. The purpose of this investigation was to study soldiers' perceptions of a dental treatment facility at a deployed location in the Middle East in support of Operations Enduring Freedom and Iraqi Freedom.

Methods

The current study used a survey instrument to gather information about soldiers' perceptions of an expeditionary dental clinic at a deployed location in the Middle East. The survey did not contain any personal information or identifiers that could link the survey to any individual; therefore, it was not possible to trace the surveys back to any person. The key components of the survey were patterned after Chisick's studies in 199413 and 199814, the only two published military dental satisfaction surveys. Chisick designed his studies to address Kress and Silversin's15 six components for measuring the quality of dental care: access, availability, cost, pain control, technical skill, and interpersonal skills of the provider and/or staff. As in the two previous military dental satisfaction studies, all of these areas were investigated in the current study except for cost, which is not usually considered a determinant of patient dental satisfaction in the military setting. After approval by the appropriate Institutional Review Board, the survey was given to the Dental Clinic Commander at the 363rd Expeditionary Medical/Dental Group, Prince Sultan Air Base, Kingdom of Saudi Arabia, for pilot testing and validity. Fifty-two original surveys were distributed. The original survey was two pages in length and contained 17 items for the patient to answer. Only 35 surveys were returned, and six patients commented on the excessive length of the survey. The survey was restructured to fit on one page and consisted of 10 items plus an open-ended question at the conclusion of the survey. The restructured survey still contained the key elements from previous dental satisfaction research performed by Chisick. The new survey was distributed for data collection from December 2002 to April 2003. Every patient who presented for care was offered a survey. Respondents rated their satisfaction with deployed military dental care in items 1 through 6 using a 5-point ordinal scale (1 = poor, 2 = fair, 3 = good, 4 = very good, 5 = excellent). Items 7 through 9 provided nominal data (yes or no responses) that were used to make inferences about the first six items. These items revealed whether this was the patient's first visit to a military dentist or a deployed dental clinic and whether the patient arrived at the dental clinic in pain. The final two items on the survey posed questions regarding concerns about receiving care in a deployed setting. Item 10 addressed the question of whether the patient was concerned about the quality of care that he/she would receive at a deployed location compared with that of a stateside military dental clinic. If the patient answered "yes" to item 10, the respondent was asked to briefly describe his/her concerns in item 11. The survey was distributed and collected by a disinterested third party to avoid bias. Every person who volunteered to complete the survey was asked to return the survey to the third party upon leaving the clinic; therefore, the collection rate was 100%. It was estimated that 5 months of data collection would provide between 300 and 500 responses to the survey. Data were purely descriptive, reporting percentages in each category. Data were further analyzed by the Mann-Whitney U test or χ^sup 2^/Fisher's exact test, where appropriate at α = 0.05, to investigate the relationship between the nominal responses to questions 7 through 10 and how the respondent answered questions 1 through 6.