PRIVACY AND CONFIDENTIALITY OF DENTAL RECORDS IN DENTAL PRACTICES

Pravo na privatnost i povjerljivost neki su od važnijih elemenata na kojima se temelji odnos pacijenta i liječnika. Cilj istraživanja je bio ispitati informiranost i stavove doktora dentalne medicine o pacijentovim pravima na privatnost i povjerljivost te primjenu istih u svakodnevnoj praksi. U istraživanju je sudjelovalo 600 nasumično izabranih ispitanika, što je prema podacima iz registra Hrvatske komore dentalne medicine 15% ukupnog broja doktora dentalne medicine. Ispitanici su ispunili upitnik koji se sastojao od tri dijela: 1. demografske i radne varijable, samoprocjena vlastite informiranosti o profesionalnoj povjerljivosti i privatnosti 2. upitnik o informiranosti o pravima pacijenta na privatnost i povjerljivost 3. upitnik o stavovima i praktičnoj primjeni profesionalne privatnosti i povjerljivosti u svakodnevnoj praksi doktora dentalne medicine. Utvrđeno je da doktorice dentalne medicine češće od svojih muških kolega komentiraju pacijente pred drugim doktorima koji ne sudjeluju u njihovom liječenju, da neovlaštene osobe češće čuju razgovor liječnika s pacijentom u slučajevima kada su doktori dentalne medicine zaposlenici u prostoru javne zdravstvene ustanove nego kada su vlasnici prakse te rade u privatnim prostorima i da doktori dentalne medicine koji obavljaju svoju profesionalnu djelatnost u prostorima javnih zdravstvenih ustanova češće od ostalih kolega neadekvatno pohranjuju pacijentovu medicinsku dokumentaciju. Istraživanjem je dokazano da su doktori dentalne medicine nedovoljno informirani o pacijentovim pravima na privatnost i povjerljivost te da u svakodnevnoj praksi ne poštuju etičke norme i pozitivne zakonske propise Republike Hrvatske koji to reguliraju. Nužna je dodatna edukacija studenata i doktora dentalne medicine o pravima pacijenata na privatnost i povjerljivost.INTRODUCTION: The right to privacy and the right to confidentiality are elements of great importance which make the core of ethics in biomedicine. These principles also determine the basis for patient-physician relationship, which is crucial for the delivery of high-quality health care in the diagnosis and treatment of patients. Since ancient times, many nations in their cultures have always had medical codes that defined and described doctors’ duties and patients' rights, including the right to privacy and the right to confidentiality. Medicine recognized these rights and they became a part of various medical codes, declarations and resolutions, but their importance was also realized by the law in many societies. Different countries of the world incorporated the patients’ rights in their law and made them a part of the legal regulations. AIMS OF THE RESEARCH: Most countries in the world, including Croatia, regulate patients' rights by different laws and medical codes. However, in everyday practice dentists sometimes don't respect their legal obligations and deny the patients their rights. According to the literature, there is no relevant scientific data that describes dentists' knowledge, attitudes, and awareness of patients' privacy and confidentiality in the Republic of Croatia. The aim of this study was to explore the dentists' knowledge, attitudes, and awareness of the patients' privacy and confidentiality in Croatia. PATIENTS AND METHODS: The research protocol has been submitted for a review to the Ethics in Research Committee of the School of Dental Medicine, University of Zagreb, and the study has been approved. The aim of this study was to assess the dentists' knowledge, attitudes, and awareness about professional confidentiality and privacy. In our survey we included 600 dentists, who according to data from the registry of the Croatian Chamber of Dentists, make 15% of the total number of dentists. Our respondents filled out a questionnaire containing queries related to the dental laws and codes of the dental ethics. The questionnaire was consisted of two parts. In the first part dentist answered ten multiple-choice questions regarding their knowledge about the professional privacy and confidentiality, while in the second part we asked them about their attitudes toward the patients’ rights to privacy and confidentiality. RESULTS: The age of the interviewees ranged from twenty-seven to sixty-six years (mean=44 years). 43,.5% (n=261) of them were male and 56,5 percent (n=339) were female. The interviewees had between one and thirty-nine years of clinical experience (mean=17 years) in the dental practice. Most of the respondents were concessionaires in the network of the public health service who had a contract with the Croatian Institute for Health Insurance (HZZO). 61% of the interviewees own their own practice, while 39% worked as employees. Majority of dentists (91,5%) were general doctors of dental medicine. There was no difference in sex, age, duration of active service, type of practice, employment status and type of work. Prior to completing the questionnaire the interviewees rated their awareness of the privacy and confidentiality. The self-rated awareness score and the summary of information were not significantly correlated. Overall, the correct answer was given by the majority of interviewees for only four statements: the first one which determines the patients’ right, the second one which describes the patient’s right to privacy, the seventh one which determines the legal obligation of revealing dental records and the ninth one which determines classification of violation of professional secrecy. On average, the interviewees answered four questions correctly (interquartile range=3-5), and the number of correct answers among the interviewees ranged from 0 to 9. There was no difference in knowledge among the interviewees with regard to sex, employment status, or type of practice. indicating that the dentists were inaccurate in assessing the degree of their awareness of the patients’ rights to privacy and confidentiality. The interviewees answered to questions about their attitudes toward the patients’ rights to privacy and confidentiality on a five-point answer scale (0=never, 1=almost never, 2=sometimes, 3=often, 4=almost always), which were mostly distributed in the range of 0-2. Dentists frequently breached patients’ confidentiality by commenting their patients to other colleagues, as the dental records were rarely inadequately stored so that unauthorized persons could have an easy access to them. CONCLUSION: To summarize, our results showed insufficient knowledge, lack of awareness, and poor attitudes of dentists toward the patients’ privacy and confidentiality in Croatia. We conclude that Croatian dentists need better informing about their obligations and patients’ rights. We believe that better education can undoubtedly improve these results. Furthermore, both dental students and dentists should be provided with classes as well as with postgraduate continuing education courses where their ethical and legal obligations would be thought and thoroughly explained

PRIVACY AND CONFIDENTIALITY OF DENTAL RECORDS IN DENTAL PRACTICES

Pravo na privatnost i povjerljivost neki su od važnijih elemenata na kojima se temelji odnos pacijenta i liječnika. Cilj istraživanja je bio ispitati informiranost i stavove doktora dentalne medicine o pacijentovim pravima na privatnost i povjerljivost te primjenu istih u svakodnevnoj praksi. U istraživanju je sudjelovalo 600 nasumično izabranih ispitanika, što je prema podacima iz registra Hrvatske komore dentalne medicine 15% ukupnog broja doktora dentalne medicine. Ispitanici su ispunili upitnik koji se sastojao od tri dijela: 1. demografske i radne varijable, samoprocjena vlastite informiranosti o profesionalnoj povjerljivosti i privatnosti 2. upitnik o informiranosti o pravima pacijenta na privatnost i povjerljivost 3. upitnik o stavovima i praktičnoj primjeni profesionalne privatnosti i povjerljivosti u svakodnevnoj praksi doktora dentalne medicine. Utvrđeno je da doktorice dentalne medicine češće od svojih muških kolega komentiraju pacijente pred drugim doktorima koji ne sudjeluju u njihovom liječenju, da neovlaštene osobe češće čuju razgovor liječnika s pacijentom u slučajevima kada su doktori dentalne medicine zaposlenici u prostoru javne zdravstvene ustanove nego kada su vlasnici prakse te rade u privatnim prostorima i da doktori dentalne medicine koji obavljaju svoju profesionalnu djelatnost u prostorima javnih zdravstvenih ustanova češće od ostalih kolega neadekvatno pohranjuju pacijentovu medicinsku dokumentaciju. Istraživanjem je dokazano da su doktori dentalne medicine nedovoljno informirani o pacijentovim pravima na privatnost i povjerljivost te da u svakodnevnoj praksi ne poštuju etičke norme i pozitivne zakonske propise Republike Hrvatske koji to reguliraju. Nužna je dodatna edukacija studenata i doktora dentalne medicine o pravima pacijenata na privatnost i povjerljivost.INTRODUCTION: The right to privacy and the right to confidentiality are elements of great importance which make the core of ethics in biomedicine. These principles also determine the basis for patient-physician relationship, which is crucial for the delivery of high-quality health care in the diagnosis and treatment of patients. Since ancient times, many nations in their cultures have always had medical codes that defined and described doctors’ duties and patients' rights, including the right to privacy and the right to confidentiality. Medicine recognized these rights and they became a part of various medical codes, declarations and resolutions, but their importance was also realized by the law in many societies. Different countries of the world incorporated the patients’ rights in their law and made them a part of the legal regulations. AIMS OF THE RESEARCH: Most countries in the world, including Croatia, regulate patients' rights by different laws and medical codes. However, in everyday practice dentists sometimes don't respect their legal obligations and deny the patients their rights. According to the literature, there is no relevant scientific data that describes dentists' knowledge, attitudes, and awareness of patients' privacy and confidentiality in the Republic of Croatia. The aim of this study was to explore the dentists' knowledge, attitudes, and awareness of the patients' privacy and confidentiality in Croatia. PATIENTS AND METHODS: The research protocol has been submitted for a review to the Ethics in Research Committee of the School of Dental Medicine, University of Zagreb, and the study has been approved. The aim of this study was to assess the dentists' knowledge, attitudes, and awareness about professional confidentiality and privacy. In our survey we included 600 dentists, who according to data from the registry of the Croatian Chamber of Dentists, make 15% of the total number of dentists. Our respondents filled out a questionnaire containing queries related to the dental laws and codes of the dental ethics. The questionnaire was consisted of two parts. In the first part dentist answered ten multiple-choice questions regarding their knowledge about the professional privacy and confidentiality, while in the second part we asked them about their attitudes toward the patients’ rights to privacy and confidentiality. RESULTS: The age of the interviewees ranged from twenty-seven to sixty-six years (mean=44 years). 43,.5% (n=261) of them were male and 56,5 percent (n=339) were female. The interviewees had between one and thirty-nine years of clinical experience (mean=17 years) in the dental practice. Most of the respondents were concessionaires in the network of the public health service who had a contract with the Croatian Institute for Health Insurance (HZZO). 61% of the interviewees own their own practice, while 39% worked as employees. Majority of dentists (91,5%) were general doctors of dental medicine. There was no difference in sex, age, duration of active service, type of practice, employment status and type of work. Prior to completing the questionnaire the interviewees rated their awareness of the privacy and confidentiality. The self-rated awareness score and the summary of information were not significantly correlated. Overall, the correct answer was given by the majority of interviewees for only four statements: the first one which determines the patients’ right, the second one which describes the patient’s right to privacy, the seventh one which determines the legal obligation of revealing dental records and the ninth one which determines classification of violation of professional secrecy. On average, the interviewees answered four questions correctly (interquartile range=3-5), and the number of correct answers among the interviewees ranged from 0 to 9. There was no difference in knowledge among the interviewees with regard to sex, employment status, or type of practice. indicating that the dentists were inaccurate in assessing the degree of their awareness of the patients’ rights to privacy and confidentiality. The interviewees answered to questions about their attitudes toward the patients’ rights to privacy and confidentiality on a five-point answer scale (0=never, 1=almost never, 2=sometimes, 3=often, 4=almost always), which were mostly distributed in the range of 0-2. Dentists frequently breached patients’ confidentiality by commenting their patients to other colleagues, as the dental records were rarely inadequately stored so that unauthorized persons could have an easy access to them. CONCLUSION: To summarize, our results showed insufficient knowledge, lack of awareness, and poor attitudes of dentists toward the patients’ privacy and confidentiality in Croatia. We conclude that Croatian dentists need better informing about their obligations and patients’ rights. We believe that better education can undoubtedly improve these results. Furthermore, both dental students and dentists should be provided with classes as well as with postgraduate continuing education courses where their ethical and legal obligations would be thought and thoroughly explained

Oral lichen planus - retrospective study of 563 Croatian patients

Objectives: To investigate the epidemiological and clinical characteristics of oral lichen planus (OLP) in a group of Croatian patients seen between 2006 and 2012. Study D esign: A group of 563 patients with a diagnosis of OLP was retrospectively reviewed in our clinic. Data regarding age, gender, medical history, drugs, smoking, alcohol, chief complaint, clinical type, localization, his - tology, treatment and malignant transformation were registered. Results: Of the 563 patients, 414 were females and 149 were males. The average age at the diagnosis was 58 (range 11-94). The most common site was buccal mucosa (82.4%). Most of our patients did not smoke (72.5%) or consume alcohol (69.6%). Patients reported oral soreness (43.3%), mucosal roughness (7%), xerostomia (3%), gingival bleeding (2%) and altered taste (0.5%) as the chief complaint, while almost half of them were asympto - matic (44.2%). The most common types of OLP were reticular (64.8%) and erosive (22.9%). Plaque-like (5.7%) atrophic/erythemtous (4.3%) and bullous (2.3%) type were also observed. Malignant transformation rate of 0.7% was recorded. Conclusions: OLP mostly affects non-smoking middle-aged women. Buccal mucosa is the most commonly af - fected site. In almost half of the cases patients are asymptomatic. In spite of the small risk for malignant transfor - mation all patients should be regularly monitored

Clinical Characteristics of Topical Propolis Induced Oral Lesions

Uvod: Propolis, smolasta tvar koju proizvode pčele, uporablja se u narodnoj medicini više od dvije tisuće godina. No, njegovi mnogobrojni sastojci mogu djelovati kao potencijalni antigen. Topikalna primjena može uzrokovati nuspojave u usnoj šupljini. Materijali i metode: Retrospektivnom studijom bili su obuhvaćeni pacijenti s oralnim lezijama zbog topikalne uporabe propolisa. Pritom su korišteni podaci iz medicinske dokumentacije pacijenata: izgled i lokalizacija lezija, kada su se pojavili simptomi, terapija i vrijeme cijeljenja te osnovni demografski podaci (dob, spol). Rezultati: Sudjelovalo je dvadeset dvoje pacijenata s lezijama uzrokovanima korištenjem propolisa. Najčešća klinička slika bila je erozivni stomatitis. Simptomi su se obično pojavljivali dva i pol dana nakon uporabe propolisa, iako su se neke lezije pojavile odmah. Većina pacijenata (21/22) uspješno je liječena topikalnim kortikosteroidima. Šestero je bilo podvrgnuto alergološkom testiranju – troje je bile pozitivno, a troje negativno. Zaključak: Topikalni preparati propolisa mogu prouzročiti teške oralne nuspojave. Dosadašnje spoznaje ne podupiru njegovu široku primjenu u terapiji bolesti usta.Objectives: Propolis, a resinous substance produced by bees, has been used in popular medicine for more than 2000 years. Material and methods: Numerous compounds of propolis can act as potent sensitizers. Topical application of propolis can induce oral lesions. Patients with oral lesions due to topical propolis are presented. Basic demographic (age, gender) and clinical data (appearance and localization of the lesions, symptoms onset, treatment and healing time) were recorded. Results: Twenty two patients with propolis-induced lesions were evaluated. The most common occurring presentation was erosive stomatitis. Symptoms tended to appear 2.5 days after propolis use although some lesions occurred immediately after utilization. Majority of patients (21/22) were successfully treated with topical corticosteroids. Six patients underwent patch testing, 3 patients were positive and 3 were negative. Conclusion: Topical propolis can have serious oral side effects. Current knowledge does not support its widespread use in the treatment of oral diseases