Article

Geographic location and indirect costs as a barrier to dental treatment: A patient perspective

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Abstract

Background: The recently published National Survey of Adult Oral Health 2004-06 indicated that tooth loss, mean decayed and number of DMF teeth were all higher outside capital city locations. In addition, dental attendance patterns were worse in terms of frequency, reason for visit, and continuity in rural and remote locations, but there was no difference by geographical location in terms of financial barriers to dental care. The objective of this research was to identify, quantify and analyse some of the non-treatment costs associated with dental treatment from the perspective of the patient and to determine whether the perceived impact of those costs may limit access to dental care. Methods: This cohort study was nested within a clinical trial. Patients had been allocated to treatment arms within clusters dependent on the randomization status of the dental practice they usually attended, classified as major city, regional or remote. A questionnaire was developed from a series of focus groups in which patients were asked to identify the domains of non-treatment costs associated with a dental visit that were important to them and to quantify those costs. Factor analysis was used to reduce these items to four core scales. These scales were assessed for reliability and validity. Regression and ANCOVA was used to explore differences in DMFS scores between the three groups and a predictive model developed to adjust for potential confounders. Results: Two core scales were identified as key drivers on the perceived impact of indirect costs associated with dental visits; travel impact and family impact. Patients living in remote locations incurred significantly higher indirect costs associated with dental treatment and higher mean DMFS scores. Conclusions: Patient perception of the impact of travel costs and impact on family life are major drivers restricting access to dental services for people living in remote locations in New South Wales. Further research using outcomes directly related to access is required to validate the claim that patients living in regional and remote locations suffer both perceived and real financial barriers to dental care.

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... 10 This is the third in a series of papers detailing a multicentred, clustered randomized trial, designed to examine the hypothesis that an intensive, preventivebased, non-invasive approach to the management of dental caries ('study group') is cost-effective when compared to standard care ('control group') in private dental practice. 11,12 The research is the first being undertaken in Australasia to establish the costs and effectiveness of a structured preventive programme designed to reduce caries increment (primary prevention) and to arrest and remineralize existing lesions not yet cavitated (secondary prevention) compared to the 'standard' care. The sample of dental practices included city, suburban and rural dental practices in fluoridated and non-fluoridated communities. ...
... The baseline DMFS was calculated from patient charts and bite-wing radiographs obtained at the recruitment appointment, and measured blind to the allocation status of the patient. Unfortunately, as previously reported, 12 the degree and accuracy of the charting was variable. In addition, we charted and graded lesions that were evident on any bite-wing radiographs taken within six months of, or at, the randomization visit. ...
Article
This paper reviews the efficacy of an intensive, preventive-based, non-invasive approach to the management of dental caries within a randomized controlled trial. The primary efficacy measure was the two-year DMFS increment. Changes in risk status, fluoride history, number of emergency visits and toothaches, along with demographic variables such as age, gender, health problems, and the location of the dental practice attended were measured. Regression analysis was undertaken to adjust for potential confounding variables. Nine hundred and two patients were recruited within 22 dental practices between May 2005 and March 2006. Baseline DMFS did not differ significantly between the control and study groups (p = 0.83). Age (p < 0.001), health status (p = 0.005), baseline risk (p < 0.001) and fluoride history (p < 0.001) were all independent significant predictors of two-year DMFS increment. Gender approached significance (p = 0.08). There were no statistically significant differences between the groups in the incidence of toothaches (p = 0.1) or number of treatment visits required (p = 0.35). There was a significant difference in the two-year incremental DMFS score in the study group compared to the control group (mean difference 2.2; p < 0.001). After adjusting for confounding variables the difference in the DMFS increment between the control and study groups remained significant (mean difference 1.7; p < 0.001). The results indicate efficacy of the preventive programme. Efficacy was independent of age, gender, medical concerns, fluoride history, or previous history of dental caries, in a population of patients attending for treatment in private dental practices, in a variety of locations, on a relatively short-term basis (two years). While encouraging, it will be essential that these results are followed over a longer period of time in order to determine whether the benefits are maintained.
... Even when considering access to care, the ease or difficulty that people face when traveling from their residence to a place where care is available has been widely discussed but not as widely researched. [1][2][3][4][5][6][7][8][9][10][11] A few reported studies document travel barriers in accessing health care. For example, Curtis et al sought to identify and quantify nontreatment costs associated with dental treatment among patients in Australia and whether the perceived impact of costs may limit access to dental care. ...
... For example, Curtis et al sought to identify and quantify nontreatment costs associated with dental treatment among patients in Australia and whether the perceived impact of costs may limit access to dental care. 3 They found that patients living in remote areas had higher indirect costs for dental care. Travel costs and its impact on the family restricted access to dental services, particularly among those living in New South Wales. ...
Article
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Patrick McNees,1,3 Karen Meneses21School of Health Professions, 2School of Nursing, University of Alabama at Birmingham, 3Kirchner Private Capital Group, Birmingham, Alabama, USAAbstract: There is a paucity of methods that examine the relative difficulty or ease of access to research. The Index of Research Access was designed to provide a quantitative index allowing a determination of the probable ease or difficulty in accessing research participation for either an individual compared to a reference group, or for a group of individuals compared to another group or reference group. The aims of this paper are to (1) describe the major factors considered in the development of the Index of Research Access, an index of research accessibility; (2) provide the rationale and formula for the Index of Research Access; (3) describe the testing and application of the Index of Research Access using a sample of 239 women participating in a longitudinal trial of psychoeducational support interventions for breast cancer survivors; and (4) consider implications of the Index of Research Access for other research endeavors.Keywords: methodology, distance barrier, travel barrier, research barrier
... Patients considered "cost" as a factor that had prevented them from accessing to dental care in the dental clinics. Curtis et al (2007) in their study examined some of the barriers to access to dental services and concluded that the indirect costs such as travel costs in remote areas had effect on access to dental care and was considered as an important barrier (53). Among Canadian adults, also, travel costs and having a low income had been considered as two access barriers (54). ...
... Patients considered "cost" as a factor that had prevented them from accessing to dental care in the dental clinics. Curtis et al (2007) in their study examined some of the barriers to access to dental services and concluded that the indirect costs such as travel costs in remote areas had effect on access to dental care and was considered as an important barrier (53). Among Canadian adults, also, travel costs and having a low income had been considered as two access barriers (54). ...
Article
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Identifying perceived access barriers to preventive dental services is one of the basic steps to improve the public health. This study aimed to determine the perceived barriers affecting access to preventive dental services in one of Tehran dental clinics in 2012. This research was a cross-sectional descriptive-analytical study conducted in one of Tehran dental clinics in 2012 using decision-making trial and evaluation laboratory (DEMATEL) method. The study sample included all patients (100 patients) who had referred to the endodontic treatment department from 26 - 31 May, 2012. The required data were collected using a questionnaire. Collected data were analyzed using SPSS 18.0 and MATLAB 7.9.0 SPSSS 18.0, as well as, some descriptive and analytical tests including Mean, Standard Deviation (SD), and Independent T- Test. The five determinants of cost, inconvenience, fear, organization, and patient-dentist relationship were determined as barriers to access to dental services among which the cost and patient-dentist relationship were identified as the first and last priorities with the coordinates (1.4 and 1.4) and (1.25 and -0.65), respectively. High cost of dental care has led to not referring patients to the clinic. Oral health costs are too high; however insurance organizations have no commitment to support such services. Policymakers, administrators, and insurance organizations have a major role in improving access to dental services. These decision-makers in making their policies can provide the required financial resources, shift the available resources towards preventive care and periodic checkups, and consider providing proper and sufficient places for dental care facilities.
... It has been shown that persons living in socially deprived communities, such as rural areas, have less access to health services and poorer health status than those from betteroff communities [2,3]. Rural populations may also experience poorer oral health and limited access to dental care [4][5][6][7]. The rate of dental attendance by people living in rural areas is lower and they are more likely to postpone dental appointments due to financial restrictions [8]. ...
... This finding was similar for interval since the last dental visit in the urban population. This suggests that the higher the financial capacity, the easier it will be to overcome barriers to access dental services [5,29]. This effect was greater among people living in rural areas. ...
Article
Full-text available
Background: The utilisation of health services is determined by complex interactions. In this context, rural populations face greater barriers in accessing dental services than do urban populations, and they generally have poorer oral health status. The evaluation of the determinants of health services utilisation is important to support planning and management of dental services. The aim of this study was to evaluate the predictors of dental services utilisation of Brazilian adults living in rural and urban areas. Methods: Data from 60,202 adults aged 18 years or older who took part in the Brazilian National Health Survey carried out in 2013 were analysed. Predisposing (age, sex, education, social networks), enabling financing (income, durable goods and household’s crowding), enabling organisation (health insurance, registration in primary health care [PHC]) and need variables (eating difficulties, self-perceived tooth loss and self-perceived oral health) were selected based upon the Andersen behavioural model. Multi-group structural equation modeling assessed the direct and indirect associations of independent variables with non-utilisation of dental services and the interval since the last dental visit for individuals living in rural and urban areas. Results: Adults living in urban areas were more likely to use dental services than those living in rural areas. Lower enabling financing, lower perceived dental needs and lack of PHC registration were directly associated with lower utilisation of dental services (non-utilisation, β = − 0.36, β = − 0.16, β = − 0.03, respectively; and interval since last dental visit, β = 1.25, β = 0.82, β = − 0.12, respectively). The enabling financing (non-utilisation, βrural = − 0.02 [95%CI: − 0.03 to − 0.02], βurban = 0.00 [95%CI: − 0.01 to 0.00]) and PHC registration (non-utilisation, βrural = − 0.03 [95%CI: − 0.04 to − 0.02], βurban = − 0.01 [95%CI, − 0.01 to − 0.01]) non-standardised total effects were stronger in rural areas. Enabling organisation (β = 0.16) and social network (β = − 2.59) latent variables showed a direct effect on the interval since last dental visit in urban areas. Education and social networks influenced utilisation of dental services through different pathways. Males showed less use of dental services in both urban and rural areas (non-utilisation, βrural = − 0.07, βurban = − 0.04; interval since last dental visit, βrural = − 0.07, βurban = − 0.07) and older adults have used dental services longer than younger ones, mainly in rural areas (βrural = 0.26, βurban = 0.17). Conclusion: Dental services utilisation was lower in rural areas in Brazil. The theoretical model was supported by empirical data and showed different relationships between the predictors in the two geographical contexts. In rural areas, financial aspects, education, primary care availability, sex and age were relevant factors for the utilisation of services.
... factors: patient-related factors (i.e., social-demographic factors, frequency of dental visits , availability for online information), dentist-related factors (clinical competencies, professional degrees, reputation), dental office-related factors (location, costs, hygiene, sterilization and infection control rules, state-of-the-art medical devices), factors associated with the courtesy of the medical staff. Besides, accessibility is important when it comes to choosing a dental care office; therefore, its location is important to the patients, especially considering the heavy traffic in a big city, a situation all our respondents have to deal with [7]. Knowing the factors which influence patients in their choice of a dental care office has recently become far more challenging to dentists. ...
... R=0.235); on the other hand, the cost is not a primordial criterion to them. In the case of those patients who go to the dental care office for emergencies, the price criterion is an important onethis fact is also found in other publications [7,9]. ...
Article
Full-text available
The factors which influence patients in their choice of a dental care office has recently become more complex. Our objective was to assess the correlations between different key factors (demographic aspects, dentists' professionalism, factors related to dental care offices) that influence the selection of a particular dental care office by adult patients. An online questionnaire (self-administered survey) was applied to a random sample of 117 adult dental patients in private clinics in Bucharest, Romania. The survey consisted of 12 questions, and it was conducted during a 2-week period. All the collected data were subjected to statistical analysis. The obtained results revealed statistically significant correlations between studied factors, i.e., elderly patients compared to younger patients considered the use of the state-of-the-art medical devices was important for the dental office (p=0.043, R=0.187). In comparison to women, male patients were searching more often information regarding the dental offices on social media (p=0.002, R=0.284); patients that attached more importance to the dentist's professional degree were the ones that attached more importance to its reputation (p<0.001, R=0.381) and to the dental office location (p=0.022, R=0.211). The results highlighted specific patterns in patients' perception of factors related to the selection of dental offices, as also found in scientific literature. The present study offers a perspective on how to improve dental care and patients' oral health.
... In a country such as Australia, the population is spread over great distances and many areas are classified as regional or remote. In these areas, patients tend to be irregular dental attendees (25). Regional practitioners have unique challenges and experiences with mucosal screening and referral, due to limited specialist support mechanisms in these locations. ...
... Practitioners should follow up with patients who are referred to ensure they are seen by a specialist in a timely manner, as patients can delay enacting referrals (31)(32)(33)(34). This is especially critical in regional areas because patients often have a lack of continuity in dental appointments (25). Participants in this study showed an understanding of the need to follow up with patients, consequently they may wish to follow up with patients to serve as a gentle reminder to enact their referral. ...
Article
Objectives: The aim of this study was to describe oral mucosal screening and referral attitudes of Australian oral health therapists (OHTs) and dental hygienists (DHs). Methods: Questionnaires were distributed to participants who attended dental hygiene courses run in both regional and metropolitan Queensland. Results: One hundred and two participants comprised 58 OHTs and 44 DHs, with a mean of 8.9 years since graduation. Thirty-four participants worked in regional locations, while 68 were from metropolitan areas. 97% of participants agreed that mucosal screening should be performed for all new and recall patients, while a minority (5%) agreed that patients will detect an oral mucosal change themselves. The majority (77%) agreed that oral cancer would be encountered in their practising career. Most participants (81%) felt comfortable discussing the presence of a suspicious lesion with patients and 88% agreed that it was their role to screen. In terms of barriers to oral cancer screening, lack of training was seen as the most prevalent barrier (56%) followed by lack of confidence (51%). Lack of time was seen as the third most prevalent barrier (40%), and lack of financial incentives was the least prevalent barrier (16%). Conclusions: Oral health therapists and DHs understand the importance of oral mucosal screening and are likely to be alert to oral mucosal changes. While lack of time and financial incentives was perceived to be impediments to mucosal screening, lack of confidence and training was the most prevalent barriers. This issue should be addressed through implementation of effective continuing education courses targeting oral cancer screening and referral practices.
... 10 This is the third in a series of papers detailing a multicentred, clustered randomized trial, designed to examine the hypothesis that an intensive, preventivebased, non-invasive approach to the management of dental caries ('study group') is cost-effective when compared to standard care ('control group') in private dental practice. 11,12 The research is the first being undertaken in Australasia to establish the costs and effectiveness of a structured preventive programme designed to reduce caries increment (primary prevention) and to arrest and remineralize existing lesions not yet cavitated (secondary prevention) compared to the 'standard' care. The sample of dental practices included city, suburban and rural dental practices in fluoridated and non-fluoridated communities. ...
... The baseline DMFS was calculated from patient charts and bite-wing radiographs obtained at the recruitment appointment, and measured blind to the allocation status of the patient. Unfortunately, as previously reported, 12 the degree and accuracy of the charting was variable. In addition, we charted and graded lesions that were evident on any bite-wing radiographs taken within six months of, or at, the randomization visit. ...
... This is due to costs associated with travel (which can be hundreds of kilometres), time off work, juggling the responsibilities associated with caring for dependents, and for those with less than adequate health insurance cover, the fees involved, especially when return visits are required for optimal treatment. 17 Limited studies in the literature suggest that rural and remote people presented to non-dental care providers with oral health problems. 10 12 One study focused on indigenous residents, 12 and the other was limited to the oral health presentations to rural pharmacies. ...
... Maybe that impacts on our teeth being worse? (Nurse, female, 45 years old) Dental workforce and service provision: The difficulty in attracting and retaining a dentist to these small communities was widely acknowledged (17). Participants, therefore, recognised the importance of establishing and maintaining regular visiting services by dentists. ...
Article
Full-text available
Objectives To investigate the challenges of providing oral health advice/treatment as experienced by non-dental primary care providers in rural and remote areas with no resident dentist, and their views on ways in which oral health and oral health services could be improved for their communities. Design Qualitative study with semistructured interviews and thematic analysis. Setting Four remote communities in outback Queensland, Australia. Participants 35 primary care providers who had experience in providing oral health advice to patients and four dental care providers who had provided oral health services to patients from the four communities. Results In the absence of a resident dentist, rural and remote residents did present to non-dental primary care providers with oral health problems such as toothache, abscess, oral/gum infection and sore mouth for treatment and advice. Themes emerged from the interview data around communication challenges and strategies to improve oral health. Although, non-dental care providers commonly advised patients to see a dentist, they rarely communicated with the dentist in the nearest regional town. Participants proposed that oral health could be improved by: enabling access to dental practitioners, educating communities on preventive oral healthcare, and building the skills and knowledge base of non-dental primary care providers in the field of oral health. Conclusions Prevention is a cornerstone to better oral health in rural and remote communities as well as in more urbanised communities. Strategies to improve the provision of dental services by either visiting or resident dental practitioners should include scope to provide community-based oral health promotion activities, and to engage more closely with other primary care service providers in these small communities.
... One suggestion is that rural children have poorer access to dental care (AIHW DSRU 2009), which may include patient perceptions of the impact of travel costs and the effect on family life (Curtis et al. 2007). An imbalance in availability of general health services has been noted between urban and rural locations in Australia, with rural areas characterised by fewer facilities and a shortage of health personnel (Humphreys et al. 2002). ...
... In contrast, contextual factors, such as deficient infrastructures, underprovided public services and unequal distribution of health services may negatively influence health perception, health behaviours and access to care in rural areas. [11][12][13][14][15][21][22][23][24][25][26][27][28][29][30][31][32][33][34] Rural disparities in oral health and underuse of dental care have been reported in both developing and industrialized countries. 5,7,10,12,14,18,[35][36][37][38][39][40][41][42][43][44][45][46] In 2009, in Canada, the dentist-population ratio was 3.5 times lower in rural than in urban areas. ...
Article
We sought to explore how rural residents perceive their oral health and their access to dental care. We conducted a qualitative research study in rural Quebec. We used purposeful sampling to recruit study participants. A trained interviewer conducted audio-recorded, semistructured interviews until saturation was reached. We conducted thematic analysis to identify themes. This included interview debriefing, transcript coding, data display and interpretation. Saturation was reached after 15 interviews. Five main themes emerged from the interviews: rural idyll, perceived oral health, access to oral health care, cues to action and access to dental information. Most participants noted that they were satisfied with the rural lifestyle, and that rurality per se was not a threat to their oral health. However, they criticized the limited access to dental care in rural communities and voiced concerns about the impact on their oral health. Participants noted that motivation to seek dental care came mainly from family and friends rather than from dental care professionals. They highlighted the need for better education about oral health in rural communities. Residents' satisfaction with the rural lifestyle may be affected by unsatisfactory oral health care. Health care providers in rural communities should be engaged in tailoring strategies to improve access to oral health care.
... The results from this study suggested that there were factors other than the presence of oral disease and poor health, which contributed to people seeking dental treatment. These factors might include poorer access to dental care, 12 which include, but might not be limited to, Mean number of dental services per dentist and dental specialist (and dental prosthetist in the case of dental prosthetic services) provided under the Chronic Disease Dental Scheme by category and Australian regional area geographical location, 14 travel costs 15 and the cost of dental treatment 1 as some dentists might have decided to charge the user a part fee rather than bulk billing. The fact that the number of services provided per dental practitioner did not vary greatly among the inner three RAs, while number of services per capita declined as one moved more remotely among these three regions, supports the contention that a geographical maldistribution in dental practitioners might have limited access to care in inner and outer RAs. 5 Furthermore, research suggested that although GPs play an important role in the management of chronic disease in Australia, people living in non-urban areas had a lower rate of GP attendance than those in urban areas. ...
Conference Paper
Objective To determine whether a different number and type of services were provided in Australian regional areas under the Australian Government-funded Chronic Disease Dental Scheme (CDDS). DesignRetrospective analysis of administrative payments data. SettingAustralia. ParticipantsPatients receiving dental services under the Medicare CDDS. InterventionsThe CDDS. Main outcome measuresNumber and type of services. MethodCDDS service categories Australian Statistical Geography Standard (ASGS) regions were collected by the Australian Department of Human Services between 2008 and 2013 and compared by Australian Bureau of Statistics ASGS estimated resident regional 2011 population, and by employed number of dentists, dental specialists and dental prosthetists from the 2011 National Health Workforce Dataset. ResultsNumber of services provided was greatest in major cities (79.0%), followed by inner regional (15.4%), outer regional (5.2%) and remote/very remote Australia (0.4%). Number of services per head of population decreased from 1.088 in major cities to 0.16 in remote/very remote areas. Number of services provided per dental practitioner showed minimal variation between major city (1672), inner (1777) and outer regional (1627) areas, but was lower in remote/very remote areas (641). Crown and bridge, periodontic, endodontic and removable prostheses per dental practitioner were most frequently supplied in the major cities, but restorative care and oral surgery were more frequently supplied in inner and outer regional areas. Conclusion The number of CDDS services provided declined with regional remoteness. There was a marked difference in the utilisation of the scheme between major cities and remote/very remote areas in both number and type of service levels.
... A suggested reason for poorer rural health has been poorer access to dental care, 1 which may include patient perceptions of the impact of travel costs and the impact on family life. 8 Access is not a simple construct. 9 It includes notions of need, availability and comprehensiveness of dental services. ...
Article
Background: Why oral health status outside capital cities is poorer than that in capital cities has not been satisfactorily explained. The aim of this study was to determine if the reason was poorer access to dental care. Methods: Data were obtained from the Australian National Survey of Adult Oral Health (2004-06). Oral health status was measured by DMFT Index, and numbers of decayed, missing and filled teeth. A two-step analysis was undertaken: comparing the dependent variables by location, socio-demographic confounders and preventive dental behaviours, and then including six access to dental care variables. Results: Of the 14 123 people interviewed, 5505 were examined, and 4170 completed the questionnaire. With socio-economic parameters in the first regression model, non-capital city people had higher DMFT (regression coefficient = 1.15, p < 0.01), more decayed (0.42, p < 0.01) and missing teeth (0.85, p < 0.01), but not filled teeth (-0.11, p = 0.71), than capital city based people. In the second step analysis, non-capital city people still had a greater DMFT (1.01, p < 0.01), more decayed (0.27, p = 0.03) and missing teeth (0.74, p < 0.01), but not filled teeth (0.00, p = 0.99) than capital city based people. Conclusions: Access to dental care was not the only reason why people outside capital cities have poorer oral health than people living in capital cities.
... A societal view, in which a broader costeffectiveness model including indirect costs, such as costs borne by sectors outside health: lost productivity and the costs to families; travel time and costs, childcare, and the opportunity cost of items forgone in order to pay for the dental treatment is planned and preliminary data published. 25 Consideration of such societal costs should allow extension of the MPP principles into public health programmes, often made in an environment of scarce resources. It is planned that the learning from this clinical trial will be leveraged to encourage wider participation in practice-based research by the dental profession, allowing a more generalizable population of both dentists and patients to be captured, and pertinent clinical questions addressed. ...
Article
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Background: The objective of this research was to assess the efficacy and cost-effectiveness of a non-invasive approach to dental caries management in private dental practice. Methods: Private dental practices from a variety of locations in New South Wales were randomly allocated to either non-invasive management of caries, or continue with usual care. Patients were followed for three years and caries incidence assessed. A patient-level decision analytic model was constructed to assess the cost-effectiveness of the intervention at two years, three years, and hypothetical lifetime. Results: Twenty-two dental practices and 920 patients were recruited. Within the clinical trial there was a significant difference in caries increment favouring non-invasive therapy at both two and three years. Efficacy was independent of age, gender, medical concerns, fluoride history, or previous history of dental caries, in a population of patients attending for treatment in private dental practices, in a variety of locations both urban and rural. Cost per DMFT avoided estimate was A$1287.07 (two years), A$1148.91 (three years) decreasing to A$702.52 in (medium) and A$545.93 (high) risk patients (three years). Conclusions: A joint preventive and non-invasive therapeutic approach appears to be cost-effective in patients at medium and high risk of developing dental caries when compared to the standard care provided by private dental practice.
... Thus, access to public clinics is more limited, and waiting times are longer, than for private clinics. Previous reports have shown that dental visit patterns are irregular for patients living in sub urban and rural locations; consequently, indirect travel costs should be considered a barrier restricting access to dental care 16 . ...
Article
Full-text available
AimsTo assess patients with acute odontogenic maxillofacial infections (AOMIs), regarding their functional dentition and dental treatment needs, and identify factors explaining these outcomes.Methods During a 1-year period, 160 patients with AOMIs were treated at the specialised dental care centre of Vilnius University. Both oral status and specific dental treatment needs were evaluated for each patient. For the restorative dental treatment need, we examined if patients needed fillings, crowns or bridges. Periodontal dental treatment needs were based only on the most severe cases, and patients were allocated either to a group for which periodontal treatment was recommended or to a group that did not need periodontal treatment. Based on these clinical assessments, four ratios for specific dental treatment needs (restorations, extractions, endodontic treatment and periodontal treatment) and two summative ratios (total dental treatment needs and presence of a functional dentition) were calculated. The questionnaire included variables from various domains.ResultsPatients with AOMIs retained one-third of their functional dentition and the mean ± standard deviation of their total dental treatment needs was 46.0 ± 29.7%, of which 32.4 ± 17.1% related to the need for restorations. Higher dental treatment needs were associated with a low level of education, low income, irregular oral self-care, systemic diseases and self-treatment of acute dental conditions before seeking professional help.Conclusions Patients with AOMIs retained one-third of their functional dentition, and almost half of their dentition were in need of dental treatment.
... The ability to define and interpret social aspects linked to the search for dental treatment are less-understood or less-studied aspects of oral health. Access to care may depend significantly on factors such as the availability of transportation, access to childcare and the opportunity to take time away from work 8 . Indeed, the social cost of adverse health conditions on daily living includes time away from work, school and normal activities. ...
Article
Objective: The aim of the present study was to evaluate the influence of oral conditions in preschool children and associated factors on work absenteeism experienced by parents or guardians. Methods: A preschool-based, cross-sectional study was conducted of 837 children, 3-5 years of age, in Campina Grande, Brazil. Parents or guardians answered the Brazilian version of the Early Childhood Oral Health Impact Scale. The item 'taken time off work' was the dependent variable. Questionnaires addressing sociodemographic variables, history of toothache and health perceptions (general and oral) were also administered. Clinical examinations for dental caries and traumatic dental injury (TDI) were performed by three dentists who had undergone training and calibration exercises. Cohen's kappa (κ) was 0.83-0.88 for interexaminer agreement and 0.85-0.90 for intra-examiner agreement. Descriptive, analytical statistics were conducted, followed by logistic regression for complex samples (α = 5%). Results: The prevalence of parents' or guardians' work absenteeism because of the oral conditions of their children was 9.2%. The following variables were significantly associated with work absenteeism: mother's low schooling [odds ratio (OR) = 2.31; 95% confidence interval (95% CI): 1.31-4.07]; history of toothache (OR = 6.33; 95% CI: 3.18-12.61); and avulsion or luxation types of TDI (OR = 8.54; 95% CI: 1.80-40.53). Conclusion: Other oral conditions that do not generally cause pain, such as dental caries with a low degree of severity or inactive dental caries and uncomplicated TDI, were not associated with parents' or guardians' work absenteeism of preschool children. It is concluded that toothache, avulsion, luxation and a low degree of mother's schooling are associated with work absenteeism.
... The study findings are in agreement with the findings of Bahadori et al. [2] who identified cost as an affecting determinant of dental service utilization on the first priority basis. Curtis et al. [9] in their study examined some of the barriers to access to dental services and concluded that the direct and indirect costs such as travel costs in remote areas had effect on access to dental care and was considered as an important barrier. ...
... The study findings are in agreement with the findings of Bahadori et al. [2] who identified cost as an affecting determinant of dental service utilization on the first priority basis. Curtis et al. [9] in their study examined some of the barriers to access to dental services and concluded that the direct and indirect costs such as travel costs in remote areas had effect on access to dental care and was considered as an important barrier. ...
Article
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Introduction: Utilization of dental service is a concept of expressing the extent of interaction between the service provider and the people for whom it is indented. However, one of the major issues in social welfare is the equitable provision of these services to the population. Aim: To determine the perceived barriers affecting access to the dental services in the dental institute. Materials and Methods: A cross-sectional survey was conducted in the dental institute during the month of February in the year 2014 using decision-making trial and evaluation laboratory (DEMATEL) method. The study sample included the 364 subjects. The required data were collected using a specially designed and pretested questionnaire. The data were analyzed using SPSS 18.0 (SPSS Inc., Chicago, IL, USA) and MATLAB 7.6.0. The mean, standard deviations were used to describe the data, and inferential statistics included one-way ANOVA and DEMATEL. Results: The five determinants of cost, inconvenience, fear, organization, and patient-dentist relationship were determined as barriers to access dental services. Based on subjects′ responses to the questions, the cost (54.75% agreed or strongly agreed) was identified as the most important factor affecting the access to dental health care followed by dentist-patient relationship (48.57%), inconvenience (36.55%), fear (23.70%), and organization (14.02%). The difference was found to be statistically significant (P = 0.0001). When the hierarchy of the affecting and affected factors was calculated, based on the factor analysis by using DEMATEL method, the cost (R−J = 0.16) and organization (R−J = 1.15), were certain affecting determinant which influenced the access to dental services and inconvenience. Conclusion: The major barriers to oral health care utilization among our patients were cost, fear, and organization. Policymakers, administrators, and insurance organizations have a major role. Hence, the policies should be fair and equitable.
... In the lack of a dental practice in a rural community, rural and remote residents may be serviced by public and/or private visiting oral health services [3]. People may also travel to larger population centres to access dental services and incur additional costs associated with the travel, time off work [4,5], arranging alternative care for dependents, and return visits to the dentist if required for optimal treatment [6]. When there is a lack of oral health services, people with an acute oral health problem may present to medical doctors [7], hospital emergency departments [7][8][9], pharmacies [10] or to an Aboriginal Health Centre [11,12]. ...
Article
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Background Collaboration between dental practitioners and non-dental primary care providers has the potential to improve oral health care for people in rural and remote communities, where access to oral health services is limited. However, there is limited research on collaboration between these professional disciplines. The purpose of this paper was to explore the relationships between dental practitioners and non-dental primary care providers from rural and remote areas of Queensland and to identify strategies that could improve collaboration between these disciplines from the perspective of dental participants. Methods Semi-structured interviews were conducted between 2013 and 2015 with visiting, local and regional dental practitioners (n = 12) who had provided dental services to patients from eight rural and remote Queensland communities that did not have a resident dentist. Participants were purposely recruited through a snow ball sampling technique. Interview data were analysed using thematic analysis with the assistance of QSR Nvivo v.10. Results Four major themes emerged from the data: (1) Communication between dental practitioners and rural primary care providers; (2) Relationships between dental and primary care providers; (3) Maintenance of professional dualism; (4) Strategies to improve interprofessional relationships (with subthemes: face to face meetings; utilisation of technology; oral health training for primary care providers; and having a community based oral health contact person). Participants observed that there was a lack of communication between the dental providers who saw patients from these rural communities and the primary care providers who worked in each community. This was attributed to poor communication, the high turnover of staff and the siloed behaviours of some practitioners. Visiting dental practitioners were likely to have stronger professional relationships with hospital nursing, administrative and allied health care staff who were often long term residents of the community. Conclusions The findings suggest that there was little relationship between the dental personnel and primary care providers. Interprofessional collaboration between dental care providers and non-dental rural primary care providers in the rural and remote communities sampled could be improved by having regular face to face meetings between practitioners from across the health disciplines, providing oral health education to primary care providers, establishing and maintaining effective communication and referral pathways, and exploring a greater role for tele-dentistry.
... In the absence of a dental practice in their community, rural and remote residents' may access services through visiting mobile dental facilities [10] though this can be difficult due to the timing and irregularity of services. They may also travel to a dentist located in another (larger) town though this can often impose an additional cost burden to the patient and their family depending on their level of health insurance and if travel distances are long [11]. ...
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Background Rural residents have poorer oral health and more limited access to dental services than their city counterparts. In rural communities, health care professionals often work in an extended capacity due to the needs of the community and health workforce shortages in these areas. Improved links and greater collaboration between resident rural primary care and dental practitioners could help improve oral health service provision such that interventions are both timely, effective and lead to appropriate follow-up and referral. This study examined the impact oral health problems had on primary health care providers; how primary care networks could be more effectively utilised to improve the provision of oral health services to rural communities; and identified strategies that could be implemented to improve oral health. Methods Case studies of 14 rural communities across three Australian states. Between 2013 and 2016, 105 primary and 12 dental care providers were recruited and interviewed. Qualitative data were analysed in Nvivo 10 using thematic analysis. Quantitative data were subject to descriptive analysis using SPSSv20. ResultsRural residents presented to primary care providers with a range of oral health problems from “everyday” to “10 per month”. Management by primary care providers commonly included short-term pain relief, antibiotics, and advice that the patient see a dentist. The communication between non-dental primary care providers and visiting or regional dental practitioners was limited. Participants described a range of strategies that could contribute to better oral health and oral health oral services in their communities. Conclusions Rural oral health could be improved by building oral health capacity of non-dental care providers; investing in oral health promotion and prevention activities; introducing more flexible service delivery practices to meet the dental needs of both public and private patients; and establishing more effective communication and referral pathways between rural primary and visiting/regional dental care providers.
... The population distribution in Australia at both state and national level is skewed, with 86% of the population residing in urban areas. 1 The irregular distribution of the population leads to significant access barriers to healthcare. [2][3][4] Overall, national shortages of health professionals, both dentists and dental auxiliaries, magnify inequalities in health. [5][6][7] Hence the site of dental practices plays a major role in terms of population accessibility for oral care. ...
Article
The purpose of this study was to analyse the geographic distribution of practice locations of graduate dentists from the University of Western Australia (UWA) over a period of six years. Using data from open access sources, all practice locations of the UWA's dental graduates from 2004 to 2009 were located. All practice locations were measured at the postcode level and the distribution of graduates was analysed across variables such as SEIFA (a socio-economic index of disadvantage) and ARIA (an index of accessibility and remoteness). Of the 228 UWA graduates, an almost equal proportion of males (49.1%) and females (50.9%) graduated over the six-year period. Of all the local graduates, 83% continued to practice in Western Australia, with 78% of the practice locations alone in ARIA 1 (highly accessible areas) and 22% of the graduates distributed among the remaining ARIA regions. Fifty-one per cent of graduates practised in the 30% most affluent suburbs and only 11.5% practised in the most socio-economically disadvantaged 30% suburbs. In SEIFA decile 10 (least disadvantaged areas), the highest numbers of practising dental graduates were also from the earliest graduates, with numbers steadily declining over the year of graduation from 2004 to 2009 (i.e. the most recent graduates). An apparent association exists between year of graduation and practice location, with more experienced dentists working in urban and higher socio-economic areas.
... The neighbourhood-level characteristics included in the analysis have been previously shown to relate to the prevalence of the two conditions or to potentially affect the conditions by impacting related health behaviours (e.g. physical activity, diet etc) (Curtis et al., 2007;Glasgow Centre for Population Health, 2013;Olafsdottir et al., 2014). In all cases, values were corrected for different population sizes in each neighbourhood. ...
Article
Objective: To examine the spatial clustering of obesity and dental caries in young children in Plymouth, United Kingdom, to evaluate the association between these conditions and deprivation, and explore the impact of neighbourhood-level characteristics on their distribution. Basic research design: Cross-sectional study analysing data from the National Child Measurement Programme (N=2427) and the Local Dental Health Survey (N=1425). The association of deprivation with weight status and caries was determined at individual and area level, using ANOVA and Poisson models. The overall spatial clustering was assessed using a modified version of the Global Moran's I, while clusters were located through Local Indicators of Spatial Association. Spatial autocorrelation was assessed using the variograms of the raw values. Log-linear Poisson models were fitted to assess the significance of neighbourhood characteristics on overweight/obesity and caries distribution. Results: At an individual level, deprivation was not associated with BMI z-scores but was a significant predictor of caries (p⟨0.05). However, at area level, deprivation related to the rates of both conditions. A significant positive autocorrelation was observed across neighbourhoods for caries. The variograms suggested spatial autocorrelations up to 2.5 km and 3 km for overweight/obesity and caries, respectively. Among several neighbourhood characteristics, the proportion of people on benefits was found to be a significant predictor of caries rates. Conclusions: Our results underline the importance of considering geographic location and characteristics of the broader environment when developing strategies to target obesity and caries.
... Therefore, non-disease-related factors, such as sociodemographic characteristics, have been reported to exert a more pronounced effect on the utilization of dental care [11][12][13][14]. Previous studies have demonstrated a difference in dental care utilization based on the area of residence (i.e., urban vs. rural), with lower utilization in rural areas [15][16][17]. Spatial accessibility, which refers to both physical impedance and use of health care services, has often been measured based on a respondent's perceived time and distance to healthcare facilities [10,18]. A variety of models were introduced to measure spatial accessibility to healthcare [18,19]. ...
Article
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The aim of the present study was to assess the regional deprivation and individual factors that influence how far a person will travel to access dental care. Using data from the Korea Health Panel (2008 to 2011), we selected a group of 4,256 subjects and geocoded their homes and dental hospitals/clinics. Using the road network analysis, we calculated the distance traveled by the subjects for dental care. We used the generalized estimating equation (GEE) for repeated data analysis and included an interaction term between regional deprivation and individual income to determine the effects of the two factors on the choice of a dental hospital/clinic. When the regional deprivation index was divided into three quarters (high, middle, and low), urban areas had higher”high” and “low" levels of deprivation, and rural areas had relatively higher middle level of deprivation. GEE regression showed that the level of education, regional deprivation level, and income all affected the distance traveled to dental clinics. The regional deprivation level had a higher association than income with the travel distance. At the same income level, subjects who lived in the least deprived areas were more likely to travel longer distances than subjects living in the most deprived areas. Regarding the distribution of dental hospitals/clinics, incentive based dental polices for either dental providers or patients are needed that will assure the delivery of dental care despite spatial inequality.
... A societal view, in which a broader costeffectiveness model including indirect costs, such as costs borne by sectors outside health: lost productivity and the costs to families; travel time and costs, childcare, and the opportunity cost of items forgone in order to pay for the dental treatment is planned and preliminary data published. 25 Consideration of such societal costs should allow extension of the MPP principles into public health programmes, often made in an environment of scarce resources. It is planned that the learning from this clinical trial will be leveraged to encourage wider participation in practice-based research by the dental profession, allowing a more generalizable population of both dentists and patients to be captured, and pertinent clinical questions addressed. ...
Article
The objective of this research was to assess the efficacy and cost-effectiveness of a non-invasive approach to dental caries management in private dental practice. Private dental practices from a variety of locations in New South Wales were randomly allocated to either non-invasive management of caries, or continue with usual care. Patients were followed for three years and caries incidence assessed. A patient-level decision analytic model was constructed to assess the cost-effectiveness of the intervention at two years, three years, and hypothetical lifetime. Twenty-two dental practices and 920 patients were recruited. Within the clinical trial there was a significant difference in caries increment favouring non-invasive therapy at both two and three years. Efficacy was independent of age, gender, medical concerns, fluoride history, or previous history of dental caries, in a population of patients attending for treatment in private dental practices, in a variety of locations both urban and rural. Cost per DMFT avoided estimate was A$1287.07 (two years), A$1148.91 (three years) decreasing to A$702.52 in (medium) and A$545.93 (high) risk patients (three years). A joint preventive and non-invasive therapeutic approach appears to be cost-effective in patients at medium and high risk of developing dental caries when compared to the standard care provided by private dental practice.
... Access to dental care in Western Australia also has a strong socioeconomic dimension with disadvantaged people having serious access problems and extensive waiting times [4][5][6] . Moreover, the association between poor oral health and low socio-economic status (as well as rural and remote living) in the Western Australian context has been well documented [4][5][6][7][8][9] . Therefore, higher rates of dental care for children under GA should, in theory, be observed in populations of lower socio-economic status, as well as in populations from rural and remote regions, due to the higher burden of oral disease in these groups. ...
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This study aimed to assess the temporal and spatial changes in the demand for general anaesthesia, relative to disease incidence, in 0-19-year-olds. Hospitalisation data were obtained from the Western Australian Morbidity Data System for the financial years 1999/2000 to 2004/2005, and principal diagnosis was obtained from every patient discharged from a public or private hospital. Hospitalisation data was correlated with socioeconomic status and the geographical location of primary residence. In the public hospital sector, there were greater rates of people residing in Statistical Local Areas (SLAs) with decreasing accessibility to healthcare services utilising the option of treatment of dental caries under general anaesthetic (GA) compared to people living within highly accessible areas. In the private sector, children who resided in SLAs with the greatest access to healthcare facilities had a greater rate of being hospitalised for the treatment of dental caries under GA. The results demonstrated distinct patterns of trends in demand for general anaesthetic care among different SES groups and geographical location of primary residence. There was an overall emerging trend of increasing demand placed on public sector both among dental care users among high and low SES. Moreover, the results demonstrated the potential application of geographic modelling as a service planning tool for estimating the future demand for GA care for dental caries in addition to the timely need for focused attention on preventive services for early identification, prevention and control of dental caries among children.
... All children are accompanied by educational monitors from participating schools. The goal of this strategy is to overcome the barriers imposed by the geographical location of services and indirect costs involved in transporting children to their dental treatment [54][55][56]. Moreover, the organization of PAS services during school hours allows greater accessibility to children's dental care, since there is no need for parents to lose working hours to take their children for dental treatment [12]. ...
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The objective of this study was to compare the socioeconomic and family characteristics of underprivileged schoolchildren with and without curative dental needs participating in a dental health program. A random sample of 1411 of 8-to-10 year-old Brazilian schoolchildren was examined and two sample groups were included in the cross-sectional study: 544 presented curative dental needs and the other 867 schoolchildren were without curative dental needs. The schoolchildren were examined for the presence of caries lesions using the DMFT index and their parents were asked to answer questions about socioenvironmental characteristics of their families. Logistic regression models were adjusted estimating the Odds Ratios (OR), their 95% confidence intervals (CI), and significance levels. After adjusting for potential confounders, it was found that families earning more than one Brazilian minimum wage, having fewer than four residents in the house, families living in homes owned by them, and children living with both biological parents were protective factors for the presence of dental caries, and consequently, curative dental needs. Socioeconomic status and family structure influences the curative dental needs of children from underprivileged communities. In this sense, dental health programs should plan and implement strategic efforts to reduce inequities in oral health status and access to oral health services of vulnerable schoolchildren and their families.
Article
Background: In 2009, the School of Dentistry and Oral Health, Griffith University, commenced a clinical placement in a remote rural and Indigenous community in Australia. This paper analyses the type of treatment services provided from 2009 to 2011 by year, type of patient and age of patient. Methods: All treatment data provided were captured electronically using the Australian Dental Association (ADA) treatment codes. Audited reports were analysed and services categorised into six broad treatment types: consultation, diagnostic, preventive, periodontics, oral surgery and restorative services. Results: The bulk of dental care episodes provided over the three-year period were for clinical examinations, restorative and oral surgery services. Preventive and periodontic services generally comprised less than 10% of the care provided. Over time fewer clinical examinations were conducted and restorative dentistry increased in the second and third years of the placement. There were no significant differences in the types of care provided to public and private patients. Conclusion: Clinical placement of final-year dental students in remote rural settings has helped address a largely unmet dental need in these regions. Implications: Dental student clinical placement is effective in providing care to communities in a remote rural setting. Student placements are, however, only able to deliver dental care in few remote rural communities, and therefore will make a negligible impact on the level of untreated dental disease in the short term. It is hoped that the experience will lead to more graduates serving some of their professional lives in remote communities.
Article
Health care systems are essential for promoting, improving and maintaining health of the population. Through an efficient health service, patients can be advised of disease that may be present and so facilitate treatment; risks factors whose modification could reduce the incidence of disease and illness in the future can be identified, and further, how controlling such factors can contribute to maintain a good quality of life. In developed countries, clinics or hospitals may be supported by health professionals from various specialties that allow their cooperation to benefit the patient; these institutions or clinics may be equipped with the latest technical facilities. In developing countries, health services are mostly directed to provide emergency care only or interventions towards certain age group population. The most common diseases are dental caries and periodontal disease and frequently intervention procedures aim, at treating existing problems and restore teeth and related structure to normal function. It is unfortunate that the low priority given to oral health hinders acquisition of data and establishment of effective periodontal care programmes in developing countries but also in some developed countries where the periodontal profile is also less than satisfactory. Despite the fact that in several developed countries there are advanced programmes oriented to periodontal disease treatments, the concern is related to the lack of preventive oriented treatments. According to data available on periodontal status of populations from developed countries, despite the number of dentists and trained specialists, dental health professionals do not presently meet adequately the need for prevention, focusing mainly on curative care. The need for strengthening disease prevention and health promotion programmes in order to improve oral health conditions and particularly periodontal status in the majority of countries around the world is evident. Unfortunately, in many countries, the human, financial and material resources are still insufficient to meet the need for oral health care services and to provide universal access, especially in disadvantaged communities, in both developing and developed countries. Moreover, even though the most widespread illnesses are avoidable, not all population groups are well informed about or able to take advantage of the proper measures for oral health promotion. In addition, in many countries, oral health care needs to be fully integrated into national or community health programmes. Improving oral health is a very challenging objective in developing countries, but also in developed countries, especially with the accelerated aging of the population now underway and intensifying over the coming years.
Article
Objectives: To examine the spatial accessibility to public dental services (PDS) relative to the estimated oral health needs of refugee populations within the state of Victoria, Australia. Methods: The study employed enhanced two-step floating catchment area method to measure spatial accessibility to PDS by driving and public transit modes at statistical area level 2 (SA2). Principal component analysis of select census-derived socioeconomic variables specific to the refugee population was conducted to derive an area-based indicator of refugee oral health needs, also at SA2 level. Individual indices were then developed for each of these components using standardized z-scores. Finally, an integrated need-accessibility index was developed to identify low-accessibility areas associated with high needs. Results: The results show clear contrast in spatial accessibility to PDS for the refugee populations between metropolitan and rural areas as well as between driving and public transit modes. There are critical limitations in accessibility for refugees living in the rural areas and those dependent on public transit mode for travel. Also, there is evident disparity between the estimated oral health needs of refugees in metropolitan and rural areas. Overall, approximately 29% of all SA2s with refugee population are in the 'High' needs category, which comprise 19.8% of the total Victorian refugee population. Integrating accessibility and oral health needs measures revealed that about 30% and 18% of refugee population are identified as under-serviced, when considering driving and public transit modes respectively. Conclusion: The findings provide implications for researchers and policy makers to address the inequalities in access to PDS among the refugee population in Victoria. The methodology outlined in this study provides a complementary approach in planning oral health service provision in the absence of population level data at a small-area scale on access to dental services or need for oral health care.
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The aim of this study was to investigate the association between markers of oral disease and geographical factors influencing access to dental care (DMFT score) among school children in Central Mexico. Retrospective data were collected during an international service-learning program between 2002 and 2009. A sample of 1,143 children (55% females; mean age 12.7±13.1years) was analyzed. The mean DMFT score, represented largely by untreated tooth decay, was 4.02 (4.76). The variables that had the most significant effect on the DMFT score were proportion of paved roads between the community and dental services, and the availability of piped potable water. The DMFT score increased in proportion to the percentage of paved roads. In contrast, the DMFT score decreased with the availability of piped potable water. Similar results were found for untreated tooth decay. The main variable associated with a significant increase in dental fillings was proportion of paved roads. Together with Brazilian reports, this is one of the first investigations of the association between geographical factors and oral health in an underdeveloped setting.
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Objective: The aim of the present study was to investigate Medicare rebate claim trends under the Australian Chronic Disease Dental Scheme (CDDS) over time, region and type of service. Methods: CDDS data obtained from the Department of Human Services reflected all Medicare item claims lodged under the CDDS by dental practitioners and processed by Medicare. Retrospective analysis of CDDS rebate claims was conducted. Results: The CDDS rebates for the period 2008-13 totalled A$2.8 billion. Just under 81% of claims were from dental practitioners working in major cities. The most frequent rebates were for crown, bridge and implant (32.4%), removable prostheses (22.4%) and restorative services (21.3%). The rebate claims of restorative services, crown and bridge, and removable prostheses per dentist in all regional areas increased over the time of the CDDS. Per capita, the rebates for every type of dental service were lower in the more remote regions. Conclusions: Rebate claims increased in each of the last 3 full years of the CDDS across all areas. The majority of Medicare rebate claims were from major city areas and for crown and bridge, removable prostheses and restorative services. The service mix varied between regions.
Article
Objectives: This study investigated the dental attendance patterns of Australian children with and without disabilities using data from Growing up in Australia: The Longitudinal Study of Australian Children. Methods: Data on 6470 participants within two groups (B cohort [aged 12-13]: n = 3381; K cohort [aged 16-17]: n = 3089) were used for the study. Binomial regression models were fitted to examine the association between disability status and dental attendance. The models were adjusted for gender, parent's country of birth, region of residence, highest parental education and household weekly income, and multiple imputations was used for handling missing data. Results: Children with disabilities constituted 2.4% and 3.8% of the study sample in the B and K cohort, respectively. The unadjusted risk ratio of irregular (vs. regular) dental attendance between children with and without disabilities was 1.07 (95% CI 0.78-1.46) in the B cohort and 1.15 (95% CI 0.93-1.42) in the K cohort. After adjustment and imputation, the risk ratios were 1.03 (95% CI 0.76-1.41) and 1.10 (95% CI 0.89-1.36) in the B and K cohort, respectively. Conclusions: Dental attendance pattern was positively, but minimally, associated with disabilities in older children, and factors including region of residence, parental education and household income were related to disability status and dental attendance. Further studies are required to clarify the association and ascertain key factors that affect the health and wellbeing of children with disabilities.
Article
Rural residents can incur substantial travel-related costs to receive needed care. In this study, we describe and compare the medical travel programs offered by provincial and territorial governments. We conducted a document analysis of medical travel subsidy programs available in Canada to the general public. Only programs funded and administered by provincial/territorial governments were included. Based on the information that we collected, we determined there were three types of programs. Discount programs (BC) allow eligible patients to receive reduced or waived prices for travel and lodging at designated providers. Non-reimbursement programs (BC, SK) cover the costs of travel and lodging without requiring patients to pay for costs up-front. In reimbursement programs (MB, ON, QC, PEI, NS, NL, YK, NWT, NT), patients generally pay costs up-front and then submit claims for reimbursement after receiving the health service. Rates, co-payments, and maximum allowable amounts vary by program. Our findings indicated that although many provinces and territories offer medical travel subsidy programs, the availability, terms, and conditions vary widely. The study highlights regional disparities that may contribute to inequitable access to care across Canada.
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Missed appointments have a great economic, social and administrative impact on the management of public health services. This research aimed to study factors associated with non-attendance to the first appointments of pediatric patients in secondary dental care services in the city of Curitiba, Brazil. A cross-sectional study was performed using secondary data from the electronic health records of the Curitiba Municipal Secretary of Health. The study included all children (0-12 years) referred to secondary dental clinics in the years 2010 to 2013. Data were analyzed by the chi-square test and Pearson linear trend chi-square (α = 0.05). Binary logistic regression models were built. Data from 1,663 children were assessed and the prevalence of non-attendance was 28.3%. The variables associated with the non-attendance in inferential analysis (p < 0.05) and in the final model were the household income per capita (95% CI: 1.93-2.82) and the waiting time in virtual queue (95% CI: 1.000-1.002). Socioeconomic aspects and the waiting time in virtual queue, should be considered in the strategic planning of health services as they may influence the attendance of pediatric patients in secondary dental referral service.
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Uruguay Trabaja (UT) es un programa socio-laboral de integración social para adultos desempleados pertenecientes a hogares en situación de vulnerabilidad socio-económica. Durante nueve meses reciben acompañamiento de expertos de Organizaciones de la Sociedad Civil (OSC) pudiendo recibir una asistencia odontológica no disponible usualmente en el Sistema de Salud del país. La tercera parte de los beneficiarios de UT inicia el tratamiento y lo abandona. El fenómeno del abandono al tratamiento odontológico fue estudiado a partir del análisis de contenido de entrevistas a participantes y expertos de las OSC. Basados en los conceptos de habitus de Bourdieu y de individualización de las protecciones de Castel, la complejidad de la vida cotidiana; ausencia de vínculo dentistas-participantes y el escaso tiempo de acompañamiento para sostener los procesos de socialización, son aspectos a considerar para comprender los abandonos de este derecho transitorio a la asistencia.
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Background: Poor recognition of medicine-induced dry mouth can have a number of adverse effects, including difficulties with speech, chewing and swallowing dry foods, gum disease, dental caries and oral candidosis. This study examined the prevalence of use of medicines that cause dry mouth and claims for dental services funded by the Department of Veterans' Affairs (DVA) in an Australian cohort. Methods: We used the DVA administrative health claims data to identify persons using medicines that can cause dry mouth at 1st of September 2016 and determine their DVA dental claims in the subsequent year. Results were stratified by gender, residence in community or residential aged cared facility, and number of medicines. Results: We identified 50,679 persons using medicines known to cause dry mouth. Of these, 72.6% were taking only one medicine that may cause dry mouth, and 21.6% were taking two. Less than half (46.2%) of all people taking at least one of these medicines had a dental claim in the following year. A smaller proportion of women (35.9%) made claims than men (56.9%), χ2 = 2248.77, p<.0001. Conclusions: Targeted interventions raising awareness of the relationship between some medicines and dry mouth, and the importance of dental visits are warranted.
Article
Background As part of a larger study, the Crossroads-II Dental sub-study determined the patterns of, and barriers to, oral healthcare service utilisation in a rural area of Victoria. Methods In this cross-sectional sub-study predisposing, enabling, needs-related, and oral health variables were considered in association with patterns of oral healthcare utilisation. A logistic regression was performed to explain the use of oral healthcare services. Results Overall, 574 adults participated, with 50.9% reporting having visited an oral healthcare service in the previous 12 months. Age, number of chronic health conditions and holding a health card; were associated with increased visiting a dentist (OR=1.01; 95% CI:1.00-1.03; OR=1.08; 95% CI:1.01-1.16; OR=2.06; 95% CI:1.26-3.36, respectively). Perceived barriers to care and number of missing teeth decreased the odds of using services (OR=0.46; 95% CI:0.36–0.58; OR=0.95; 95% CI:0.92–0.98, respectively). Conclusions Results suggest that use of oral healthcare services is associated with a range of financial, educational, health, and structural barriers. Increasing the use of oral healthcare services in rural populations requires additional efforts beyond the reduction of financial barriers.
Article
AimIt is the aim of this paper to consider the factors associated with a patient's continuing attendance at a particular dentist's surgery.MethodsA data set was established consisting of General Dental Services' (GDS) patients whose birthdays were included within a set of randomly selected dates, 20 in each possible year of birth. The data set was restricted to those patients aged 18 or older in 2003 who attended only one dentist in only one postcode area in 2003, and who also attended only one dentist in the same postcode area in 2005, and where the dentist attended in 2003 was also practising in the same postcode area in 2005. The patients were classified by age, gender and charge-paying status, and by whether they had attended a GDS dentist in 2002, and the dentists attended in 2003 were classified by age and gender. The proportion of patients changing dentists between 2003 and 2005 was calculated, together with standard error (se), for each combination of these factors. This was then replicated for each year from 1993-2002.ResultsData for 323,382 patients were included in the analysis for 2003, these patients having not changed address during a two-year period, nor had their dentist changed location. The proportion of patients changing dentist over the period 2003 and 2005 was 15.5% (se 0.06 PCT). This has increased steadily since 1993, when the proportion was 12.4%.Conclusions Factors influencing whether a patient changes dentist include patient age and charge paying status, dentist age and gender, and the patient's previous attendance pattern.
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The performance of five methods for determining the number of components to retain (Horn's parallel analysis, Velicer's minimum average partial [MAP], Cattell's scree test, Bartlett's chi-square test, and Kaiser's eigenvalue greater than 1.0 rule) was investigated across seven systematically varied conditions (sample size, number of variables, number of components, component saturation, equal or unequal numbers of variables per component, and the presence or absence of unique and complex variables). We generated five sample correlation matrices at each of two sample sizes from the 48 known population correlation matrices representing six levels of component pattern complexity. The performance of the parallel analysis and MAP methods was generally the best across all situations. The scree test was generally accurate but variable. Bartlett's chi-square test was less accurate and more variable than the scree test. Kaiser's method tended to severely overestimate the number of components. We discuss recommendations concerning the conditions under which each of the methods are accurate, along with the most effective and useful methods combinations.
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Readers may question the interpretation of findings in clinical trials when multiple outcome measures are used without adjustment of the p-value. This question arises because of the increased risk of Type I errors (findings of false "significance") when multiple simultaneous hypotheses are tested at set p-values. The primary aim of this study was to estimate the need to make appropriate p-value adjustments in clinical trials to compensate for a possible increased risk in committing Type I errors when multiple outcome measures are used. The classicists believe that the chance of finding at least one test statistically significant due to chance and incorrectly declaring a difference increases as the number of comparisons increases. The rationalists have the following objections to that theory: 1) P-value adjustments are calculated based on how many tests are to be considered, and that number has been defined arbitrarily and variably; 2) P-value adjustments reduce the chance of making type I errors, but they increase the chance of making type II errors or needing to increase the sample size. Readers should balance a study's statistical significance with the magnitude of effect, the quality of the study and with findings from other studies. Researchers facing multiple outcome measures might want to either select a primary outcome measure or use a global assessment measure, rather than adjusting the p-value.
Article
Abstract Growing recognition that quality of life is an important outcome of dental care has created a need for a range of instruments to measure oral health-related quality of life. This study aimed to derive a subset of items from the Oral Health Impact Profile (OHIP-49) - a 49-item questionnaire that measures people's perceptions of the impact of oral conditions on their well-being. Secondary analysis was conducted using data from an epidemiologic study of 1217 people aged 60+ years in South Australia. Internal reliability analysis, factor analysis and regression analysis were undertaken to derive a subset (OHIP-14) questionnaire and its validity was evaluated by assessing associations with sociodemographic and clinical oral status variables. Internal reliability of the OHIP-14 was evaluated using Cronbach's coefficient α. Regression analysis yielded an optimal set of 14 questions. The OHIP-14 accounted for 94% of variance in the OHIP-49; had high reliability (α=0.88); contained questions from each of the seven conceptual dimensions of the OHIP-49; and had a good distribution of prevalence for individual questions. OHIP-14 scores and OHIP-49 scores displayed the same pattern of variation among sociodemographic groups of older adults. In a multivariate analysis of dentate people, eight oral status and sociodemographic variables were associated (P<0.05) with both the OHIP-49 and the OHIP-14. While it will be important to replicate these findings in other populations, the findings suggest that the OHIP-14 has good reliability, validity and precision.
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The third edition of the volume Educational Measurement gives, as the previous two editions of Lindquist (1951) and Thorndike (1971), a comprehensive review of the state of art of educational measurement. The volume is edited and introduced by R.L. Linn and is organized in three parts:(1) Theory and General Principles (chapters 2 through 7), (2) Construction, Administration, and Scoring (chapters 8 through 11), and (3) Applications (chapters 12 through 18). More than half of the number of pages is devoted to theory and general principles and the emphasis of the review is also on this part
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Reliability coefficients often take the form of intraclass correlation coefficients. In this article, guidelines are given for choosing among 6 different forms of the intraclass correlation for reliability studies in which n targets are rated by k judges. Relevant to the choice of the coefficient are the appropriate statistical model for the reliability study and the applications to be made of the reliability results. Confidence intervals for each of the forms are reviewed. (23 ref) (PsycINFO Database Record (c) 2006 APA, all rights reserved).
Article
Current measures of dental health status are primarily clinical in nature and rely on clinical and radiographic assessment of the patient's dental health. Information about a patient's ability to perform usual activities related to good dental health--for example, chewing, speaking, and smiling--is not routinely collected. This study investigated what measures contribute to dental functional status, how they are related to traditional clinical measures, whether dental factors contribute to other generic measures of health, and the extent to which dental factors contribute to overall quality of life. Regression analyses of interview and clinical data from 159 dental patients show that while periodontal status and the number of dental symptoms do explain some of dental functional status, the clinical measures of decayed, missing, and filled teeth do not. Severity of medical condition is correlated with decayed/missing teeth and periodontal health. Quality of life is explained by medical functional status, perceived medical health, and perceived dental health. The dental functional status index may be useful in clarifying the relationship between dental health and overall health and quality of life measures.
Article
An epidemic caused by group C sulfonamide-resistant Neisseria meningitidis occurred during an eight-month period in two lower socioeconomic communities in Dade County, Florida. Five of 85 close contacts of patients (5.9%) contracted meningococcal disease. Nasopharyngeal carriage and serologic evidence of meningococcal infection were significantly more frequent among close contacts than among controls in the neighborhood. The risk of meningococcal infection was found to be significantly greater for persons who shared five-person bedrooms than for those who slept in less crowded bedrooms. A trial was conducted with rifampin among close contacts of patients. Rifampin eradicated meningococcal carriage in 92% of the treated group, and rifampin-resistant strains did not emerge. The data indicate the need for chemoprophylaxis of all close contacts of persons with meningococcal disease without regard for the results of nasopharyngeal cultures. Casual acquaintances (such as schoolmates) were not found to need prophylactic therapy.
Article
The capacity of dental clinicians and researchers to assess oral health and to advocate for dental care has been hampered by limitations in measurements of the levels of dysfunction, discomfort and disability associated with oral disorders. The purpose of this research was to develop and test the Oral Health Impact Profile (OHIP), a scaled index of the social impact of oral disorders which draws on a theoretical hierarchy of oral health outcomes. Forty nine unique statements describing the consequences of oral disorders were initially derived from 535 statements obtained in interviews with 64 dental patients. The relative importance of statements within each of seven conceptual subscales was assessed by 328 persons using Thurstone's method of paired comparisons. The consistency of their judgements was confirmed (Kendall's mu, P < 0.05). The reliability of the instrument was evaluated in a cohort of 122 persons aged 60 years and over. Internal reliability of six subscales was high (Cronbach's alpha, 0.70-0.83) and test-retest reliability (intraclass correlation coefficient, 0.42-0.77) demonstrated stability. Validity was examined using longitudinal data from the 60 years and over cohort where the OHIP's capacity to detect previously observed associations with perceived need for a dental visit (ANOVA, p < 0.05 in five subscales) provided evidence of its construct validity. The Oral Health Impact Profile offers a reliable and valid instrument for detailed measurement of the social impact of oral disorders and has potential benefits for clinical decision-making and research.
Article
Critical scrutiny of public health care and medical strategy depends, among other things, on how individual states of health and illness are assessed. One of the complications in evaluating health states arises from the fact that a person's own understanding of his or her health may not accord with the appraisal of medical experts. More generally, there is a conceptual contrast between “internal” views of health (based on the patient's own perceptions) and “external” views (based on the observations of doctors or pathologists). Although the two views can certainly be combined (a good practitioner would be interested in both), major tension often exists between evaluations based respectively on the two perspectives. The external view has come under considerable criticism recently, particularly from anthropological perspectives, for taking a distanced and less sensitive view of illness and health. 1 2 It has also been argued that public health decisions are quite often inadequately responsive to the patient's own understanding …
Article
Background: This introductory paper details the recruitment and standardization of a group of dentists participating in a clinical trial. The trial is being undertaken to determine the cost-effectiveness of a structured preventive programme compared to standard care within private dental practices. We recruited private dental practitioners from a variety of locations in New South Wales (NSW) and the Australian Capital Territory (ACT). We sought to quantify the diagnostic reliability of dentists involved, and to define, quantify, and analyse standard care. Methods: This is a multi-centre, clustered randomized controlled trial, where dentists are allocated to an intervention preventive or control group. Recruitment was facilitated with the support of key stakeholders and included oral presentations at divisional meetings of the Australian Dental Association, NSW Branch (ADA). A detailed time-in-motion study of 426 dental procedures was undertaken in order to define the parameters of standard care. The reliability study involved each dentist reading a set of 12 pairs of bitewing radiographs that had been produced and reviewed under standardized conditions. The reliability analysis was undertaken blind to allocation status of the dentist. Results: Recruitment ceased three months into the planned six-month recruitment period, 31 practices having approached the researchers. Eight suburban, five Central Business District (CBD), five rural (in fluoridated communities), and four rural (in non-fluoridated communities) practices have been recruited. Standard care did not differ significantly between intervention and control practices (Mann-Whitney U: z = -0.50; P = 0.6). Diagnostic reliability was substantial (Kappa = 0.79 [range 0.73-0.811 and 0.78 [range 0.72-0.82]) in relation to the intervention and control practices, respectively; P = 0.6. Conclusion: The involvement of private dental practices in research is feasible and well supported by the profession. Standard care does not differ significantly between intervention and control practices. Inter- and intra-observer reliability was substantial, and not statistically different between the two arms of the trial.
Oral health trends among adult public patients
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Brennan DS, Spencer AJ. Oral health trends among adult public patients. AIHW Cat No. DEN 127. Canberra: AIHW, 2004.
Health: Perception versus observation Address for correspondence/reprints: Dr Bradley Curtis 13511 Brentwood Lane Carmel
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Sen A. Health: Perception versus observation. BMJ 2002;324:860-861. Address for correspondence/reprints: Dr Bradley Curtis 13511 Brentwood Lane Carmel, Indiana 46033 United States of America Email: bradcurtis13@msn.com
Australian Research Centre for Population Oral Health. Oral health and access to dental care in Australia -Comparisons by cardholder status and geographic location
Australian Research Centre for Population Oral Health. Oral health and access to dental care in Australia -Comparisons by cardholder status and geographic location. Aust Dent J 2005;50:282-285.
Australian Institute of Health and Welfare. Australia's dental generations. The National Survey of Adult Oral Health 2004–06
Australian Institute of Health and Welfare. Australia's dental generations. The National Survey of Adult Oral Health 2004–06. AIHW Cat No. DEN 165. Canberra: AIHW, 2007.
Australian Research Centre for Population Oral Health. Geographic distribution of the dentist labour force
Australian Research Centre for Population Oral Health. Geographic distribution of the dentist labour force. Aust Dent J 2005;50:119-122.
Oral health trends among adult public patients. AIHW Cat No. DEN 127
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Brennan DS, Spencer AJ. Oral health trends among adult public patients. AIHW Cat No. DEN 127. Canberra: AIHW, 2004.