Changes and factors associated with dentists' willingness to treat patients with severe disabilities

Specialist Networks Influence Clinician Willingness to Treat Individuals with Special Needs

BACKGROUND

The South Australian Dental Service's Special Needs Network was established to support oral health professionals working within their statewide government-funded dental service to treat patients with special needs. This study aimed to investigate how a structured network relationship with specialists in special needs dentistry influenced the willingness of dentists to treat this group of patients.

METHODS

Semi-structured interviews were used to explore the views of specialists and dentists involved in the South Australian Dental Service's Special Needs Network. Inductive thematic analysis identified emerging themes enabling completion of a SWOT (strengths, weaknesses, opportunities, threats) analysis.

RESULTS

Dentists felt that a strength of the Network was a greater sense of collegiality, particularly for those working in rural areas. Although the inability to get immediate advice was seen as a weakness, dentists felt a more structured relationship with specialists improved communication pathways and resulted in more timely care. The aging workforce, systemic barriers in the public dental system, such as productivity pressures and infrastructure, and the lack of support from other health professionals were seen as ongoing barriers and threats. Regardless, dentists identified the use of telehealth and visiting specialists as future opportunities. Specialists felt that the Network was a valuable resource but were skeptical about its effectiveness, feeling that a limitation was the ability of dentists to recognize the complexity of cases.

CONCLUSIONS

Ongoing support from and communication with specialists in special needs dentistry through a structured network improved the perceived ability and willingness of dentists to treat patients with special needs.

KNOWLEDGE TRANSFER STATEMENT

This research suggests that providing support to dentists through a hub-and-spoke network that facilitates additional training, professional interaction, and improved communication with specialists in special needs dentistry may help overcome some of the current barriers to access to care experienced by individuals with special needs, particularly those associated with the willingness and capability of clinicians treat them.

Perceived barriers encountered by oral health professionals in the Australian public dental system providing dental treatment to individuals with special needs

AIMS

To investigate barriers experienced by clinicians treating individuals with special needs in the Australian public dental system.

METHODS AND RESULTS

Oral health professionals working at primary care clinics in the public dental system were invited to participate in semi-structured interviews or focus groups to discuss the challenges they faced in managing patients with special needs. Qualitative methods, employing inductive thematic analysis, revealed two primary barriers: 1. clinicians lacked confidence in their ability to treat patients with special needs because of insufficient training and experience, and difficulties obtaining information about their patients, and 2. barriers within the public dental system, including inadequate funding, equipment and facilities, and productivity pressures prevented clinicians from being able to provide the care patients required. The priority and understanding of the oral health for these individuals within the public dental system and wider disability sector was also raised.

CONCLUSION

A perceived lack of training and experience in managing individuals with special needs was a barrier to treating patients with special needs. Other significant barriers were under-resourcing of the public dental system and a lack of priority and understanding regarding oral health among carers of individuals with special needs and other health professionals.

Knowledge, Attitude, and Practices of Dental Practitioners in Thiruvananthapuram on Oral Health Care for Children with Special Needs

The objective of this study was to investigate knowledge, attitude, and practices of dental practitioners in Thiruvananthapuram, India regarding dental management of children with special healthcare needs (CSHCN).

MATERIALS AND METHODS

A structured questionnaire was given to 400 dental practitioners. The data were analyzed using SPSS software (version 23.0) and Chi-square test was used.

RESULTS

The response rate was 94%. An estimated 73.8% treated children, 66.5% showed willingness to treat CSHCN, and 70.8% had attended CSHCN in their practice. A partial knowledge in dental management of CSHCN was reported by 67.5%. An estimated 36% had undergone training in special care dentistry (SCD) but 45% were not sure whether they can provide dental care with the graduate-level training. Knowledge regarding guidelines for CSHCN was known to 19.5% and that regarding timing of the first dental visit was known to 69% of participants. Tooth extraction (43.1%) and a subsequent caries treatment (39.1%) were the most frequently done procedures, and nonpharmacological management (46.5%) was the mostly used behavior management technique. Among the barriers faced by dentists in treating CSHCN, time consumption (55.6%) and lack of training (55.1%) were commonly enlisted. Further training and improved facilities would motivate the respondents in providing better care to CSHCN.

CONCLUSION

This study suggests that majority of the dentists participated had a partial knowledge on SCD and were willing to treat CSHCN. Insufficient training in the field of SCD was a major drawback, which prevented most general dentists from effectively managing CSHCN. Additional training and improving facilities can improve dental care to CSHCN.

HOW TO CITE THIS ARTICLE

Rajan S, Kuriakose S, et al. Knowledge, Attitude, and Practices of Dental Practitioners in Thiruvananthapuram on Oral Health Care for Children with Special Needs. Int J Clin Pediatr Dent 2019;12(4):251-254.

Are dental care providers in Saudi Arabia prepared to treat patients with special needs?

Background: Equity in services accessibility is one of the major components of good quality healthcare. However, patients with special needs have limited access to dental care services, which could be due to the lack of training and experience of the dental care providers that might effect on their preparedness and willingness when it comes to caring for the patients with special needs.

Objectives: The main objective of this study is to determine the factors influencing the preparedness and willingness of dental care providers at different Saudi Arabian universities to provide treatment to patients with special needs.

Methods: A Cross-sectional study design targeting all dental care providers such as interns, residents, specialists, consultants, dental nurses and students from universities around Saudi Arabia. Two scales were adapted to determine the dental care providers’ perceived preparedness and willingness to treat patients with special needs.

Results: A total of 243 participants from dental colleges around Saudi universities were included in the study. Males appeared to be more prepared and willing to treat patients with special needs compared to females. Dental care providers from King Saud University perceived more preparedness compared to other universities in the study. While graduates from King Abdulaziz University exhibit more preparedness to treat patients with special needs compared to graduates from other universities in the study. Also, dental care providers who have treated a patient with special needs perceived more preparedness to treat them again.

Conclusion: When a dental care provider have treated a patient with special needs or just dealt with them in a daily life, this experience procured high preparedness score, however, did not influence on their willingness score in the treatment of these individuals. Good dental education programs are important to provide equity of dental care services to all parts of the community equally.

Preparedness and willingness of dental care providers to treat patients with special needs

This study aimed to review the available literature about special needs dentistry, factors affecting treatment of patients with special needs, dental education, and the preparedness and willingness of dental care providers to treat patients with special needs. The study also aimed to assess the validity and reliability of available scales that measure the preparedness of dental care providers to treat patients with special needs. Forty studies from esteemed refereed journals were reviewed in this article. The topics in the study were relevant to special needs dentistry, Saudi Arabia, and dental care providers' perceptions of treating patients with special needs. Reviewed studies were extracted from several electronic databases, such as PubMed and Medline. Studies in Saudi Arabia about special needs dentistry and the preparedness of dental care providers to treat patients with special needs are scarce. Further research in this area needs to be conducted in Saudi Arabia.

Perception of Special Needs Dentistry education and practice amongst Australian dental auxiliary students

INTRODUCTION

The role of dental auxiliaries in collaborative care of patients with special needs is compelling. This study was undertaken to investigate the perceptions of Special Needs Dentistry (SND) education and practice amongst students enrolled in Australian programmes in dental auxiliary, namely dental hygiene, dental therapy and oral health therapy (DH/DT/OHT).

MATERIALS AND METHODS

All Australian institutions offering DH/DT/OHT programmes (n = 14) were invited to participate in a self-administered questionnaire survey, conducted online, involving students across all academic years. Twelve institutions agreed to participate, but only five institutions were included in the final analysis, with a student response rate of 31.1%. Answers to open-ended questions were coded and grouped for measurement of frequencies. Quantitative data were analysed via chi-squared and Fisher's exact tests (significance taken as P < .05).

RESULTS

The majority of students could not define SND (87.0%) were not aware of the existence of this specialty (53.5%) and did not have clinical experience treating patients with special needs (68.9%). Nevertheless, they felt comfortable and positive about treating these patients independently. Most agreed that they should receive clinical and didactic education in SND, with many of them expressing interest in pursuing a specialty training in this field.

CONCLUSION

DH/DT/OHT students' comfort levels, positive attitudes and supportiveness for SND suggested positive implications for these practitioners to partake in multidisciplinary management of patients with special needs, thus indicating the need for standardised training requirements and practice guidelines in this area of care.

Factors associated with free adult preventive health care utilization among physically disabled people in Taiwan: nationwide population-based study

Background

Few previous studies have specifically addressed the health care utilization situation of the physically disabled. This study aimed to investigate the utilization of free adult preventive health care for physically disabled people and its’ affecting factors.

Methods

The data was obtained from three nationwide databases from 2006 to 2008. This study comprised 329,264 physically disabled people in Taiwan above the age of 40 who had eligible health checks during 2008. We employed descriptive statistics to analyze the use and rate of free preventive health care use by physically disabled adults. Logistic regression analysis was used to explore the factors that affect physically disabled adults’ use of free adult preventive health care.

Results

16.37% of the physically disabled adults used free adult preventive health care. Women (17.66%), married (17.16%), a junior high education level (17.89%), and mildly disabled adults (18.77%) had the highest use rate among various participant subgroups. The variables that significantly influenced the use of free adult preventive health care by the physically disabled included gender, age, education, marital status, urbanization of the residence areas, monthly payroll, aboriginal status, catastrophic illnesses status, relevant chronic diseases, and severity of disability.

Conclusions

Physically disabled using preventive health care tend to be low. Governments should use the media to reinforce propagation and education of these services to specific, low-utilization groups, and encourage doctors to actively provide preventive health care to communities.

Electronic supplementary material

The online version of this article (doi:10.1186/s12913-014-0610-5) contains supplementary material, which is available to authorized users.

Examining related influential factors for dental calculus scaling utilization among people with disabilities in Taiwan, a nationwide population-based study

Limited studies with large samples have been conducted on the utilization of dental calculus scaling among people with physical or mental disabilities. This study aimed to investigate the utilization of dental calculus scaling among the national disabled population. This study analyzed the utilization of dental calculus scaling among the disabled people, using the nationwide data between 2006 and 2008. Descriptive analysis and logistic regression were performed to analyze related influential factors for dental calculus scaling utilization. The dental calculus scaling utilization rate among people with physical or mental disabilities was 16.39%, and the annual utilization frequency was 0.2 times. Utilization rate was higher among the female and non-aboriginal samples. Utilization rate decreased with increased age and disability severity while utilization rate increased with income, education level, urbanization of residential area and number of chronic illnesses. Related influential factors for dental calculus scaling utilization rate were gender, age, ethnicity (aboriginal or non-aboriginal), education level, urbanization of residence area, income, catastrophic illnesses, chronic illnesses, disability types, and disability severity significantly influenced the dental calculus scaling utilization rate.

Disparities in the use of preventive health care among children with disabilities in Taiwan

Children with disabilities face more barriers accessing preventive health services. Prior research has documented disparities in the receipt of these services. However, most are limited to specific types of disability or care. This study investigates disparities in the use of preventive health care among children with disabilities in Taiwan. Three nationwide databases from the Ministry of the Interior, Bureau of Health Promotion, and National Health Research Institutes were linked to gather related information between 2006 and 2008. A total of 8572 children with disabilities aged 1-7 years were included in this study. Multivariate logistic regression analysis was conducted to adjust for covariates. Nationally, only 37.58% of children with disabilities received preventive health care in 2008. Children with severe and very severe disabilities were less likely to use preventive care than those with mild severity. Children with disabilities from the lowest income family were less likely to have preventive care than other income groups. Urbanization was strongly associated with the receipt of preventive health care. However, surprisingly, urban children with disabilities were less likely to receive preventive care than all others. Under universal health insurance coverage, the overall usage of preventive health care is still low among children with disabilities. The study also identified several disparities in their usage. Potential factors affecting the lack of use deserve additional research. Policymakers should target low socioeconomic brackets and foster education about the importance of preventive care. Mobile health services should be continually provided in those areas in need. Capitation reimbursement and other incentives should be considered in improving the utilization among children with disabilities.

The assessment of the likelihood of mammography usage with relevant factors among women with disabilities

Research that identifies the determinants of low mammography use among disabled people is scant. This study examines the determining factors related to the low usage of mammography among women with disabilities. To identify the barriers that prevent women with disabilities from participating in mammography screening can help authorities conceive feasibly useful strategies for avoiding worse suffering. With women aged between 50 and 69 as subjects, this study was conducted using the database of Ministry of the Interior, Taiwan, in 2008, coupled with information gathered between 2006 and 2008 on preventive health care and medical claim data from the Bureau of Health Promotion and the National Health Research Institutes, respectively. This study examined the factors determining the use of mammography with logistic regression analysis. Only 8.49% of the disabled women used mammographies. When women with disabilities were in higher income level, they were more likely to use mammography for breast cancer screening. Similar findings were found for education levels. Moreover, subjects with a more severe form of disability were less likely to use mammography with ORs of 0.84, 0.63, and 0.52. Disabled women with major organ malfunction, chronic mental illness, or mental retardation had a higher likelihood to use mammography services, whereas women with multiple disabilities had the lowest likelihood of usage. Those with experience using other preventive services showed 1.9 times to 7.54 times (95% CI: 1.82-1.98, 7.15-7.95, respectively) increased likelihood of mammography usage. In summary, mammography usage is relatively different for disabled and nondisabled populations. To mitigate the disparities, we can use community healthcare institutions or public health nurses and social workers to provide related preventive health services through community events to implement integrated cancer screening services.

Determining factors for utilization of preventive health services among adults with disabilities in Taiwan

Taiwan has provided free health checks for adults since 1995. However, very little previous research has explored the use of preventive health services by physically and mentally disabled adults. The present study aimed to understand this use of preventive health services and the factors that influence it. Research participants included disabled people registered in a Ministry of the Interior database in 2008 (a total of 785,746 adults who met the conditions for being physically or mentally disabled and using preventive health services). These data were merged with the Bureau of Health Promotion's 2006-2008 dataset on preventive health and the 2006-2008 health insurance database published by the National Health Research Institutes. In addition to descriptive and bivariate analysis, the study used logistic regression analysis to investigate the factors that influence the use of adult preventive health services. The results showed that 15.81% of physically and mentally disabled adults used preventive health services. The rate of use among females was significantly higher than the rate among males, and rates were higher among residents of relatively less urbanized areas. Usage rates were also universally higher among sufferers of chronic diseases. However, more serious disabilities had lower usage rates. From the logistic regression analysis, we ascertained that the factors that influenced the use of preventive health services were gender, age, level of urbanization, monthly salary, low-income household status, aboriginal status, catastrophic disease/injury status, chronic diseases, type of disability, and severity of the disability. The study's main conclusion is that although Taiwan's Department of Health has provided free preventive health services for more than 15 years, the usage rate of this care among the disabled remains low. Demographic features, health status, and type of disability are the main factors influencing the use of preventive healthcare services.

The use of fluoride varnish and its determining factors among children with disability in Taiwan

The oral health of children with disability is often not as good as that of other children. In view of improving their oral health, this study aims to explore the utilization of fluoride varnish services among children with disability in Taiwan and its relevant influencing factors. With children under the age of 5 as subjects, this study is conducted based on the database of Ministry of the Interior, Executive Yuan, ROC in 2008, coupled with information gathered between 2006 and 2008 on preventive health care and health insurance from the Bureau of Health Promotion and the National Health Research Institute, respectively. In addition to descriptive statistics and bivariate analysis, this study examined the factors determining the use of fluoride varnish with logistic regression analysis. Research revealed that fluoride varnish is used by up to 9.84% of children with disability; the use increases with age and decreases with increased level of disability, but is remarkably higher in those with catastrophic illness/injury. The probability of fluoride varnish use is lower among those living in areas of lower urbanization (levels 5-7) and higher among those whose parents have higher premium-based monthly salaries. Recommendations include (1) providing a differential pricing scheme for fluoride varnish based on the level of disability of the child, (2) promoting proactively among dentists to carry out regular fluoride varnish in rural areas and collaboration with pediatricians to provide convenient services and (3) targeting families in low socioeconomic brackets, improving knowledge of fluoride varnish.