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Bradley N. The role of mobile dental units in providing care to vulnerable communities. Br Dent J 2023; 235:850-851. [PMID: 38066128 DOI: 10.1038/s41415-023-6649-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Affiliation(s)
- Natalie Bradley
- Clinical Director, Dentaid the Dental Charity, United Kingdom.
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Serban S, Bradley N, Atkins B, Whiston S, Witton R. Best practice models for dental care delivery for people experiencing homelessness. Br Dent J 2023; 235:933-937. [PMID: 38102260 DOI: 10.1038/s41415-023-6455-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 05/24/2023] [Accepted: 05/29/2023] [Indexed: 12/17/2023]
Abstract
People experiencing homelessness have been encountering significant barriers in accessing healthcare services, including dental care services. There are several definitions for homelessness: it includes people sleeping rough but also people living in temporary accommodation. These categories are dynamic and individuals often find themselves on a continuum oscillating between sleeping rough and living in temporary accommodation. Their health-seeking behaviours are shaped by their living arrangements; therefore, one single model of dental care service delivery might not capture the needs of all those experiencing homelessness within an area. The service models presented in this paper are based on primary care delivery, mobile dental units and community clinics. Each of these models presents advantages and disadvantages and consideration should be given to delivering these on a complementary basis to maximise access to dental care, regardless of where patients are on the continuum between sleeping rough and living in temporary accommodation.
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Affiliation(s)
- Stefan Serban
- School of Dentistry, Faculty of Medicine and Health, University of Leeds, UK; Public Health Directorate, NHS England North West Region, Manchester, UK; School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, United Kingdom.
| | | | - Ben Atkins
- The Oral Health Foundation, Warwickshire, United Kingdom
| | - Sandra Whiston
- NHS England North East and Yorkshire, Leeds, United Kingdom
| | - Robert Witton
- University of Plymouth Faculty of Health, Medicine, Dentistry and Human Sciences, Derriford Dental Education Facility, 20 Research Way, Plymouth Science Park, Plymouth, PL6 8BT, United Kingdom
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Bradley N, Heidari E, Andreasson S, Newton T. Models of dental care for people experiencing homelessness in the UK: a scoping review of the literature. Br Dent J 2023; 234:816-824. [PMID: 37291313 DOI: 10.1038/s41415-023-5904-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 01/23/2023] [Accepted: 02/07/2023] [Indexed: 06/10/2023]
Abstract
Background People who experience homelessness have poor oral health and face barriers to accessing care. Recommendations have been outlined for health services to address their needs, termed 'inclusion health'. The Smile4Life report recommended three 'tiers' of dental service: emergency, ad hoc and routine care. Other medical services have developed into different models of care, for example mainstream practices with enhanced services for people who experience homelessness. There is little understanding of how inclusion health recommendations have been implemented across dental settings.Aims To describe and compare dental services that exist for people who experience homelessness in the UK.Methods Two Medline searches were performed in October 2020 to assess the models of dental care for people who experience homelessness in the UK.Results Nine dental services in the UK were identified who treated people who experience homelessness. Most did not explore definitions of homelessness. There were a mixture of models, including using blended approaches, such as different sites and appointment types, to flex to the needs of their population.Conclusion Many services that are dedicated to treat this population are based in the community dental services which allows for flexible models of care due to sporadic patient attendance, high treatment requirements and complex needs. More research is required to determine how other settings can accommodate these patients, as well as understanding how more rural populations access dental care.
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Affiliation(s)
| | | | | | - Tim Newton
- King´s College London, London, United Kingdom
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Macdonald ME, Muirhead V, Doughty J, Freeman R. Critically engaging vulnerability: Rethinking oral health with vulnerabilized populations. Community Dent Oral Epidemiol 2022; 50:469-475. [PMID: 34751455 DOI: 10.1111/cdoe.12703] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 07/08/2021] [Accepted: 10/08/2021] [Indexed: 01/27/2023]
Abstract
This paper is the third in a series of narrative reviews challenging core concepts in oral health research and practice. Our series started with a framework for Inclusion Oral Health. Our second review explored one component of this framework, looking at how intersectionality adds important complexity to oral public health. This current manuscript drills into a second component of Inclusion Oral Health, exploring how labels can lead to 'othering' thereby misrepresenting populations and (re)producing harms. Specifically, we address a common oral public health label: vulnerable populations. This term is commonly used descriptively: an adjective (vulnerable) is used to modify a noun (population). What this descriptor conceals is the 'how,' 'why,' and 'therefore' that leads to and from vulnerability: How and why is a population made vulnerable; to what are they vulnerable; what makes them 'at risk,' and to what are they 'at risk'? In concealing these questions, we argue our conventional approach unwittingly does harm. Vulnerability is a term that implies a population has inherent characteristics that make them vulnerable; further, it casts populations as discrete, homogenous entities, thereby misrepresenting the complexities that people live. In so doing, this label can eclipse the strengths, agency and power of individuals and populations to care for themselves and each other. Regarding oral public health, the convention of vulnerability averts our research gaze away from social processes that produce vulnerability to instead focus on the downstream product, the vulnerable population. This paper theorizes vulnerability for oral public health, critically engaging its production and reproduction. Drawing from critical public health literature and disability studies, we advance a critique of vulnerability to make explicit hidden assumptions and their harmful outcomes. We propose solutions for research and practice, including co-engagement and co-production with peoples who have been vulnerabilized. In so doing, this paper moves forward the potential for oral public health to advance research and practice that engages complexity in our work with vulnerabilized populations.
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Affiliation(s)
- Mary Ellen Macdonald
- Faculty of Dentistry, and Institute of Health Sciences Education, McGill University, Montreal, Quebec, Canada
| | - Vanessa Muirhead
- Centre for Dental Public Health and Primary Care, Institute of Dentistry, Barts and The London, School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Janine Doughty
- Pathway Homelessness and Inclusion Oral Health Fellow, University College London Hospitals NHS Foundation Trust, London, UK
| | - Ruth Freeman
- Dental Health Services Research Unit, School of Dentistry, University of Dundee, Dundee, UK
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McNeill S, O'Donovan D, Hart N. Access to healthcare for people experiencing homelessness in the UK and Ireland: a scoping review. BMC Health Serv Res 2022; 22:910. [PMID: 35831884 PMCID: PMC9281084 DOI: 10.1186/s12913-022-08265-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 06/23/2022] [Indexed: 11/10/2022] Open
Abstract
Background People experiencing homelessness (PEH) have poorer physical and mental health than the general population. They are also more likely to have less access to healthcare. These processes of access can be better understood using Levesque’s access framework which addresses both supply (service provision) and demand (user abilities). Methods Following the Joanna Briggs Institute (JBI) guidelines, electronic peer-reviewed databases were searched in February 2022 for studies published since 2000 related to access to healthcare for PEH ages 16 and older in the United Kingdom (UK) and Ireland. Retrieved articles were screened and those eligible were selected for data extraction. Qualitative and quantitative studies were included. Results Fifty-six papers out of 538 identified were selected and aliased. Six main themes were identified: staff education, flexibility of systems, service coordination, patient preparedness, complex health needs and holistic care. These relate to the Levesque access framework. Conclusions Improving access to healthcare for PEH requires changes to how services are provided and how service-user abilities are supported. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08265-y.
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Affiliation(s)
- Sarah McNeill
- Centre for Public Health, Queen's University Belfast, Institute of Clinical Science, Block A, Royal Victoria Hospital, Belfast, Northern Ireland, BT12 6BA.
| | - Diarmuid O'Donovan
- Centre for Public Health, Queen's University Belfast, Institute of Clinical Science, Block A, Royal Victoria Hospital, Belfast, Northern Ireland, BT12 6BA
| | - Nigel Hart
- Centre for Public Health, Queen's University Belfast, Institute of Clinical Science, Block A, Royal Victoria Hospital, Belfast, Northern Ireland, BT12 6BA
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Doughty J, Grossman A, Paisi M, Tran C, Rodriguez A, Arora G, Kaddour S, Muirhead V, Newton T. A survey of dental services in England providing targeted care for people experiencing social exclusion: mapping and dimensions of access. Br Dent J 2022:10.1038/s41415-022-4391-7. [PMID: 35725913 PMCID: PMC9208541 DOI: 10.1038/s41415-022-4391-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 11/16/2021] [Indexed: 11/13/2022]
Abstract
Introduction Poor oral health and barriers to accessing dental services are common among people experiencing social exclusion. This population experience a disproportionate and inequitable burden of oral disease. A small number of dental services have published models of care that target this population, but no national surveys have been conducted.Aims This study aims to identify what types of services are providing dental and oral healthcare for people experiencing social exclusion in England and the models of delivery adopted by these services.Methods A snowballing sampling strategy was used to identify services that provide targeted for adults experiencing social exclusion. The study used a survey to collect data about the location, service models and barriers and enablers of these services.Results In total, 74 responses from different services met the inclusion criteria for the study. Seventy one were included in the mapping exercise and 53 provided free-text comments that contributed to an understanding of barriers and enablers of services.Discussion Most services operated to meet the needs of the mainstream population and described inflexibilities in their service design models as barriers to providing care for socially excluded groups.Conclusion Limitations of current models of service delivery create frustrations for providers and people experiencing social exclusion. Creative commissioning and organisational flexibility are key to facilitating adaptable services.
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Affiliation(s)
- Janine Doughty
- Inclusion Oral Health Fellow, Pathway Charity, University College London Hospitals, UK.
| | - Alina Grossman
- Senior Clinical Policy Manager, Office of Chief Dental Officer England, UK
| | - Martha Paisi
- Institute of Dentistry, Faculty of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Christina Tran
- Specialty Dentist, Oral and Maxillofacial Surgery, York and Scarborough Teaching Hospitals NHS Foundation Trust, UK
| | | | | | - Sarah Kaddour
- Inclusion Oral Health Fellow, Pathway Charity, University College London Hospitals, UK
| | - Vanessa Muirhead
- Centre for Dental Public Health and Primary Care, Institute of Dentistry, Barts and the London School of Medicine and Dentistry, Queen Mary University London, London, UK
| | - Tim Newton
- Professor of Psychology as Applied to Dentistry at King´s College London Faculty of Dentistry, Oral and Craniofacial Sciences, King´s College London, UK
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Systematic Review of the Literature on Dental Caries and Periodontal Disease in Socio-Economically Disadvantaged Individuals. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312360. [PMID: 34886085 PMCID: PMC8656978 DOI: 10.3390/ijerph182312360] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 11/12/2021] [Accepted: 11/19/2021] [Indexed: 12/23/2022]
Abstract
Dental caries and periodontal disease represent a health problem and a social cost for the entire population, and in particular for socio-economically disadvantaged individuals who are less resistant to disease. The aim of this review is to estimate the prevalence and severity of the two dental pathologies, caries and periodontal disease, in the different classes of socio-economically disadvantaged subjects and to understand which of them are most affected. A systematic search of the literature was performed in MEDLINE (via PubMed), EMBASE and Web of Science after establishing a suitable search strategy for each database, using keywords related to socio-economically vulnerable classes and health outcomes. Socio-economically disadvantaged individuals are more susceptible to tooth decay and periodontal disease (with relative tooth loss) than non-vulnerable people. Additionally, when multiple vulnerabilities are combined in the same subject, these oral diseases worsen. There is no type of vulnerability more affected by caries and periodontitis than others, since overall they all have severe disease indices. The data from this systematic literature review might be useful for health policy makers looking to allocate more resources and services to socially disadvantaged individuals, resulting in making them more resilient to oral disease due to their social marginalization.
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Holmes CT, Holmes KA, MacDonald A, Lonergan FR, Hunt JJ, Shaikh S, Cheeti R, D'Etienne JP, Zenarosa NR, Wang H. Dedicated homeless clinics reduce inappropriate emergency department utilization. J Am Coll Emerg Physicians Open 2020; 1:829-836. [PMID: 33145527 PMCID: PMC7593501 DOI: 10.1002/emp2.12054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 02/28/2020] [Accepted: 03/04/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The homeless patient population is known to have a high occurrence of inappropriate emergency department (ED) utilization. The study hospital initiated a dedicated homeless clinic targeting patients experiencing homelessness with a combination of special features. We aim to determine whether this mode of care can reduce inappropriate ED utilization among homeless patients. METHODS We conducted a retrospective observational study from July 1, 2017 to Dec 31, 2017. The study enrolled all homeless patients who visited any hospital regular clinic, dedicated homeless clinic, and ED at least once during the study period. ED homeless patients were divided into four groups (A: no clinic visits; B: those who only visited hospital regular clinic; C: those who only visited dedicated homeless clinic; and D: those who visited both hospital regular clinic and dedicated homeless clinic). The New York University algorithm was used to determine appropriate ED utilization. We compared inappropriate ED utilization among patients from these groups. Multivariate logistic regression was used to determine the risks of different clinical visits in association with inappropriate ED utilization. RESULTS A total of 16,323 clinic and 8511 ED visits occurred among 5022 unique homeless patients, in which 2450 unique patients were seen in hospital regular clinic, 784 patients in dedicated homeless clinic, 688 patients in both hospital regular clinic and dedicated homeless clinic, and 1110 patients with no clinic visits. Twenty-nine percent (230/784) of patients from dedicated homeless clinic utilized the ED, among which 21% (175/844) of their ED visits were considered inappropriate. In contrast, 40% of patients from hospital regular clinic utilized the ED, among which 29% were inappropriate (P < 0.001). The adjusted odds ratio (OR) was 0.61 (95% confidence interval [CI] = 0.50-0.74, P < 0.001) on dedicated homeless clinic predicting inappropriate ED visits in multivariate logistic regression. CONCLUSION Implementing a dedicated homeless clinic with these features can reduce ED inappropriate utilization among patients experiencing homelessness.
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Affiliation(s)
- Chad T. Holmes
- Department of Emergency MedicineJohn Peter Smith Health NetworkFort WorthTexas
- Integrative Emergency ServicesDallasTexas
| | - Katherine A. Holmes
- Department of Emergency MedicineJohn Peter Smith Health NetworkFort WorthTexas
- Integrative Emergency ServicesDallasTexas
| | - Andrew MacDonald
- Department of Emergency MedicineJohn Peter Smith Health NetworkFort WorthTexas
| | - Frank R. Lonergan
- Department of Family MedicineJohn Peter Smith Health NetworkFort WorthTexas
| | - Joel J. Hunt
- Department of Family MedicineJohn Peter Smith Health NetworkFort WorthTexas
| | - Sajid Shaikh
- Department of Information TechnologyJohn Peter Smith Health NetworkFort WorthTexas
| | - Radhika Cheeti
- Department of Information TechnologyJohn Peter Smith Health NetworkFort WorthTexas
| | - James P. D'Etienne
- Department of Emergency MedicineJohn Peter Smith Health NetworkFort WorthTexas
- Integrative Emergency ServicesDallasTexas
| | - Nestor R. Zenarosa
- Department of Emergency MedicineJohn Peter Smith Health NetworkFort WorthTexas
- Integrative Emergency ServicesDallasTexas
| | - Hao Wang
- Department of Emergency MedicineJohn Peter Smith Health NetworkFort WorthTexas
- Integrative Emergency ServicesDallasTexas
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Doughty J, Johnson A, Tatari A, Kothari C, Patel R, Newman A, Yazdi M, O’Leary F, Shah N. A pilot denture service collaboration between Den-Tech denture charity and Crisis at Christmas Dental Service (CCDS): A Plan-Do-Study-Act analysis. Br Dent J 2020; 228:183-190. [DOI: 10.1038/s41415-020-1253-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Goode J, Hoang H, Crocombe L. Strategies to improve access to and uptake of dental care by people experiencing homelessness in Australia: a grey literature review. AUST HEALTH REV 2019; 44:297-303. [PMID: 31262395 DOI: 10.1071/ah18187] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 01/25/2019] [Indexed: 11/23/2022]
Abstract
Objectives The poor oral health of Australians experiencing homelessness negatively affects their quality of life. Better oral health is associated with having annual dental check-ups. Because there is limited peer-reviewed literature describing strategies that improve access to and uptake of dental care by homeless people, in this study we searched the grey literature to discover what strategies are used. Methods The Informit database and Google and Bing search engines were searched using the keywords 'homeless and oral and dental services'. Bing and Google were searched unrestricted by site and Google was searched for sites ending in 'org.au'. Searches were restricted to Australia from June 2008 to June 2018. The first 300 websites were read, and those describing or linking to pages describing a strategy that improved access to or uptake of dental care were included in the study. The content of the webpages was evaluated and summarised, with common strategies reported as a narrative description. Results Nineteen programs were described. Common strategies were providing free care, in-reach care, outreach care and the need to work closely with support organisations. Conclusions To improve access to and uptake of dental care by people experiencing homelessness, dental services need to be free and organised in collaboration with support organisations. What is known about the topic? The peer-reviewed literature describing strategies used to improve access to and uptake of dental care by people experiencing homelessness in Australia is limited. The authors could only locate two such studies, one based in Melbourne and one in Brisbane. Both programs had a similar aim, but used different strategies to achieve it, suggesting a lack of consensus about the best way to encourage dental visiting by people experiencing homelessness. What does this paper add? This paper used the grey literature to describe common strategies used in Australia to improve access to and uptake of dental care by people experiencing homelessness. What are the implications for practitioners? Dental service providers aiming to increase access to and uptake of dental care by people experiencing homelessness need to work collaboratively with support organisations and provide care free of charge.
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Affiliation(s)
- Jacqueline Goode
- Centre for Rural Health, School of Health Sciences, University of Tasmania, Locked Bag 1322, Launceston, Tas. 7250, Australia. ; and Department of Dentistry and Oral Health, Rural Health School, La Trobe University, PO Box 199, Bendigo, Vic. 3552, Australia; and Corresponding author.
| | - Ha Hoang
- Centre for Rural Health, School of Health Sciences, University of Tasmania, Locked Bag 1322, Launceston, Tas. 7250, Australia.
| | - Leonard Crocombe
- Centre for Rural Health, School of Health Sciences, University of Tasmania, ABC Building, 1 Liverpool Street, Hobart, Tas. 7000, Australia.
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