Association between disability status and dental attendance in Australia-A population-based study

Supporting the oral health of people with intellectual disability: A survey of disability staffs' knowledge, perceptions, disability service barriers, and training

BACKGROUND

People with intellectual disabilities experience poorer oral health outcomes, which can negatively impact their quality of life. Disability support staff who support peoplewith an intellectual disability have the potential to assist with oral hygiene. However, there is limited understanding of the current practices of disability support staff around oral health, particularly in Australia.

OBJECTIVE

To describe disability support staff knowledge about oral health, explore their practice perceptions when supporting people with intellectual disabilities around oral health and their experiences of oral health training.

METHODS

A national cross-sectional survey was undertaken with 156 disability support staff across Australia. Recruitment was via publicly available websites of disability services and social media.

RESULTS

Disability staff were generally knowledgeable about appropriate oral hygiene practices and risks to oral health. They were less knowledgeable about the links between poor oral health and chronic diseases (<40%) and the importance of oral care for individuals who are fed enterally. Most participants (>80%) felt oral health was an important part of their care and were interested in further oral health training. Staff in semi-assisted living felt they had more time for oral health tasks compared to home-based living and residential facilities (p = 0.007). Lack of oral health training programs was the main barrier cited (44%), with only a quarter receiving any training in this area.

CONCLUSIONS

Disability support staff are receptive to promoting oral health. More training around oral health and intellectual disability is needed for this workforce to support them in undertaking this role.

Disparity in access for people with disabilities to outpatient dental care services: a retrospective cohort study

BACKGROUND

People with disabilities face difficulties in oral health management and gaining access to dental care. The availability of a regular source of dental care (RSDC) is an important factor that influences the access to health services and care management. The purpose of this study was to determine the effect of the availability of RSDC on the number of annual dental visits and dental expenses per visit among people with disabilities.

METHODS

Data of 7,896,251 patients with dental problems in South Korea were analyzed using the 2002-2018 National Health Insurance claims data. A generalized estimating equation was applied to analyze the repeated-measurement data, and the interaction effect between RSDC and the disability severity was evaluated.

RESULTS

The number of annual dental visits was higher among people with (2.62) than among those without (2.23) disabilities. Despite their increased dental needs, both annual dental visits and dental expenses per visit were low among older individuals (p < 0.001). The proportion and frequency of annual dental visits was lower among women than among men with disabilities. RSDC had differential effects on the severity of disability. Compared to people without disabilities, RSDC increased the number of annual dental visits (p = 0.067) and the dental expenses per visit (p < 0.05) among those with severe disabilities, but the effect on the number of annual dental visits was not significant among those with mild disabilities (p = 0.698).

CONCLUSIONS

Our results suggest a need for a special dental care system for people with disabilities, to ensure an RSDC, particularly for women and for older people with disabilities.

Dental procedures in children with or without intellectual disability and autism spectrum disorder in a hospital setting

BACKGROUND

This population-based cohort study investigated dental procedures in the hospital setting in Western Australian children with or without intellectual disability (ID) and/or autism spectrum disorder (ASD) aged up to 18 years. Considering previously reported disparities in dental disease between Indigenous and non-Indigenous Australian children, this study also investigated the effect of Indigenous status on dental procedures.

METHODS

Data on Western Australian live births from 1983 to 2010 from the Midwives Notification System were linked to the Intellectual Disability Exploring Answers database and the Hospital Morbidity Data collection. Primary admissions for relevant dental diagnoses were identified, and treatment procedures for dental hospitalization were investigated. Descriptive statistics and Pearson's chi-squared test of independence were used for analysis.

RESULTS

Overall, 76 065 episodes of dental hospitalization were recorded. Amongst children with ID and/or ASD, Indigenous children experienced more extractions and fewer restorations (68.7% and 16.2%) compared to non-Indigenous children (51.5% and 25.9%). After 6 years, extraction occurred less often in children with ID and/or ASD than in those without, where most surgical dental extractions were in the age group of 13-18 years.

CONCLUSIONS

This study indicates a need for further improvements in access to dental services and the quality of care provided in hospitals for children with ID/ASD. There is also concern that more vulnerable Indigenous and all disadvantaged children are receiving an inadequate level of dental services resulting in more emergency dental hospitalization and invasive treatment.

Mentoring of oral health professionals is crucial to improving access to care for people with special needs

Introduction

Individuals with special health care needs continue to experience difficulties with accessing regular dental care. This has largely been due to clinicians feeling they lack the training and experience to manage their needs. The aim of this study was to determine whether working closely with specialists in special need dentistry influenced the willingness of clinicians to treat patients with special needs.

Materials and methods

Semi-structured interviews were conducted with specialists and clinicians involved in these mentoring initiatives. Qualitative thematic analysis was used to determine perspectives towards how this additional support influenced their willingness to treat individuals with special needs.

Results

The views of all participants towards these supports were positive with clinicians feeling it not only offered them opportunities to learn from the specialists, but also increased their willingness to treat individuals with special needs and the timeliness and quality of care they were able to provide. Likewise, despite some concerns about the inappropriate use of specialist support, the specialists felt these mentoring relationships offered many benefits including improving timely access to care and ensuring individuals were able to receive appropriate care.

Conclusions

Mentoring provided by specialists in special needs dentistry improved the willingness of clinicians to provide care for individuals with special health care needs. Supports such as these are likely to be crucial to overcoming concerns of clinicians about their ability to manage the needs of these individuals and begin to address a significant barrier to access of care for individuals with special health care needs.

Oral health care for people with disabilities in Brazil: Transition from the specialized dental services between 2014 and 2018

OBJECTIVE

To identify changes in the dental service provision to people with disabilities (PD) in the Dental Specialties Centers (acronym CEO in Portuguese-Centro de Especialidades Odontológicas) between the first and second cycles of the Program for the Improvement of Access and Quality of CEO and analyse factors associated with any changes.

METHODS

This nationwide ecological time series study adopted the CEO as the analysis unit. The 827 CEO who participated in the two program's cycles (2014 and 2018) were included. Data on the structure and the work process were considered to identify features of providing services to PD in both cycles. Latent transition analysis (LTA) was performed to identify latent status (LS) with similar features and model the transition between LS over time. Models with five variables and with two to five LS were tested, considered best conceptual interpretability and best model fit parameters: human resources structure (dentist working exclusively with PD) and work process that identified guarantee of PD treatment at the CEO, the CEO's interface with primary care, and the interface with tertiary care. Spatial analysis was performed to identify spatial patterns of LS in the Brazilian territory with choropleth maps. A multinomial logistic regression model was performed to identify factors associated with changes in the provision of CEO (improved, remained or worsened).

FINDINGS

The best-fit model identified four LS: 'Better', 'Medium better', 'Medium worse' and 'Worse'. CEO remained in the LS 'Better' (94%), LS 'Medium' (5.3%) and LS 'Worse' (78.4%). It is noteworthy that the highest proportion of CEO, in both cycles, was in the LS 'Better', featured by the CEO, characterized by all the CEO guaranteeing treatment to users with PD, high proportions of professionals working exclusively with PD, and most CEO articulated with primary care and with tertiary care. However, there is a decrease in the number of postgraduate professionals specializing in this service profile (1.3%). The higher the population growth, the greater the likelihood of the CEO achieving 'improved' in the LS. Moreover, the higher the number of goals, the lower the likelihood of the CEO getting 'worse' in the LS.

CONCLUSION

Advances in dental service provision were observed, with more significant transitions to the 'Better' class, with improvements mainly in the interface with primary and tertiary care. Disability will be an even more significant concern as the population ages. Initiatives that can remove barriers and empower PD are potent in the provision of oral health services.

Age and gender differences in the relationship between obesity and disability with self-perceived employment discrimination: Results from a retrospective study of an Australian national sample

BACKGROUND

Health status is a crucial determinant of an individuals' labour market outcomes. The present study investigates the association between obesity and disability with perceived employment discrimination within Australia.

METHODS

A total of 17,174 person-year observations from the 11,079 respondents were analysed using four waves of data from the Household, Income, and Labour Dynamics in Australia (HILDA) survey. The primary outcome examined was employment discrimination, using obesity and disability as the main exposure variables. The longitudinal random-effects regression technique was applied to investigate the between-person differences in employment discrimination associated with obesity and disability.

RESULTS

The findings suggest that more than one in ten (12.68 %) Australians experienced employment discrimination. The odds of being discriminated against while applying for a job were 1.56 times (aOR: 1.56, 95 % CI: 1.15-2.11) higher for obese than their healthy weight counterparts in youngest women. Adults with a disability had 1.89 times (aOR: 1.89, 95 % CI: 1.65-2.17) higher odds of being discriminated against than peers without disability.

CONCLUSION

The results provide evidence that obesity and disability contribute to employment discrimination in Australia. The findings can assist government and related agencies to consider the adequacy of existing discrimination legislation and help organisations to develop appropriate policies to address discrimination against obese and disabled people in their workplaces.

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.

Self-reported disability and its association with obesity and physical activity in Australian adults: Results from a longitudinal study

BACKGROUND

A high prevalence of disability has been previously observed in developed countries. Identifying trends in its prevalence and risk, as well as protective factors of disability, are essential to establish effective prevention strategies.

OBJECTIVE

The purposes of this study are to outline trends in the prevalence of disability among Australian adults and to analyse the relationship between obesity, and physical activity with disability.

DESIGN

A retrospective longitudinal research design.

METHODS

The study utilized the most recent 14 waves (wave 6 through 19) of the nationally-representative Household, Income and Labour Dynamics in Australia (HILDA) survey (2006-2019). The Generalized Estimating Equation (GEE) with the logistic link function model was employed to estimate the relationships between obesity and physical activity with disability. The final study sample consisted of 189,519 person-year observations from 26,208 participants.

RESULTS

The pooled prevalence of disability in adults is 28%. The prevalence of disability among older adults (65 and above years) is more than 50%, irrespective of gender. Further, it identifies obesity and physical activity as risk and protective factors of disability for adults, respectively. The odds of acquisition of a disability was 1.33 times (Odds Ratios [OR]: 1.33, 95% Confidence Interval [CI]: 1.28-1.39) higher among obese adults than healthy weight counterparts. However, adults undertaking recommended level of physical activity (more than thrice a week to everyday) per week have 17% (OR: 0.83, 95% CI: 0.81-0.85) lower chances of disability acquisition.

CONCLUSIONS

Obesity imposes a significant toll on adult Australians' health. This risk factor of disability can be reduced through public health interventions.

Perspectives of the public dental workforce on the dental management of people with special needs

BACKGROUND

People with special health care needs continue to have difficulties accessing regular dental care partly due to oral health professionals feeling they lack the knowledge and experience to provide treatment to these individuals.

METHODS

Qualitative interviews and focus groups provided an insight into the types and nature of supports that oral health professionals working in the Australian public dental system desired and felt may improve their willingness and/or ability to treat patients with special needs.

RESULTS

Although participants did not identify one group of patients with special needs that were more difficult to treat, they did report a feeling of being unsupported. Clinicians felt that improved training and access to ongoing education in Special Needs Dentistry, opportunities for greater support from specialists or other health professionals, either through networking or other media such as telehealth, and fostering a more supportive clinical environment, particularly in relation to appointment lengths and productivity pressures, may improve their willingness and ability to treat patients with special needs.

CONCLUSIONS

Additional support, in the form of greater interaction with specialists and reduced time and productivity pressures, may improve the willingness of oral health professionals in the public dental system to treat patients with special needs.

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.