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Han C, Lin C, Raichur A, Hall M, Nguyen TM. Leadership, regulatory approaches and policy to re-orientate health services towards health promotion. Health Promot Int 2024; 39:daae050. [PMID: 38809234 PMCID: PMC11135209 DOI: 10.1093/heapro/daae050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2024] Open
Abstract
Globally, oral conditions remain the most prevalent of all non-communicable diseases. Among the broad range of target goals and recommendations for action by the World Health Organization's Global Oral Health Strategy, we call out three specific actions that provide an enabling environment to improve population oral health including: (i) enabling population oral health reform through leadership, (ii) enabling innovative oral health workforce models, (iii) enabling universal health coverage that includes oral health. The aim of the article is to outline how leadership, regulatory approaches and policy in Australia can strengthen health promotion practice and can inform global efforts to tackle the complex wicked problems associated with population oral health. Examples in Australia show that effective leadership, regulatory approaches and well-designed policies can address the growing burden of non-communicable diseases, and are made possible through public health advocacy, collaboration and research.
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Affiliation(s)
- Chun Han
- Dental Health Services Victoria, Level 1, 720 Swanston Street, Carlton, Victoria, 3053, Australia
| | - Clare Lin
- Dental Health Services Victoria, Level 1, 720 Swanston Street, Carlton, Victoria, 3053, Australia
- Melbourne Dental School, University of Melbourne, Level 1, 720 Swanston Street, Carlton, Victoria, 3053, Australia
| | - Anil Raichur
- Victorian Department of Health, 50 Lonsdale Street, Melbourne, Victoria, 3000, Australia
| | - Martin Hall
- Dental Health Services Victoria, Level 1, 720 Swanston Street, Carlton, Victoria, 3053, Australia
- Melbourne School of Population & Global Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, 207 Bouverie Street, Carlton, Victoria, 3053, Australia
| | - Tan Minh Nguyen
- Dental Health Services Victoria, Level 1, 720 Swanston Street, Carlton, Victoria, 3053, Australia
- Institute for Health Transformation, Deakin Health Economics, Deakin University, 221 Burwood Highway, Burwood, Victoria, 3125, Australia
- Health Economics Group, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences. Monash University, Level 4, 553 St Kilda Road, Melbourne, Victoria, 3004, Australia
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Jadidfard MP, Tahani B. Painless cost control as a central strategy for universal oral health coverage: A critical review with policy guide. Int J Dent Hyg 2024. [PMID: 38764157 DOI: 10.1111/idh.12818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Revised: 04/19/2024] [Accepted: 04/29/2024] [Indexed: 05/21/2024]
Abstract
AIM This study aimed to critically review the methods used to control the significantly increasing costs of dental care. METHODS Through a comprehensive search of the available literature, the cost control (CC) mechanisms for health services were identified from a healthcare system perspective. The probable applicability of each CC method was evaluated mainly based on its potential contribution to oral health promotion. Each mechanism was then classified and discussed under any of the two headings of financing and service provision. An operational guide was finally presented for policy-making in each of the three main models of healthcare systems, including National Health Services, social/public health insurance and private insurance. RESULTS From a total of 142 articles/reports retrieved in PubMed, 73 in Scopus and 791 in Google Scholar, 35 were included in the final review after eliminating the duplicates and screening process. Totally ten mechanisms were identified for CC of dental care. Seven were discussed under the financing function, including cost sharing, preauthorization, mixed payment method and an evidence-based approach to benefit package definition, among others. Three further methods were classified under the service provision function, including workforce skill mix with emphasis on primary oral healthcare providers, development of primary healthcare (PHC) network and an appropriate use of tele-dentistry. CONCLUSION Painless control of dental expenditures requires a smart integration of prevention into the CC plans. The suggested policy guide emphasizes organizational factors; particularly including the development of PHC-based networks with midlevel providers (desirably extended-duty dental hygienists) as the frontline oral healthcare providers.
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Affiliation(s)
- Mohammad-Pooyan Jadidfard
- Dental Research Center, Research Institute of Dental Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Community Oral Health, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Bahareh Tahani
- Department of Oral Public Health, Dental Research Center, Dental Research Institute, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran
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Nguyen TM, Bridge G, Hall M, Theodore K, Lin C, Scully B, Heredia R, Le LKD, Mihalopoulos C, Calache H. Is value-based healthcare a strategy to achieve universal health coverage that includes oral health? An Australian case study. J Public Health Policy 2023; 44:310-324. [PMID: 37142745 PMCID: PMC10232653 DOI: 10.1057/s41271-023-00414-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2023] [Indexed: 05/06/2023]
Abstract
The 2021 Resolution on Oral Health by the 74th World Health Assembly supports an important health policy direction: inclusion of oral health in universal health coverage. Many healthcare systems worldwide have not yet addressed oral diseases effectively. The adoption of value-based healthcare (VBHC) reorients health services towards outcomes. Evidence indicates that VBHC initiatives are improving health outcomes, client experiences of healthcare, and reducing costs to healthcare systems. No comprehensive VBHC approach has been applied to the oral health context. Dental Health Services Victoria (DHSV), an Australian state government entity, commenced a VBHC agenda in 2016 and is continuing its efforts in oral healthcare reform. This paper explores a VBHC case study showing promise for achieving universal health coverage that includes oral health. DHSV applied the VBHC due to its flexibility in scope, consideration of a health workforce with a mix of skills, and alternative funding models other than fee-for-service.
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Affiliation(s)
- Tan M Nguyen
- Deakin Health Economics, Deakin University, Level 3, Building BC, 221 Burwood Highway, Burwood, Melbourne, VIC, 3125, Australia.
- Dental Health Services Victoria, Level 1, Corporate Services, 720 Swanston Street, Carlton, Melbourne, VIC, 3053, Australia.
- Public Health and Preventive Medicine, Monash University, Level 4, 553 St Kilda Road, Melbourne, VIC, 3004, Australia.
| | - Gemma Bridge
- Queen Mary University of London, Mile End Road, London, E1 4NS, UK
| | - Martin Hall
- Dental Health Services Victoria, Level 1, Corporate Services, 720 Swanston Street, Carlton, Melbourne, VIC, 3053, Australia
- Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC, 3010, Australia
| | - Katy Theodore
- Deakin Health Economics, Deakin University, Level 3, Building BC, 221 Burwood Highway, Burwood, Melbourne, VIC, 3125, Australia
| | - Clare Lin
- Dental Health Services Victoria, Level 1, Corporate Services, 720 Swanston Street, Carlton, Melbourne, VIC, 3053, Australia
- Melbourne Dental School, The University of Melbourne, Parkville, VIC, 3010, Australia
| | - Ben Scully
- Dental Health Services Victoria, Level 1, Corporate Services, 720 Swanston Street, Carlton, Melbourne, VIC, 3053, Australia
| | - Ruth Heredia
- Dental Health Services Victoria, Level 1, Corporate Services, 720 Swanston Street, Carlton, Melbourne, VIC, 3053, Australia
| | - Long K-D Le
- Public Health and Preventive Medicine, Monash University, Level 4, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Cathrine Mihalopoulos
- Public Health and Preventive Medicine, Monash University, Level 4, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Hanny Calache
- Deakin Health Economics, Deakin University, Level 3, Building BC, 221 Burwood Highway, Burwood, Melbourne, VIC, 3125, Australia
- La Trobe University, Bendigo, VIC, 3552, Australia
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Azimi S, Troeung L, Martini A. Patterns and predictors of dental hospitalizations in patients with acquired brain injury from pre-injury to acute and post-acute injury. NeuroRehabilitation 2023; 53:309-321. [PMID: 37927284 DOI: 10.3233/nre-230145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Abstract
BACKGROUND Acquired brain injury (ABI) can cause long-term disability and functional impairment. OBJECTIVE This study aims to determine the prevalence of dental hospitalizations in an ABI cohort across different phases of injury and identify factors associated with such hospitalizations. METHODS The cohort comprises patients with ABI (n = 683), traumatic (n = 282) and non-traumatic (n = 401) who were admitted to a neurorehabilitation service in Western Australia between 1991 and 2016. De-identified patient data were linked to the Hospital Morbidity Data Collection. The incidence of dental hospitalizations was calculated per 1,000 person-years (PY), and associated factors were investigated using multilevel mixed-effects logistic regression. RESULTS Dental hospitalizations significantly increased from pre-injury (3.35/1,000PY) to acute injury (302.65, Δ+299.3) and remained elevated in the post-acute phase (23.98, Δ+20.63). Dental caries had the highest incidence rate among all diagnoses in the pre-injury and post-acute phases (0.68 and 8.93, respectively), followed by gingivitis and periodontal diseases (3.60) in the post-acute phase. Tooth extractions were performed more often than restorative and preventive treatment in the pre-and post-injury phase, p < 0.001. Dental hospitalizations were associated with the type of ABI, age at injury, remoteness, and history of pre-injury hospitalization. CONCLUSION Implementing comprehensive preventive dental care can reduce potentially preventable dental hospitalization among ABI patients.
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Affiliation(s)
- Somayyeh Azimi
- Brightwater Research Centre, Brightwater Care Group, Inglewood, WA, Australia
- International Research Collaborative - Oral Health and Equity, Department of Anatomy, Physiology and Human Biology, School of Human Sciences, University of Western Australia, Crawley, WA, Australia
| | - Lakkhina Troeung
- Brightwater Research Centre, Brightwater Care Group, Inglewood, WA, Australia
| | - Angelita Martini
- Brightwater Research Centre, Brightwater Care Group, Inglewood, WA, Australia
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Bastani P, Izadi R, Manchery N, Ha D, Calache H, George A, Do L. How does the dental benefits act encourage Australian families to seek and utilise oral health services? PLoS One 2022; 17:e0277152. [PMID: 36441685 PMCID: PMC9704637 DOI: 10.1371/journal.pone.0277152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 10/20/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND This study aimed to analyse the content of the Dental Benefits Act 2008 as a foundation for the Child Dental Benefits Schedule (CDBS) to determine how the Act encourages Australian families to seek and utilise oral health services. METHODS This was a qualitative narrative document analysis conducted in 2022. Data was collected by searching formal websites for retrieving documents that reported the Australian Dental Benefits Act. The eligibility of the retrieved documents was assessed based on authenticity, credibility, representativeness, and meaningfulness of the data. A seven-steps procedure was applied for framework analysis. RESULTS The content of the Dental Benefits Act 2008 provides directions on the three categories of operational, collective, and constitutional rules. Operational rules at the level of oral health providers and the population, as the service end users, can be demonstrated as rules in use in a mutual interaction with the collective and constitutional rules. The consequence of governing the rules at the community level can easily define how the oral health services are provided and utilised. The response is sent to the government level for better regulation of oral health service delivery and utilisation. Then, with interaction and advocacy with the diverse range of stakeholders and interdisciplinary partnerships, with community groups, non-government sectors and councils, the rules can be transformed, adopted, monitored, and enforced. Another mechanism of response has occurred at the providers' and users' level and to the operational rules to community groups and stakeholders via advertising and promoting the utilisation and provision of oral health services. CONCLUSION This study integrates the perspective of politicians with those of policy makers to reconsider the role and significance of the rules based on the triple collaborations among oral health users and oral service providers, the community, and the stakeholders as well as the government. A comprehensive attention is still needed in future revisions of the Dental Benefits Act 2008 according to the contextual factors, socioeconomic and geographical attributes of the population for better implementation of de facto rules and more effective outcomes of the interventions. It is recommended that further research be undertaken utilising a mix-method approach for a holistic view prior to further revisions of the Act or proposal of probable upcoming schemes.
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Affiliation(s)
- Peivand Bastani
- School of Dentistry, The University of Queensland, Brisbane, Queensland, Australia
- * E-mail:
| | - Reyhane Izadi
- School of Health Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Nithin Manchery
- School of Dentistry, The University of Queensland, Brisbane, Queensland, Australia
| | - Diep Ha
- School of Dentistry, The University of Queensland, Brisbane, Queensland, Australia
| | - Hanny Calache
- La Trobe Rural Health School, Australian Centre for Integration of Oral Health (ACIOH), La Trobe University, Melbourne, Australia
| | - Ajesh George
- Australian Centre for Integration of Oral Health (ACIOH), School of Nursing and Midwifery, Western Sydney University, Penrith, Australia
- Ingham Institute Applied Medical Research, Liverpool, Australia
- School of Dentistry, The University of Sydney, Camperdown, Australia
| | - Loc Do
- School of Dentistry, The University of Queensland, Brisbane, Queensland, Australia
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A global review of the education and career pathways of dental therapists, dental hygienists and oral health therapists. Br Dent J 2021; 230:533-538. [PMID: 33893429 DOI: 10.1038/s41415-021-2836-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 09/14/2020] [Indexed: 11/08/2022]
Abstract
Introduction With ongoing needs in oral healthcare being unmet, dental therapists, dental hygienists and oral health therapists have the potential to assume greater roles and responsibilities in the provision of care. This review provides a global overview of the education and career opportunities of these professions, contributing to the discussion on the future trajectories of all three professions.Methods A scoping review was conducted to collate and summarise the current available evidence from peer-reviewed journal articles, published reports and books, and websites of professional associations and government agencies.Results Of the 145 sources identified and reviewed, 53 were included in the qualitative synthesis. The themes were categorised into domains: 1) dental therapy; 2) dental hygiene; and 3) oral health therapy.Conclusion The results of this review indicated that, although there has been continuous advocacy for dental therapists, dental hygienists and oral health therapists to assume roles beyond the traditional clinical practice, the majority of the professionals still mainly practise as clinicians. Many dental therapists, dental hygienists and oral health therapists felt limited by their scope of practice and were dissatisfied with the lack of career pathways. Additional research is needed to examine the influences behind career development for all three professions.
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Nguyen TM, Tonmukayakul U, Calache H. A Cost Analysis of an Outreach School-Based Dental Program: Teeth on Wheels. CHILDREN (BASEL, SWITZERLAND) 2021; 8:154. [PMID: 33670541 PMCID: PMC7922806 DOI: 10.3390/children8020154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 02/11/2021] [Accepted: 02/12/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND This study evaluated an outreach mobile dental service called Teeth on Wheels (TOW). The dental program targeted Australian children from low household income, who are eligible for the Child Dental Benefits Scheme (CDBS) in Victoria, Australia. The program is complemented with a school-based oral health promotion element. METHODS A retrospective cohort study was performed with a convenience sample. Children must have had at least three dental examinations during the 2016-2019 calendar years to be included in the study. Comparisons were made between the 2016-17 and 2018-19 calendar years. It was hypothesised that the program would result in reduced costs and the number of restorations and extractions in the latter period. RESULTS A total of 414 children were included in the analysis. The total mean costs of the program per child reduced from AU$605.3 in 2016-17 to AU$531.1 in 2018-19. The results showed an overall mean reduction in all restorations and extractions performed, but only statistical significance was noted for reductions of restored deciduous teeth. CONCLUSIONS This outreach program, which is focused on prevention and minimally invasive dentistry, can be a promising alternative model of delivery for dental services in young children.
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Affiliation(s)
- Tan Minh Nguyen
- Deakin Health Economics, Institute of Health Transformation, Faculty of Health, Deakin University, Waurn Ponds, VIC 3216, Australia; (U.T.); (H.C.)
- Community Dental Program, Peninsula Health, Frankston, VIC 3199, Australia
- Coburg Hill Oral Care, Coburg North, VIC 3058, Australia
| | - Utsana Tonmukayakul
- Deakin Health Economics, Institute of Health Transformation, Faculty of Health, Deakin University, Waurn Ponds, VIC 3216, Australia; (U.T.); (H.C.)
| | - Hanny Calache
- Deakin Health Economics, Institute of Health Transformation, Faculty of Health, Deakin University, Waurn Ponds, VIC 3216, Australia; (U.T.); (H.C.)
- Dentistry and Oral Health, La Trobe Rural Health School, La Trobe University, Bendigo, VIC 3552, Australia
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Orenstein L, Chetrit A, Oberman B, Benderly M, Kalter-Leibovici O. Factors associated with disparities in out-of-pocket expenditure on dental care: results from two cross-sectional national surveys. Isr J Health Policy Res 2020; 9:30. [PMID: 32552866 PMCID: PMC7298819 DOI: 10.1186/s13584-020-00387-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 05/26/2020] [Indexed: 12/12/2022] Open
Abstract
Background Socioeconomic differences in oral health and dental care utilization are a persistent problem in many high-income countries. We evaluated demographic, geographic and socioeconomic factors associated with disparities in households’ out-of-pocket expenditure (OOPE) on dental care, and the effect of ongoing dental health reform on these disparities. Methods This cross-sectional analysis used data collected in two Israeli Household Expenditure Surveys conducted in 2014 and 2018. OOPE for dental care was estimated using a two-part multivariable model. A logistic regression was used to examine the likelihood of reporting any OOPE, and a log-transformed linear regression model examined the level of expenditure among those who reported any OOPE. Results In 2018, OOPE on dental care accounted for 22% of total health expenditure for all households, whereas among those who reported dental OOPE it reached 43%. Households with children up to age 14 years reported lower OOPE, regardless of ownership of supplementary health insurance. Owning supplementary health insurance had a heterogeneous effect on the level of OOPE, with a significant increase among those with 0–8 years of education, compared to households without such insurance, but not among those of higher educational level. In 2014, Arab ethnic minority and residence in the country periphery were associated with a greater likelihood for any OOPE and higher amounts of OOPE on dental care. While the gaps between Jewish and Arab households persisted into 2018, those between peripheral and non-peripheral localities seem to have narrowed. Conclusions The burden of dental OOPE on Israeli households remains heavy and some disparities still exist, even after the implementation of the dental health reform. Expanding the dental health reform and addressing barriers to preventive dental care, especially among Arabs and those of lower educational level, may help in reducing households’ private expenses on dental care.
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Affiliation(s)
- Liat Orenstein
- Cardiovascular Epidemiology Unit, Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, 52621, Ramat-Gan, Israel.
| | - Angela Chetrit
- Cardiovascular Epidemiology Unit, Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, 52621, Ramat-Gan, Israel
| | - Bernice Oberman
- Biostatistics and Biomathematics Unit, Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat-Gan, Israel
| | - Michal Benderly
- Cardiovascular Epidemiology Unit, Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, 52621, Ramat-Gan, Israel.,Epidemiology and Preventive Medicine Department, The Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ofra Kalter-Leibovici
- Cardiovascular Epidemiology Unit, Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, 52621, Ramat-Gan, Israel.,Epidemiology and Preventive Medicine Department, The Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Fiorillo L, Cervino G, De Stefano R, Iannello G, Cicciù M. Socioeconomic behaviors on dental professions: a Google Trends investigation in Italy. ACTA ACUST UNITED AC 2020; 69:317-323. [PMID: 32278342 DOI: 10.23736/s0026-4970.20.04352-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Dental profession has expanded, and the knowledge that oral health affects systemic health is of greater concern to patients. The purpose of this study is to understand the demand for dental treatments in Italy, knowing if there is any correlation between socioeconomic condition and oral rehabilitation typology. Moreover, focusing on the requested rehabilitations type and on finding alternatives, unconventional solutions. EVIDENCE ACQUISITION The research was conducted using an important research database defined Google Trends, with search terms such as "dolore denti" (toothache). A statistical analysis has been conducted in this study evaluation Pearson Correlation Coefficient. EVIDENCE SYNTHESIS The results divided region by region provide data that reflect the socio-economic conditions of the population concerned. Other results have been obtained from government source, to learn about the economic situations of the individual regions, for this reason the GDP was examined. Furthermore, there are important results regarding the parasanitary professions to which patients, for economic reasons, tend to refer. CONCLUSIONS This study will surely be an excellent starting point to investigate professional abuse and above all to assess the needs of the different regions.
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Affiliation(s)
- Luca Fiorillo
- Department of Biomedical and Dental Sciences, Morphological and Functional Imaging, School of Dentistry, G. Martino Polyclinic, University of Messina, Messina, Italy -
| | - Gabriele Cervino
- Department of Biomedical and Dental Sciences, Morphological and Functional Imaging, School of Dentistry, G. Martino Polyclinic, University of Messina, Messina, Italy
| | - Rosa De Stefano
- Department of Biomedical and Dental Sciences, Morphological and Functional Imaging, School of Dentistry, G. Martino Polyclinic, University of Messina, Messina, Italy
| | - Gaetano Iannello
- Department of Biomedical and Dental Sciences, Morphological and Functional Imaging, School of Dentistry, G. Martino Polyclinic, University of Messina, Messina, Italy
| | - Marco Cicciù
- Department of Biomedical and Dental Sciences, Morphological and Functional Imaging, School of Dentistry, G. Martino Polyclinic, University of Messina, Messina, Italy
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10
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Poudel P, Griffiths R, Wong VW, Arora A, Flack JR, Khoo CL, George A. Perceptions and practices of general practitioners on providing oral health care to people with diabetes - a qualitative study. BMC FAMILY PRACTICE 2020; 21:34. [PMID: 32054440 PMCID: PMC7020546 DOI: 10.1186/s12875-020-1102-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 01/29/2020] [Indexed: 12/12/2022]
Abstract
Background Poorly controlled diabetes leads to multiple complications including oral health problems. General practitioners (GPs) are at the forefront of management of chronic diseases in primary health care. Diabetes guidelines encourage a proactive role for GPs in oral health complications management in people with diabetes, yet little is known about this area of care. This study aimed to explore current practices, perceptions and barriers of GPs towards oral health care for people with diabetes. Methods We employed a qualitative research method utilising telephone interviews. Purposive and snowball sampling were used to recruit 12 GPs from Greater Sydney region. A thematic analysis involving an inductive approach was used to identify and analyse contextual patterns and themes. Results A majority of participants were males (n = 10), working in group practices (n = 11) with a mean ± SD age of 55 ± 11.4 years and 25 ± 13.6 years work experience. Three major themes emerged: oral health care practices in general practice settings; barriers and enablers to oral health care; and role of diabetes care providers in promoting oral health. Most GPs acknowledged the importance of oral health care for people with diabetes, identifying their compromised immune capacity and greater risks of infections as risk factors. GPs reported 20–30% of their patients having oral health problems, however their current oral health care practices relating to education, risk assessment and referrals were reported as very limited. GPs identified several barriers including time constraints, absence of referral pathways, and limited knowledge and training in promoting oral health care. They also reported patient barriers including oral health care costs and lower oral health awareness. GPs perceived that resources such as education/training, a standardised assessment tool and patient education materials could support them in promoting oral health care. GPs also perceived that other diabetes care providers such as diabetes educators could play an important role in promoting oral health. Conclusions Despite current recommendations, GPs’ current oral health care practices among people with diabetes are limited. Further strategies including capacity building GPs by developing appropriate oral health training programs and simple risk assessment tools along with accessible referral pathways are needed to address the current barriers.
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Affiliation(s)
- Prakash Poudel
- Centre for Oral Health Outcomes and Research Translation (COHORT), Liverpool, New South Wales (NSW), 2170, Australia. .,School of Nursing & Midwifery, Western Sydney University, Campbelltown, NSW, 2560, Australia. .,South Western Sydney Local Health District, Liverpool, NSW, 2170, Australia. .,Ingham Institute for Applied Medical Research, Liverpool, NSW, 2170, Australia.
| | - Rhonda Griffiths
- School of Nursing & Midwifery, Western Sydney University, Campbelltown, NSW, 2560, Australia
| | - Vincent W Wong
- South Western Sydney Local Health District, Liverpool, NSW, 2170, Australia.,Ingham Institute for Applied Medical Research, Liverpool, NSW, 2170, Australia.,Faculty of Medicine, University of New South Wales, Kensington, NSW, 2052, Australia
| | - Amit Arora
- School of Health Sciences, Western Sydney University Campbelltown Campus, Campbelltown, NSW, 2751, Australia.,Translational Health Research Institute, Western Sydney University, Penrith, NSW, 2751, Australia.,Discipline of Child and Adolescent Health, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Westmead, NSW, 2145, Australia.,Oral Health Services, Sydney Local Health District and Sydney Dental Hospital, NSW Health, Surry Hills, NSW, 2010, Australia
| | - Jeff R Flack
- South Western Sydney Local Health District, Liverpool, NSW, 2170, Australia.,Faculty of Medicine, University of New South Wales, Kensington, NSW, 2052, Australia.,Diabetes Centre Bankstown-Lidcombe Hospital, Bankstown, NSW, 2200, Australia.,School of Medicine, Western Sydney University, Campbelltown, NSW, 2560, Australia
| | - Chee L Khoo
- Health focus Family Practice, Ingleburn, NSW, 2565, Australia
| | - Ajesh George
- Centre for Oral Health Outcomes and Research Translation (COHORT), Liverpool, New South Wales (NSW), 2170, Australia.,School of Nursing & Midwifery, Western Sydney University, Campbelltown, NSW, 2560, Australia.,South Western Sydney Local Health District, Liverpool, NSW, 2170, Australia.,Ingham Institute for Applied Medical Research, Liverpool, NSW, 2170, Australia.,Translational Health Research Institute, Western Sydney University, Penrith, NSW, 2751, Australia.,University of Sydney, Camperdown, NSW, 2050, Australia
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