The use of geographical information systems in examining variations in sociodemographic profiles of dental practice catchments: a case study of a Swansea practice

Geospatial methodology for determining the regional prevalence of hospital-reported childhood intussusception in patients from India

Both developed and developing countries carry a large burden of pediatric intussusception. Sentinel site surveillance-based studies have highlighted the difference in the regional incidence of intussusception. The objectives of this manuscript were to geospatially map the locations of hospital-confirmed childhood intussusception cases reported from sentinel hospitals, identify clustering and dispersion, and reveal the potential causes of the underlying pattern. Geospatial analysis revealed positive clustering patterns, i.e., a Moran's I of 0.071 at a statistically significant (p value < 0.0010) Z score of 16.14 for the intussusception cases across India (cases mapped n = 2221), with 14 hotspots in two states (Kerala = 6 and Tamil Nadu = 8) at the 95% CI. Granular analysis indicated that 67% of the reported cases resided < 50 km from the sentinel hospitals, and the average travel distance to the sentinel hospital from the patient residence was calculated as 47 km (CI 95% min 1 km-max 378 km). Easy access and facility referral preferences were identified as the main causes of the existing clustering pattern of the disease. We recommend designing community-based surveillance studies to improve the understanding of the prevalence and regional epidemiological burden of the disease.

Evaluating oral health promotion activity within a general dental practice

The prevention of the common dental diseases is fundamental to modern day general dental practice. Oral health promotion (OHP) is therefore key to facilitating health outcomes within organisations. The literature surrounding OHP stresses the importance of evaluation in order to assess the effectiveness of OHP activities. This paper describes the evaluation of OHP within a general dental practice setting. Early attendance, the use of adult toothpastes during childhood and consequential fluorosis are investigated. A small service evaluation study of 100 consecutive patients was undertaken. The results support the ongoing promotion of early attendance and the use of toothpastes with adequate fluoride levels. There was no evidence of unsightly fluorosis in the sample studied.

Spatial analysis of the home addresses of hospital patients with hepatitis B infection or hepatoma in Shenzhen, China from 2010 to 2012

Background: Hepatoma associated with hepatitis B infection is a major public health problem in Shenzhen (China) and worldwide. China has the largest number of people infected with the hepatitis B virus (HBV), and many studies have demonstrated that HBV infection is associated with hepatoma development. Shenzhen officials have been attempting to monitor and control these diseases for many years. The methodology and the results of this study may be useful in developing a system to monitor, prevent and control these diseases. Methods: The aim of the study was to analyze HBV infection and hepatoma distribution characteristics and patterns in Shenzhen by combining geographic information system (GIS) technology and spatial analysis. The study used data from patients at the district level from the 2010–2012 population censuses. Results: Only one-third of the patients were female, and 70.7% of all cases were 20–50 years of age. There was no global spatial correlation of the distribution of hepatitis B infections and hepatomas; however, there was a local spatial correlation, and certain sub-districts of the Nanshan district had significant agglomeration effects. Based on incidence density and rate maps, we can conclude that the Shenzhen special zone had a higher incidence density and rate of hepatitis B infections and hepatomas compared with the area outside of the Shenzhen special zone during 2010–2012. Conclusions: This study demonstrated substantial geographic variation in the incidence of hepatitis B infection and hepatoma in Shenzhen. The prediction and control of hepatitis B infections and hepatoma development and interventions for these diseases should focus on disadvantaged areas to reduce disparities. GIS and spatial analysis play an important role in public health risk-reduction programs and may become integral components in the epidemiologic description, analysis and risk assessment of hepatitis B and hepatoma.

A novel technique to optimize facility locations of new nephrology services for remote areas

BACKGROUND AND OBJECTIVES

Travel distance to healthcare facilities affects healthcare access and utilization. Using the example of patients with kidney disease and nephrology services, we investigated the feasibility and utility of using geographic information system (GIS) techniques to identify the ideal location for new clinics to improve care for patients with kidney disease, on the basis of systematically minimizing travel time for remote dwellers.

DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS

Using a provincial laboratory database to identify patients with kidney disease and where they lived, we used GIS techniques of buffer and network analysis to determine ideal locations for up to four new nephrology clinics. Service-area polygons for different travel-time intervals were generated and used to determine the best locations for the four new facilities that would minimize the number of patients with kidney disease who were traveling >2 hours.

RESULTS

We studied 31,452 adults with living in Alberta, Canada. Adding the four new facilities would increase the number of patients living <30 minutes from a clinic by 2.2% and reduce the number living >120 minutes away by 72.5%. Different two- and three-clinic scenarios reduced the number of people living >120 minutes away by as much as 65% or as little as 32%, emphasizing the importance of systematic evaluation.

CONCLUSIONS

GIS techniques are an attractive alternative to the current practice of arbitrarily locating new facilities on the basis of perceptions about patient demand. Optimal location of new clinical services to minimize travel time might facilitate better patient care.

An Audit of Dental General Anaesthetic Referral from a General Dental Practice in South Wales

Aims

The aim of this audit was to quantify the number of patients that received a dental general anaesthetic (DGA) between 1999 and 2007 following referral from a general dental practice. It also aimed to establish the deprivation status of those referred and to investigate further dental treatment pathways of these patients.

Methods

Data were collected from all patient records held by the practice. The information collected included: postcode, gender, age at the close of the study, age at time of DGA, reason for DGA, number of teeth extracted, and details of further ongoing care. In the absence of individual level socioeconomic data, a deprivation score (derived from the Welsh Index of Multiple Deprivation [WIMD]) was appended to each record in order to provide a measure of deprivation based on the postcode of the patient.

Results

Two hundred and eighty-seven patients were referred for DGA during the nine-year period. Their mean age was 9.4 years (95% confidence interval [CI] = 8.4, 10.4) and 30.7% were children aged five years or younger. The most common reason for DGA was dental caries. The mean number of teeth extracted was 4.5 (95% CI = 4.1, 4.9). Patients living in deprived areas were more likely to be referred for DGA. Of the 87 who did not subsequently attend for continuing care, 72 were from deprived areas compared with 15 from more affluent areas ( P=0.003).

Conclusions

In proportion to the number of patients registered at a practice, the number of referrals for DGAs was relatively low. Patients categorised as deprived (based on their residential postcode) received more referrals for DGAs than those from more affluent areas. Patients from deprived locations were significantly more likely not to attend for continuing care after their DGA than those from more affluent areas.

Improving oral health with the new dental contract

The challenge for the twenty-first century for oral health is to reduce the social inequality observed in populations. This challenge has been made explicit by the Department of Health (DH) in England. Turning rhetoric into reality is difficult for all concerned whatever field or profession. A cohesive model that embraces philosophical ideals can help individuals achieve change as it provides structure on which to develop ideas. This paper describes a model of care in general dental practice that fits the requirements of the DoH in addressing social inequalities, in the context of developing general dental services.

Reasons for tooth extraction in four general dental practices in South Wales

Tooth retention has been one of the main aims of oral care which in turn could have contributed to the social oral health divide. To investigate this issue further, data collected for a group audit was used to study the reasons for tooth extraction for patients attending for routine treatment at four dental practices. The practices served populations in areas with different levels of deprivation in South Wales. In 558 teeth extracted over 417 visits, the reasons for extractions were: caries 59%, periodontal disease 29.1%, pre-prosthetic 1%, wisdom teeth 4.6%, orthodontic 5.5%, trauma 1.2%, patient request 2.4% and 6.2% other reason. The number of extraction visits per day within the group of dental surgeons varied with three practitioners performing more than three extraction visits per day while one practitioner had only 0.51. These reasons did not significantly depend on levels of deprivation. However, significantly more teeth were extracted for caries in the most deprived group in comparison to the least deprived. Therefore, could there be a case for appropriate extractions in the quest for equitable care?

Research protocol: EB-GIS4HEALTH UK - foundation evidence base and ontology-based framework of modular, reusable models for UK/NHS health and healthcare GIS applications

EB-GIS4HEALTH UK aims at building a UK-oriented foundation evidence base and modular conceptual models for GIS applications and programmes in health and healthcare to improve the currently poor GIS state of affairs within the NHS; help the NHS understand and harness the importance of spatial information in the health sector in order to better respond to national health plans, priorities, and requirements; and also foster the much-needed NHS-academia GIS collaboration. The project will focus on diabetes and dental care, which together account for about 11% of the annual NHS budget, and are thus important topics where GIS can help optimising resource utilisation and outcomes. Virtual e-focus groups will ensure all UK/NHS health GIS stakeholders are represented. The models will be built using Protégé ontology editor based on the best evidence pooled in the project's evidence base (from critical literature reviews and e-focus groups). We will disseminate our evidence base, GIS models, and documentation through the project's Web server. The models will be human-readable in different ways to inform NHS GIS implementers, and it will be possible to also use them to generate the necessary template databases (and even to develop "intelligent" health GIS solutions using software agents) for running the modelled applications. Our products and experience in this project will be transferable to address other national health topics based on the same principles. Our ultimate goal is to provide the NHS with practical, vendor-neutral, modular workflow models, and ready-to-use, evidence-based frameworks for developing successful GIS business plans and implementing GIS to address various health issues. NHS organisations adopting such frameworks will achieve a common understanding of spatial data and processes, which will enable them to efficiently and effectively share, compare, and integrate their data silos and results for more informed planning and better outcomes.

Is NHS dentistry in crisis? 'Traffic light' maps of dentists distribution in England and Wales

BACKGROUND: 'Traffic light' (red-yellow-green) maps are potentially powerful tools for 'at a glance' problem detection, for optimising resource allocation/reallocation, setting priorities, and targeting interventions to areas most in need. The maps can be also used for administrative area comparisons and performance monitoring over time. Interactive Web versions of the maps can be generated with many handy features to further empower organisations and decision makers. Methodological issues to consider when creating 'traffic light' maps include hue thresholding, data timeliness and stability of administrative boundaries. RESULTS: We used 'traffic light' maps to study the distribution of dentists per 1,000 population in all 304 English Primary Care Trusts (PCTs) and 22 Welsh Local Health Boards (LHBs) using datasets of dentist numbers per PCT (as at 31 December 2002) and LHB (as at 26 February 2004) from the Dental Practice Board, and 2001 Census population figures for PCTs and LHBs from the Office for National Statistics. The overall NHS dentists per 1,000 population figures for England (0.374) and Wales (0.359) are low compared to many other countries, with less than 0.3 dentist per 1,000 people available to 24.1% of the total population of England (81 PCTs or 26.6% of all PCTs) and 26.1% of the total population of Wales (6 LHBs or 27.3% of all LHBs). A general shortage of NHS dentists can be observed at a glance across England and Wales on all the 'traffic light' maps in our study, even on those using a more "tolerant" classification and an additional orange-yellow class. The distribution of NHS dentists in England and Wales was also found to be not uniform, with some PCTs/LHBs, especially those located in some of the deprived or less populated urban and rural communities, suffering significantly more shortage of dentists than others (see http://healthcybermap.org/PCT/dentists/). These results confirm recent media reports of a shortage of NHS dentists in various parts of England and Wales. CONCLUSION: Suitable programmes are urgently needed to increase the numbers of NHS dentists across England and Wales. We have included a set of recommendations to dental health policymakers and planners, in addition to ideas for further work.

Towards evidence-based, GIS-driven national spatial health information infrastructure and surveillance services in the United Kingdom

The term "Geographic Information Systems" (GIS) has been added to MeSH in 2003, a step reflecting the importance and growing use of GIS in health and healthcare research and practices. GIS have much more to offer than the obvious digital cartography (map) functions. From a community health perspective, GIS could potentially act as powerful evidence-based practice tools for early problem detection and solving. When properly used, GIS can: inform and educate (professionals and the public); empower decision-making at all levels; help in planning and tweaking clinically and cost-effective actions, in predicting outcomes before making any financial commitments and ascribing priorities in a climate of finite resources; change practices; and continually monitor and analyse changes, as well as sentinel events. Yet despite all these potentials for GIS, they remain under-utilised in the UK National Health Service (NHS). This paper has the following objectives: (1) to illustrate with practical, real-world scenarios and examples from the literature the different GIS methods and uses to improve community health and healthcare practices, e.g., for improving hospital bed availability, in community health and bioterrorism surveillance services, and in the latest SARS outbreak; (2) to discuss challenges and problems currently hindering the wide-scale adoption of GIS across the NHS; and (3) to identify the most important requirements and ingredients for addressing these challenges, and realising GIS potential within the NHS, guided by related initiatives worldwide. The ultimate goal is to illuminate the road towards implementing a comprehensive national, multi-agency spatio-temporal health information infrastructure functioning proactively in real time. The concepts and principles presented in this paper can be also applied in other countries, and on regional (e.g., European Union) and global levels.

Towards evidence-based, GIS-driven national spatial health information infrastructure and surveillance services in the United Kingdom

The term "Geographic Information Systems" (GIS) has been added to MeSH in 2003, a step reflecting the importance and growing use of GIS in health and healthcare research and practices. GIS have much more to offer than the obvious digital cartography (map) functions. From a community health perspective, GIS could potentially act as powerful evidence-based practice tools for early problem detection and solving. When properly used, GIS can: inform and educate (professionals and the public); empower decision-making at all levels; help in planning and tweaking clinically and cost-effective actions, in predicting outcomes before making any financial commitments and ascribing priorities in a climate of finite resources; change practices; and continually monitor and analyse changes, as well as sentinel events. Yet despite all these potentials for GIS, they remain under-utilised in the UK National Health Service (NHS). This paper has the following objectives: (1) to illustrate with practical, real-world scenarios and examples from the literature the different GIS methods and uses to improve community health and healthcare practices, e.g., for improving hospital bed availability, in community health and bioterrorism surveillance services, and in the latest SARS outbreak; (2) to discuss challenges and problems currently hindering the wide-scale adoption of GIS across the NHS; and (3) to identify the most important requirements and ingredients for addressing these challenges, and realising GIS potential within the NHS, guided by related initiatives worldwide. The ultimate goal is to illuminate the road towards implementing a comprehensive national, multi-agency spatio-temporal health information infrastructure functioning proactively in real time. The concepts and principles presented in this paper can be also applied in other countries, and on regional (e.g., European Union) and global levels.