Priority setting in emergency public dental care in NSW, Australia

The use of priority setting in public health services experiencing high levels of demand is accelerating in the U.K, Canada and NZ. In 2000, NSW Oral Health Branch implemented the Priority Oral Health Program (POHP). The rationale for POHP is to provide access to public oral health services to patients in a timely, rational, clinically valid and transparent manner. POHP hence relies on a computer driven algorithm to generate a priority score from patients’ self reported oral symptoms. This study reports on 260 patients from 6 NSW dental clinics who self reported at least one emergency criteria: swelling of the face, mouth or neck, avulsed or subluxed teeth, trauma/injury or uncontrolled or prolonged bleeding. Bi-variate analysis revealed that patients coded as emergency were disproportionately female (54.8%), Indigenous (25.6%) or spoke a language other than English at home (24.7%) (Chi-Square; P<0.05). The largest proportion of patients was in the 31-40 year age group (23.1%) while the lowest proportion of emergency patients (9.6%) were in the 51-60 year age group (ANOVA; P<0.05). Dentists confirmed patients self reported symptoms in 82.0 % of cases. Almost 80% of patients were assessed by the dentist as requiring care <3 days, 57.3% of whom required care within 24 hours. This is a considerable increase in emergency patients when compared with the pre-POHP proportion of emergency patients needing care < 48 hours (33.8%) when using the traditional booking system. Correlation analysis of the emergency screening criteria showed no significant associations. This suggests that emergency patients can and do discriminate between oral conditions or symptoms and do not engage in gaming behaviours as has been suggested as a possible barrier to effective utilisation of such priority systems. Priority setting in public oral health care appears to be meeting objectives of providing needs based oral health care in a timely, appropriate and equitable manner, however there may be implications for clinic management and human resources assuming changes to case mix. This research was done as a consultancy for NSW Oral Health Branch.

K Jones*, A Patterson, L Luzzi, K Roberts-Thomson, AJ Spencer

Presented at the 43rd Annual Meeting of the IADR (ANZ Division), 28 September – 1 October 2003, Melbourne, Australia

Note: * indicates presenter

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