Using Indicators of Relative Social Disadvantage in a Screening Tool to Prioritize Access to General Dental Care

OBJECTIVES: High demand for public dental services in Australia is stimulating the development of approaches to prioritise access to public dental care based on patient need. This research aimed to determine whether indicators of relative social disadvantage could be used as criteria for prioritisingprovision of routine care to adult patients in public dental clinics in New South Wales, Australia.

METHODS: Subjects were a convenience sample of adults seeking public general dental care. Questionnaires administered prior to the first dental visit collected socio-demographic data (age, sex) and six indicators of relative social disadvantage (RSD): Aboriginality, institutional or boarding house resident, serious medical condition, intellectual/physical disability, homebound, homeless or refugee. During the first dental visit additional questions regarding subjective oral health were measured using the Oral Health Impact Profile (OHIP_14) and dentists rated dental care as urgent if treatment was required < 6 months (UrgentTx) and non urgent otherwise and a standardised dental examination was conducted.

RESULTS: Subjects with 1+ RSD ndicators (n=425) were more likely to be male and they were older than non-RSD subjects (n=190) (P<0.05). RSD subjects had fewer natural teeth reflecting past treatment experience and higher OHIP scores than non-RSD subjects (P<0.01), indicating greater social impact. Mean DMFT values did not differ between the two groups. In bivariate analysis, RSD status was a significant predictor of UrgentTx (x2; P<0.001). In multivariate analysis, RSD persisted as an independent predictor of UrgentTx (OR=3.6, 95% CI=2.3-5.8).

CONCLUSIONS: There is considerable heterogeneity among patients seeking public general dental care. Relative social disadvantage within an already disadvantaged eligible population is a risk factor for greater social impact and urgency for care. RSD as screening criteria when used within a triage system for access to care may help address issues of equity in access to public oral health service delivery systems.

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

Presented at the 81st General Session and Exhibition of the IADR, 25-28 June 2003, Goteborg, Sweden

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