Estie Kruger

A national audit of Australian dental practice distribution: do all Australians get a fair deal?

Australia is the sixth biggest (by area) country in the world, having a total area of about 7.5 million km(2) (3 million square miles). This study located every dental practice in the country (private and public) and mapped these practices against population. The total population of Australia (21.5 million) is distributed across 8,529 suburbs. On average about one-third of the population from each State lives in suburbs without practices and 46% live in suburbs with one to five dentists. Of those living within the study frameset, 86.6% live within 5 km of a private practice and 84.4% live within 10 km of a government practice. Australias dental practices are distributed in a very uneven fashion across its vast area. Three-quarters of suburbs have no dental practice and over one-third of the population live in these suburbs. This research clearly identified that in a vast and uneven socio-geographically distributed country, service planning, if left to market forces, will end with a practice distribution that is fixed by economic drivers of scale and not that of disease burden. A more population health-driven approach to future design and construction of government safety net services is needed to address these disparities.

Networked remote area dental services: a viable, sustainable approach to oral health care in challenging environments.

OBJECTIVEnThis study examines the cost effectiveness of a model of remote area oral health service.nnnDESIGNnRetrospective financial analysis.nnnSETTINGnRural and remote primary health services.nnnPARTICIPANTSnClinical activity data and associated cost data relating to the provision of a networked visiting oral health service by the Centre for Rural and Remote Oral Health formed the basis of the study data frameset. The cost-effectiveness of the Centres model of service provision at five rural and remote sites in Western Australia during the calendar years 2006, 2008 and 2010 was examined in the study.nnnMAIN OUTCOME MEASUREDnCalculations of the service provision costs and value of care provided were made using data records and the Fee Schedule of Dental Services for Dentists. The ratio of service provision costs to the value of care provided was determined for each site and was benchmarked against the equivalent ratios applicable to large scale government sector models of service provision.nnnRESULTS AND CONCLUSIONnThe use of networked models have been effective in other disciplines but this study is the first to show a networked hub and spoke approach of five spokes to one hub is cost efficient in remote oral health care. By excluding special cost-saving initiatives introduced by the Centre, the study examines easily translatable direct service provision costs against direct clinical care outcomes in some of Australias most challenging locations. This study finds that networked hub and spoke models of care can be financially efficient arrangements in remote oral health care.

Turning Australia into a 'flat-land': what are the implications for workforce supply of addressing the disparity in rural-city dentist distribution?

Dentistry in Australia has faced, and continues to face, significant workforce issues, in particular, a grossly distorted workforce distribution. In this study, an analysis of the consequences for the workforce that would occur under a series of reduced maldistribution scenarios is examined and reported. Three different scenarios were tested based on existing dental practice to population data at a national level. This study clearly highlights the very significant maldistribution of practices in Australia. However, more importantly, it highlights that to address this maldistribution requires something in the order of a tenfold increase in dental practice numbers (and the commensurate increase in workforce), which is not possible (or reasonable). As a nation, Australia has to look to other methods of achieving equity in access to good oral health. The application of modes of care delivery including, but not limited to visiting services needs to be examined and extended. Clearly, these new methodologies are going to rely on non-dental health professionals taking a far more significant role in leading oral health-care models as well as the expanded application of technology to bring unique skill bases to areas where these skilled individuals do not (and will not) reside.

Is mix of care influenced by the provider environment? A comparison of four care pathways in oral health

OBJECTIVEnIn Australia, access to dental care has been available through several different pathways: (1) private practice; (2) public clinics; (3) Aboriginal Medical Services (AMS)-based clinics; and (4) until recently, the Chronic Disease Dental Scheme (CDDS). The aim of the present study was to compare the types of dental services most commonly delivered in the various clinical pathways based on the hypothesis that disease-driven care should lead to similar mixes of dental care provided.nnnMETHODSnData from a series of previously published sources was used to identify and compare the most commonly performed dental procedures in the different pathways. A comparison was also made with the available international data (US).nnnRESULTSnThere was a marked difference between service mixes provided through the four pathways. Patients obtaining dental care through AMS-based and public pathways had more extractions and less restorative and preventive care compared with private and CDDS pathways. Compared with the international data, dental service mixes in Australia were found to be not as evenly distributed. Value of care provided through private and CDDS pathways were two- to threefold higher than that of AMS-based and public pathways.nnnCONCLUSIONnThe data indicate that the original hypothesis that the disease-driven care should lead to similar mixes of provided dental care, is not supported.

A decade of experience evolving visiting dental services in partnership with rural remote Aboriginal communities.

BACKGROUNDnEmbedding research capabilities and workforce development activities with clinical service entities promotes the development of sustainable, innovative, quality-focused oral health care services. Clinical and strategic governance is an important area of consideration for rural and remote dental services, posing particular challenges for smaller service structures. Sustaining remote area dental services has some significant complexities beyond those involved in urban service models.nnnMETHODSnThis study describes the sustaining structure of a remote area dental service with a decade of history.nnnRESULTSnIn the current climate, chief among these challenges may be those associated with dental workforce shortages as these impact most heavily in the public sector, and most particularly, in remote areas. As sustained workforce solutions come from developing a future workforce, an essential element of the workforce governance framework for remote dental service provision should be the inclusion of a student participation programme. Collaborative partnership approaches with Aboriginal health services promote the development and maintenance of effective, culturally sensitive dental services within rural and remote Aboriginal communities. Having sustained care for 10 years, this collaborative model of integrated research, education and service has demonstrated its effectiveness as a service model for Aboriginal communities in Western Australia.nnnCONCLUSIONSnThis descriptive study finds the core values for this success have been communication, clinical leadership, mentorship within effective governance systems all linked to an integrated education and research agenda.

Application of spatial analysis technology to the planning of access to oral health care for at-risk populations in Australian capital cities

Australians are one of the healthiest populations in the world but there is strong evidence that health inequalities exist. Australia has 23.1 million people spread very unevenly over -20 million square kilometres. This study aimed to apply spatial analysis tools to measure the spatial distribution of fixed adult public dental clinics in the eight metropolitan capital cities of Australia. All population data for metropolitan areas of the eight capital cities were integrated with socioeconomic data and health-service locations, using Geographic Information Systems, and then analysed. The adult population was divided into three subgroups according to age, consisting of 15-year-olds and over (n = 7.2 million), retirees 65 years and over (n = 1.2 million), and the elderly, who were 85 years and over (n = 0.15 million). It was evident that the States fell into two groups; Tasmania, Northern Territory, Australian Capital Territory and Western Australia in one cluster, and Victoria, New South Wales, Queensland and South Australia in the other. In the first group, the average proportion of the population of low socioeconomic status living in metropolitan areas within 2.5 km of a government dental clinic is 13%, while for the other cluster, it is 42%. The clustering remains true at 5 km from the clinics. The first cluster finds that almost half (46%) of the poorest 30% of the population live within 5km of a government dental clinic. The other cluster of States finds nearly double that proportion (86%). The results from this study indicated that access distances to government dental services differ substantially in metropolitan areas of the major Australian capital cities.

Geographic distribution of point-in-time access to subsidised dental services in Western Australia

Dental Health Services (DHS) is the largest public primary oral healthcare provider in WA. The objective of this study was to calculate probable distance patients are expected to travel to the nearest clinic, gauge utilisation rates and predict the direction of likely changes in future demand for subsidised dental care. Eligible population data was collected from the Department of Human Services and the Australian Bureau of Statistics websites and integrated with the waiting list and the recall list data provided by the DHS. In total, 65% of the eligible WA population are residing in the metropolitan area; however, only 19% of those are either on the waiting list or have already received subsidised care. In all, 35% of the total eligible WA population are residing in country areas. A total of 30% of the eligible country WA patients are located within a 100-km range of a Government Dental Clinic, with only 11% of those either on the waiting list or having already received subsidised dental care. Country WA residents are at a significant disadvantage by comparison to their metropolitan counterparts. Eligible WA country residents are up to 40% less likely to receive treatment when compared to the metropolitan residents.

National dental waitlists: what would it take to reset to zero?

Objective Over the years, long public dental waitlists across Australia have received much attention from the media. The issue for eligible patients, namely a further deterioration of dental health because of not being able to address dental concerns relatively quickly, has been the subject of several state and Federal initiatives. The present study provides a cost model for eliminating public dental waitlists across Australia and compares these results with the cost of contracting out public dental care to private clinics. Methods Waitlist data from across Australia were collected from publicly available sources and confirmed through direct communication with each individual State or Territory Dental Health body. Average costs associated with employing key dental personnel and performance figures were used from previously published data to estimate the potential financial commitment and probable public benefits. Results The cost model suggests that, on average, it would be more than twice as expensive to contract the work out to private dental clinics as to treat eligible patients within public dental clinics. It is estimated that the cost of eliminating the legacy dental waiting lists (over 12 months) would be between A

Sustaining supply of senior academic leadership skills in a shortage environment: a short review of a decade of dental experience

50 and A

A national analysis of dental waiting lists and point-in-time geographic access to subsidised dental care: can geographic access be improved by offering public dental care through private dental clinics?

100million depending on the method adopted. The effort would require some 360 dental teams. Conclusion The design of the Australian public dental care system that is targeted at meeting the needs of eligible patients into the future, in addition to being effective and sustainable, must also offer a level of protection to the taxpayer. The ability to address waitlist backlog identified in the present study clearly would require a mix of service models depending on service availability at different locations. Further research is needed to optimise the mix of service providers to address community needs. What is known about the topic? Long public dental waitlists across Australia have received much attention from the media. The topic has been the subject of debate at the government level and, over the years, has seen an increase in allocation of public funds in an effort to address the policy needs. What does this paper add? This study calculates the actual number of people on the public dental waitlist, provides a detailed analysis of the distribution of the demand for the services and offers a cost model for resetting public dental waitlists across Australia. What are the implications for practitioners? This study carries no implications for individual practitioners at the clinical level. However, at the state and national levels, this model offers direction to a more cost-effective allocation of public funds and human resources.