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Overcoming Barriers to Access and Provision of Dental Care for Patients with Special Needs in the Australian Public Dental System

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Overcoming Barriers to Access and Provision of Dental Care for Patients with Special Needs in the Australian Public Dental System Overcoming barriers to access and provision of dental care for patients with special needs in the Australian public dental system Mathew Albert Wei Ting Lim BDS, BScDent (Hons), MRACDS, FSCD ORCID ID: 0000-0003-3712-0519 Doctor of Clinical Dentistry / Doctor of Philosophy January 2021 Melbourne Dental School, Faculty of Medicine, Dentistry, and Health Sciences University of Melbourne This thesis is submitted in total fulfilment of the requirements for the degree of Doctor of Philosophy, which will be completed as part of the conjoint degree of Doctor of Clinical Dentistry / Doctor of Philosophy 1 Abstract: Background Individuals with special needs report being unable to find oral health professionals with adequate experience who are willing to treat them despite the recognition of a dedicated dental specialty, special needs dentistry, to advocate for and assist with their oral health treatment needs. Aims: The aims of this study were: • To develop a profile of the patients receiving specialist dental care in special needs dentistry around Australia, • To explore the challenges associated with providing dental care to individuals with special needs in the public dental system, and • To identify ways to overcome barriers to treating individuals with special needs. Methods: A cross-sectional clinical audit of patient appointments was conducted at two of Australia’s largest and most well-established specialist units in special needs dentistry: the Integrated Special Needs Department at the Royal Dental Hospital of Melbourne and the Special Needs Unit at the Adelaide Dental Hospital, as well as specialised dental clinics operated by Oral Health Services Tasmania; the Special Care Dental Units. Quantitative methods were used to analyse patient demographics, referrals, medical profiles, and treatment received. 2 Qualitative methods were used to explore the views of specialists in special needs dentistry and other oral health professionals in relation to the challenges they faced in providing care to individuals with special needs. Semi-structured interviews and focus groups were employed to understand their perspectives towards the factors that influenced specialist services and the willingness of clinicians to treat patients with special needs. Results: Inconsistencies were noted between the patient cohorts being treated at the two specialist clinics that may have reflected differences in referrals, available services and facilities, and the local oral health care systems. Specialists in special needs dentistry felt that the biggest challenge facing specialist services was the strain placed on the limited specialist workforce and resources by referrals from oral health professionals not willing to treat individuals with special needs. Oral health professionals working in the primary care setting felt that the two most significant barriers to providing care for patients with special needs were insufficient training and experience in special needs dentistry or a lack of support within their work environment. Additional education and training, opportunities for networking with more experienced clinicians, and a more supportive work environment were identified as ways to overcome these barriers. Additional support provided by specialists in special needs dentistry, in the form of a network arrangement or visiting specialist, were found to improve the willingness of oral health professionals to treat patients with special needs. 3 Conclusions: The profile of patients receiving dental care from specialist dental clinics in special needs dentistry is variable and largely influenced the willingness of oral health professionals to treat them. Providing additional support to these oral health professionals, to overcome their perceived lack of training and experience and barriers within the public dental system, will be vital to improving the willingness of clinicians to treat patients with special needs and addressing access to care issues for this population. 4 Student Declaration I, Mathew Albert Wei Ting Lim, declare that: (i) This thesis comprises only of my original work towards the Doctor of Clinical Dentistry / Doctor of Philosophy except where indicated in the preface; (ii) Due acknowledgement has been made in the text to all other materials used; and (iii) The thesis is fewer than the maximum word limit in length, exclusive of tables, maps, bibliographies, and appendices. Date: Friday 22 January 2021 5 Preface Publications and author contributions Manuscript 1 Patient referrals to special needs dental units in Tasmania, Australia Authors: Mathew AWT Lim and Gelsomina L Borromeo Study design Data collection Data analysis Manuscript Lim M ✓ ✓ ✓ ✓ Borromeo G ✓ ✓ ✓ Article status: Published by Journal of Disability and Oral Health, 2017 Lim MAWT, Borromeo GL. Patient referrals to special needs dental units in Tasmania, Australia. Journal of Disability and Oral Health 2017; 18(3): 87-94 Manuscript 2 Special Needs Dentistry: Interdisciplinary management of medically-complex patients at hospital-based dental units in Tasmania, Australia Authors: Mathew AWT Lim and Gelsomina L Borromeo Study design Data collection Data analysis Manuscript Lim M ✓ ✓ ✓ ✓ Borromeo G ✓ ✓ ✓ Article status: Published in International Journal of Medical Research and Health Sciences, 2017 Lim MAWT, Borromeo GL. Special Needs Dentistry: Interdisciplinary management of medically-complex patients at hospital-based dental units in Tasmania, Australia. International Journal of Medical Research and Health Sciences 2017; 6(6): 123-131 6 Manuscript 3 Utilisation of dental services for people with special health care needs in Australia Authors: Mathew AWT Lim, Sharon AC Liberali, and Gelsomina L Borromeo Study design Data collection Data analysis Manuscript Lim M ✓ ✓ ✓ ✓ Liberali, S ✓ ✓ Borromeo G ✓ ✓ ✓ Article status: Published in BMC Oral Health, 2020 Lim MAWT, Liberali SAC, Borromeo GL. Utilisation of dental services for people with special health care needs in Australia. BMC Oral Health 2020; 20: 360. https://doi.org/10.1186/s12903-020-01354-6 Manuscript 4 Oral health of patients with special needs requiring treatment under general anaesthesia Authors: Mathew AWT Lim and Gelsomina L Borromeo Study design Data collection Data analysis Manuscript Lim M ✓ ✓ ✓ ✓ Borromeo G ✓ ✓ ✓ Article status: Published in Journal of Intellectual and Developmental Disability, 2018 Lim MAWT, Borromeo GL. Oral health of patients with special needs requiring treatment under general anaesthesia. Journal of Intellectual and Developmental Disability 2018 May 29: 1-6. 7 Manuscript 5 Dental treatment for patients with special needs provided by domiciliary dental services Authors: Mathew AWT Lim and Gelsomina L Borromeo Study design Data collection Data analysis Manuscript Lim M ✓ ✓ ✓ ✓ Borromeo G ✓ ✓ ✓ Article status: Submitted for publication to Journal of Dental Science, Oral and Maxillofacial Research on 16 December 2020 Manuscript 6 Challenges associated with providing specialist dental care for individuals with special health care needs Authors: Mathew AWT Lim, Sharon AC Liberali, Hanny Calache, Peter Parashos, and Gelsomina L Borromeo Study design Data collection Data analysis Manuscript Lim M ✓ ✓ ✓ ✓ Liberali, S ✓ ✓ Calache, H ✓ Parashos, P ✓ Borromeo G ✓ ✓ ✓ Article status: Submitted for publication to Medicina oral patologia oral y cirugia bucal on 15 January 2021 8 Manuscript 7 Perceived barriers encountered by oral health professionals in the Australian public dental system providing dental treatment to individuals with special needs Authors: Mathew AWT Lim, Sharon AC Liberali, Hanny Calache, Peter Parashos, and Gelsomina L Borromeo Study design Data collection Data analysis Manuscript Lim M ✓ ✓ ✓ ✓ Liberali, S ✓ ✓ Calache, H ✓ Parashos, P ✓ Borromeo G ✓ ✓ ✓ Article status: In revision following peer review by Special Care in Dentistry Manuscript 8 Perspectives of the public dental workforce on the dental management of people with special needs Authors: Mathew AWT Lim, Sharon AC Liberali, Hanny Calache, Peter Parashos, and Gelsomina L Borromeo Study design Data collection Data analysis Manuscript Lim M ✓ ✓ ✓ ✓ Liberali, S ✓ ✓ Calache, H ✓ Parashos, P ✓ Borromeo G ✓ ✓ ✓ Article status: In revision following peer review by Australian Dental Journal 9 Manuscript 9 Specialist networks influence clinician willingness to manage individuals with special needs Authors: Mathew AWT Lim, Sharon AC Liberali, Hanny Calache, Peter Parashos, and Gelsomina L Borromeo Study design Data collection Data analysis Manuscript Lim M ✓ ✓ ✓ ✓ Liberali, S ✓ ✓ Calache, H ✓ Parashos, P ✓ Borromeo G ✓ ✓ ✓ Article status: Submitted for publication to JDR Clinical and Translational Research on 12 January 2021 Manuscript 10 The impact of collaboration with specialists on the willingness of oral health professionals to treat people with special needs Authors: Mathew AWT Lim, Sharon AC Liberali, Hanny Calache, Peter Parashos, and Gelsomina L Borromeo Study design Data collection Data analysis Manuscript Lim M ✓ ✓ ✓ ✓ Liberali, S ✓ ✓ Calache, H ✓ Parashos, P ✓ Borromeo G ✓ ✓ ✓ Article status: Submitted for publication to Qualitative Health Research on 17 January 2021 10 Funding sources Mathew Lim would like to acknowledge the financial support provided through: • The Australian Government Research Training Program Scholarship; • The University of Melbourne Rowden White Scholarship; and • The Postgraduate Research Grant provided by the Melbourne Dental School, Faculty of Medicine, Dentistry, and Health Sciences,
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