Geographical variation in preventable hospital admissions for dental conditions: An Australia-wide analysis.

OBJECTIVE: To describe the characteristics of hospital admissions for dental conditions, by Australian Statistical Geography Standard remoteness area for the 5 years 2010/2011 to 2014/2015. DESIGN: Retrospective analysis of preventable hospital admissions due to dental conditions. SETTING: National data set provided by the Australian Institute of Health and Welfare. PARTICIPANTS: Every hospital admission for patients who were admitted for dental conditions over five financial years, from 2010/2011 to 2014/2015. MAIN OUTCOME MEASURES: The number (and rate per 1000 population) of hospital admissions due to dental conditions in each Australian Statistical Geography Standard remoteness area (major city, inner regional, outer regional, remote and very remote). RESULTS: There were 316 937 hospital admissions for dental conditions over the 5-year period. The rate of potentially preventable dental hospital admissions ranged from an average of 2.5 per 1000 population in major cities to 3.2 in inner regional areas, 3.1 in outer regional areas, and 4.1 per 1000 in remote and very remote areas. The rate of admissions was highest among those aged 0-14 years living in remote (9.0-10.0 per 1000) and very remote (9.8-12.5 per 1000) areas. Dental caries was the most common reason for admissions. CONCLUSIONS: There is an urgent need to address the social determinants of oral health in children aged 0-14 years living in remote and very remote Australia. The delivery of mobile primary dental care services needs to be expanded in remote and very remote areas to prevent and treat dental caries.

Views of Australian dental practitioners towards rural recruitment and retention: a descriptive study.

BACKGROUND: Despite an increase in the supply of dental practitioners in Australia in recent years, there remains an unequal distribution of dental practitioners with more dental practitioners working in city areas. This is in part due to difficulties in attracting and retaining dental practitioners to rural practice. The aim of this study was to investigate the attitudes of Australian dental practitioners towards what may attract them to rural areas and why they may remain in them. METHOD: A descriptive study, utilising telephone, semi-structured interviews with dental practitioners across Australia. Dental practitioners were recruited through their professional associations. Data were analysed using content and thematic analysis. RESULTS: Fifty participants; 34 dentists, eight oral health therapists, and eight dental prosthetists working in rural and urban areas of Australia. Four main themes were identified: Business Case: concerns related to income and employment security, Differences in Clinical Practices: differences in clinical treatments and professional work, Community: fitting in and belonging in the area in which you live and work, and Individual Factors: local area provision for lifestyle choices and circumstances. The most influential of these themes were business case and individual factors. Smaller rural areas, due to low populations and being unable to provide individuals with their lifestyle needs were considered unappealing for dental practitioners to live. Previous experience of rural areas was highly influential. CONCLUSIONS: The main factors influencing rural recruitment and retention were income sustainability and employment security, and individual factors. Dental practitioners felt that it was harder to earn a sustainable income and provide quality lifestyles for their family in rural areas. Previous experience of rural areas was influential towards long-term rural retention. These factors should be considered in order to develop effective strategies to address the unequal distribution of dental practitioners.

Costly chronic diseases: a retrospective analysis of Chronic Disease Dental Scheme expenditure.

OBJECTIVE: The aim of the present study was to investigate Medicare rebate claim trends under the Australian Chronic Disease Dental Scheme (CDDS) over time, region and type of service. METHODS: CDDS data obtained from the Department of Human Services reflected all Medicare item claims lodged under the CDDS by dental practitioners and processed by Medicare. Retrospective analysis of CDDS rebate claims was conducted. RESULTS: The CDDS rebates for the period 2008-13 totalled A$2.8 billion. Just under 81% of claims were from dental practitioners working in major cities. The most frequent rebates were for crown, bridge and implant (32.4%), removable prostheses (22.4%) and restorative services (21.3%). The rebate claims of restorative services, crown and bridge, and removable prostheses per dentist in all regional areas increased over the time of the CDDS. Per capita, the rebates for every type of dental service were lower in the more remote regions. CONCLUSIONS: Rebate claims increased in each of the last 3 full years of the CDDS across all areas. The majority of Medicare rebate claims were from major city areas and for crown and bridge, removable prostheses and restorative services. The service mix varied between regions.

Regional use of the Australian Chronic Disease Dental Scheme.

OBJECTIVE: To determine whether a different number and type of services were provided in Australian regional areas under the Australian Government-funded Chronic Disease Dental Scheme (CDDS). DESIGN: Retrospective analysis of administrative payments data. SETTING: Australia. PARTICIPANTS: Patients receiving dental services under the Medicare CDDS. INTERVENTIONS: The CDDS. MAIN OUTCOME MEASURES: Number and type of services. METHOD: CDDS service categories Australian Statistical Geography Standard (ASGS) regions were collected by the Australian Department of Human Services between 2008 and 2013 and compared by Australian Bureau of Statistics ASGS estimated resident regional 2011 population, and by employed number of dentists, dental specialists and dental prosthetists from the 2011 National Health Workforce Dataset. RESULTS: Number of services provided was greatest in major cities (79.0%), followed by inner regional (15.4%), outer regional (5.2%) and remote/very remote Australia (0.4%). Number of services per head of population decreased from 1.088 in major cities to 0.16 in remote/very remote areas. Number of services provided per dental practitioner showed minimal variation between major city (1672), inner (1777) and outer regional (1627) areas, but was lower in remote/very remote areas (641). Crown and bridge, periodontic, endodontic and removable prostheses per dental practitioner were most frequently supplied in the major cities, but restorative care and oral surgery were more frequently supplied in inner and outer regional areas. CONCLUSION: The number of CDDS services provided declined with regional remoteness. There was a marked difference in the utilisation of the scheme between major cities and remote/very remote areas in both number and type of service levels.

Dental practitioner rural work movements: a systematic review.

INTRODUCTION: There is a globally observed unequal distribution of dental and other health practitioners between urban and rural areas in OECD countries. Dental practitioners provide important primary healthcare services to rural populations. Workforce shortages and stability issues in underserved areas can have negative effects on rural communities. Strategies used to fix the dental practitioner workforce maldistribution need to be investigated. METHOD: The study had primary focus on Australia and included relevant international literature. Databases used were PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Informit, Web of Science, Scopus and Summon. Search terms included dental practitioner, rural, remote, retention, recruitment and strategies. RESULTS: Sixteen articles met the inclusion criteria. The articles described a total of eight different positive factors and 12 negative factors towards rural practice. The positive factors related to the nature of the type of clinical work being a 'challenge', close social and professional support networks, enjoyment of rural lifestyle and successful integration into the rural community. The negative factors mentioned included social and professional isolation, workload and type of clinical work, access to further education opportunities, access to facilities, education for children and job opportunities for a partner, and inability to integrate into the rural community. The articles that analysed recruitment incentives described three strategies currently used to influence recruitment, all of which were financial or contractual in nature. Articles mentioning retention factors described seven long-term retention motivators; of these, six of them were personal reasons. The most commonly mentioned motivational factor for recruitment and retention of the rural dental practitioner workforce was the effect of prior rural exposure for dental practitioners. CONCLUSIONS: The results of this review indicate that the most important influences on rural dental practitioner workforce recruitment and retention were a combination of financial reimbursement and personal reasons. There was also a large influence of rural medical workforce research on untested assumptions and drivers of the rural dental practitioner workforce. The high recruitment rate compared with the low retention rate indicates that current strategies were not effective in addressing rural dental practitioner workforce shortages in the long term.