Dr Len Crocombe Centre for Research Excellence in Primary Oral Health Care Primary health care Primary health care is essential health care based on practical scientifically sound and socially acceptable methods and technology made universally accessible to individuals and families in the com ID: 493705
Download Presentation The PPT/PDF document "The changing oral health situation in Au..." is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.
Slide1
The changing oral health situation in Australia: Will Australia move towards primary oral health care?
Dr Len Crocombe
Centre for Research Excellence in
Primary Oral Health CareSlide2
Primary health care
Primary health care is essential health care based on practical, scientifically sound and socially acceptable methods and technology made universally accessible to individuals and families in the community through their full participation and at a cost that the community and the country can afford to maintain at every stage of their development in the spirit of self-reliance and self-determination.
WHO 1978Slide3
Primary oral health care
Primary
oral
health
care is essential
oral
health
care based on practical, scientifically sound and socially acceptable methods and technology made universally accessible to individuals and families in the community through their full participation and at a cost that the community and the country can afford to maintain at every stage of their development in the spirit of self-reliance and self-determination
.Slide4
Overview
Where are we now?
How did it come to this?
Where are we heading?
Commonwealth Government policies
Does our CRE have a role?Slide5
Where are we now?
Avoidance of food due to dental problems
(AIHW
2008)
Restricted activity and
days of work lost
(
Reisine
1984;
Sternbach
1986; Spencer & Lewis
1988;
Gift & Redford
1992
)
Dental caries - second most costly diet related disease in Australia
(AHMAC 2001)Slide6
Where are we now?
%
Periodontal (gum) disease 19.0
1+ tooth, untreated decay 25.5
1+ tooth extracted due to decay 61.0
(AIHW 2008)Slide7
Where are we now?
Expenditure
on dentistry in Australia was 7.7b in
2009-10
(AIHW,
2012).Slide8
Those missing out on primary oral health care:
frail
and older
people
(
Chalmers 2002
)
rural residents
(Crocombe et al. 2010
)
Indigenous Australians
(
Slack-Smith 2011
)
Australians
with physical and intellectual disabilities (Pradhan et al. 2009)People of low socio-economic status (Sanders et al. 2006)
Where are we now?Slide9
Where are we now?
Expenditure:
Coverage
of health care expenses (2004/05) (all insurance
):
Hospitals 98.4
Medical 89.1
Pharmaceutical 54.5
Dental 33.3
Social cover of dental expenses:
Commonwealth government 9.1 (via PHI)
State government 9.7
Private Health Insurance
14.2
Total
33.0
(AIHW Health Expenditure Bulletin)Slide10
Where are we now?
85% of dental care is provided in the private sector
m
ale dominated
dominated by baby boomers
vast majority of clinicians are dentists as opposed to dental hygienists, dental therapists or oral health therapists
(
Balasubramanian & Teusner, 2011)Slide11
Where are we now?Slide12
Where are we now?Slide13
Where are we now?Slide14
Where are we now?
Planning is currently happening on an ad hoc basis
(AJ Spencer, 2007)
Slide15
“
the body is nothing else than a statue or machine
”
René Descartes. Portrait
by
Frans
Hals,
1648.
How did this come about?Slide16
How did this come about?
Lay
perceptions of health among Canadians
oral
conditions should not constitute a
justification
for exemption from work
oral
conditions not regarded as illnesses because
they
do not conform with the "sick
role“
(
Gerson
, 1972
)Perceptions of health in UK
population
not
recognized or accepted as ill health(Dunnell & Cartwright, 1972)Slide17
How did this come about?
Lisbon
, Portugal
Venice, Italy
4
th
– 7
th
Century: Northern India
Venice monopoly
Lisbon, Portugal
White GoldSlide18
How did this come about?
Harvesting Sugar Cane 1870Slide19
How did this come about?
Audubon Park Laboratory 1894Slide20
How did this come about?
20
th
Century:
Reduced
sugar prices
Increased sugar
consumption
(Porter, 1997)
Massive increase in
tooth decay
More dentists neededSlide21
65+ total no. teeth Rx (millions)
1989 1.8
1999 2.9
2009 4.3
2019 7.0
Teeth potentially in need of treatment
Where are we heading? Slide22
Where are we heading?
Mix
of services per year by dentists
is shifting:
-
more diagnostic, preventive,
root fillings
and crown &
bridge
-
less restorative,
denture and
extraction
services
-
increased use of dental services by adults
Brennan,
2000Slide23
Where are we heading?
Department of Education, Employment and Workplace
Relations, 2012 Slide24
Where are we heading?
The make-up of dental graduates is changing:
Feminisation
Cultural background
(Burgess , Crocombe et al. 2009).
X & Y Generation outlook
Allied dental practitioners
(
Balasubramanian & Teusner, 2011
).Slide25
Where are we heading?
The make-up of dental graduates is changing:
Feminisation
Cultural background
(Burgess , Crocombe et al. 2009).
X & Y Generation outlook
Allied dental practitioners
(
Balasubramanian & Teusner, 2011
).Slide26
“Dental is a State issue”
“51 The
Parliament shall, subject to this
Constitution
,
have power
to
make laws
for the
peace
, order, and
good government
of
the
Commonwealth with
respect to…..:(xxiiiA) endowment
, unemployment, pharmaceutical
,
sickness and hospital benefits, medical and dental services (but not so as to authorize any form of civil conscription), benefits to students and family allowances…”
Government PoliciesSlide27
Chronic Disease Dental Scheme
“
Health measure not dental
measure”
Chronic
medical condition
Complex
care
needs
Oral
health must be impacting on, or likely to impact on,
general health
Government PoliciesSlide28
Chronic Disease Dental Scheme
Government PoliciesSlide29
Medicare Teen Dental Plan
Cost
of an annual preventative dental
check for teenagers
who:
are aged between 12 to 17 years
receive (or their family receives) certain government
benefits
are eligible for
Medicare
Government PoliciesSlide30
National Advisory Council on Dental Health:
an
individual universal capped dental benefit
entitlement for children
a means-tested
individual capped dental benefit
entitlement for adults
measures
targeting specific at-risk groups, which would be expanded over time to include the broader
population
NACDH, 2012
Government PoliciesSlide31
Minister’s response:
a
dental scheme that targeted the
financially disadvantaged.
addressed workforce
and infrastructure constraints.
did
not duplicate existing state dental
services.
was fiscally
responsible.
Plibersek, Press release 27 Feb 2012
Government PoliciesSlide32
The 2012 Federal Budget:
$515.3 million, over four years, for dental
health.
$10.5 million for oral health promotion and to develop a National Oral Health Promotion Plan
$35.7 million for an expansion of the Voluntary Dental Graduate
Year Program
$
45.2 million for a Graduate Year Program for Oral Health Therapists
$77.7 million for a Rural and Remote Infrastructure and Relocation Grants for Dentists
$
450,000 to
a NGO
to coordinate further pro-bono work by
dentists
.
Government PoliciesSlide33
The 2012 Federal Budget:
$515.3 million, over four years, for dental
health.
$10.5 million for oral health promotion and to develop a National Oral Health Promotion Plan
$35.7 million for an expansion of the Voluntary Dental Graduate Year
Program
$
45.2 million for a Graduate Year Program for Oral Health Therapists
$77.7 million for a Rural and Remote Infrastructure and Relocation Grants for Dentists
$
450,000 to
a NGO
to coordinate further pro-bono work by
dentists.
Government PoliciesSlide34
The 2012 Federal Budget:
$515.3 million, over four years, for dental
health.
$10.5 million for oral health promotion and to develop a National Oral Health Promotion Plan
$35.7 million for an expansion of the Voluntary Dental Graduate Year
Program
$
45.2 million for a Graduate Year Program for Oral Health Therapists
$77.7 million for a Rural and Remote Infrastructure and Relocation Grants for Dentists
$
450,000 to
a NGO
to coordinate further pro-bono work by
dentists.
Government PoliciesSlide35
The 2012 Federal Budget:
$515.3 million, over four years, for dental
health.
$10.5 million for oral health promotion and to develop a National Oral Health Promotion Plan
$35.7 million for an expansion of the Voluntary Dental Graduate Year
Program
$
45.2 million for a Graduate Year Program for Oral Health Therapists
$77.7 million for a Rural and Remote Infrastructure and Relocation Grants for Dentists
$
450,000 to
a NGO
to coordinate further pro-bono work by
dentists.
Government PoliciesSlide36
Siloing continues:
- Dental
care has been largely
excluded
from the Medicare
Local process
- From
the
eHealth
innovation
-
National Health Workforce Reform Workshop
.
Government PoliciesSlide37
Senator Peter Walsh AO
“..dental
treatment has
the potential to be a
bottomless fiscal pit
…”
$7 and $11 billion
per
annum
(NHHRC,
2008)
)
Government PoliciesSlide38
House of Representatives Standing Committee on Health and
Ageing:
Inquiry into adult dental services to identify priorities for Commonwealth funding
Government PoliciesSlide39
Centre of Research Excellence
A/Prof David Brennan
Dr Len Crocombe
Prof Kaye Roberts-Thomson
A/Prof Tony Barnett
Prof Linda Slack-Smith
A/Prof Erica Bell
RE
Primary
Oral
Health
CareSlide40
Centre of Research Excellence
Theme 1: Successful aging and oral health
Community based trial: Medical GP assessment of need for dental care.
Incorporating dental professionals into aged care facilities.Slide41
Centre of Research Excellence
Theme 2: Rural oral health
Dental practitioners: Rural work movements
Relationship of dental practitioners to rural primary care networks
Oral health policy: International policy implications for AustraliaSlide42
Centre of Research Excellence
Theme 3: Indigenous oral health
Why Aboriginal adults who are referred for priority dental care do not take up or complete a course of dental care
Perceptions and beliefs regarding oral health of Aboriginal adults in Perth and key rural centres, Western AustraliaSlide43
Centre of Research Excellence
Community-based Trial: train carers of people with physical and intellectual disabilities then evaluate carers’ knowledge and practices & clinical outcomes for adults with disabilitySlide44
Causes of poor oral health
Poor hygiene
(Davies et al. 2003;
Hujoel
et al. 2006)
Poor
diet
(
Rugg
-Gunn, 1993
)
Lack of access to primary health care
(National Oral Health Plan 2004-2013)
. Social determinants (Sanders et al. 2006).Smoking
(Do et al. 2008).
Low fluoride exposure
(Slade et al. 2013).Centre of Research ExcellenceSlide45
Causes of poor oral health
Poor hygiene
(Davies et al. 2003;
Hujoel
et al. 2006)
Poor
diet
(
Rugg
-Gunn, 1993
)
Lack of access to primary health care
(National Oral Health Plan 2004-2013)
. Social determinants (Sanders et al. 2006).Smoking (Do et al. 2008).
Low fluoride exposure
(ARCPOH, 2006)
.
Centre of Research ExcellenceSlide46
Causes of poor oral health
Poor hygiene
(Davies et al. 2003;
Hujoel
et al. 2006)
Poor
diet
(
Rugg
-Gunn, 1993
)
Lack of access to primary health care
(National Oral Health Plan 2004-2013)
. Social determinants (Sanders et al. 2006).Smoking (Do et al. 2008).
Low fluoride exposure
(ARCPOH, 2006)
.
Centre of Research ExcellenceSlide47
Causes of poor oral health
Poor hygiene
(Davies et al. 2003;
Hujoel
et al. 2006)
Poor
diet
(
Rugg
-Gunn, 1993
)
Lack of access to primary health care
(National Oral Health Plan 2004-2013)
. Social determinants (Sanders et al. 2006).Smoking (Do et al. 2008).
Low fluoride exposure
(ARCPOH, 2006)
.
Centre of Research ExcellenceSlide48
Causes of poor oral health
Poor hygiene
(Davies et al. 2003;
Hujoel
et al. 2006)
Poor
diet
(
Rugg
-Gunn, 1993
)
Lack of access to primary health care
(National Oral Health Plan 2004-2013)
. Social determinants (Sanders et al. 2006).Smoking (Do et al. 2008).
Low fluoride exposure
(ARCPOH, 2006)
.
Centre of Research ExcellenceSlide49
Causes of poor oral health
Poor hygiene
(Davies et al. 2003;
Hujoel
et al. 2006)
Poor
diet
(
Rugg
-Gunn, 1993
)
Lack of access to primary health care
(National Oral Health Plan 2004-2013)
. Social determinants (Sanders et al. 2006).Smoking (Do et al. 2008).
Low fluoride exposure
(ARCPOH, 2006)
.
Centre of Research ExcellenceSlide50
Causes of poor oral health
Poor hygiene
(Davies et al. 2003;
Hujoel
et al. 2006)
Poor
diet
(
Rugg
-Gunn, 1993
)
Lack of access to primary health care
(National Oral Health Plan 2004-2013)
. Social determinants (Sanders et al. 2006).Smoking
(Do et al. 2008).
Low fluoride exposure
(Slade et al. 2013).
Centre of Research ExcellenceSlide51
Parameters
Est.
p
Est.
p
Age (15-<45 years, ref: 60+ years)
-15.57
<0.01
-5.91
<0.01
Age (45-<60 years, ref: 60+ years)
-3.45
<0.01
1.22
<0.01
Income ($30,000-<$60.000,
ref: <$30,000)
-0.19
0.69
0.66
0.25
Income ($60,000+,
ref: <$30,000)
-1.22
0.02
0.16
0.77
Educ. (Trade/Dip/Cert, ref: No post sec)
0.58
0.14
1.19
<0.01
Educ.
(
Deg
/Teach/
Nur
, ref: No post sec)
-0.13
0.75
1.54
<0.01
Country of birth (Not Aust., ref: Aust.)
0.13
0.71
-0.71
0.05
Eligibility for public care (Yes, ref: No)
-0.11
0.80
-0.40
0.41
FTE dentists/100,000 (<50, ref: 50+)
0.00
0.99
-0.12
0.72
Av time visits (<12
mths
, ref: 12+
mths
)
-2.28
<0.01
-2.08
<0.01
Usual reason visit (
Chk
-up, ref: Prob.)
-2.10
<0.01
-0.38
0.25
Lifetime fluoride exposure
-0.02
<0.01
Regional Location (Non-Metro,
ref:Metro
)
1.01
<0.01
-0.31
0.38
Centre of Research ExcellenceSlide52
Oral health
is important.
The prevention of oral diseases has been largely due to public health
measures.
There
is an inequitable access to primary oral health care
.
Primary oral health
care will improve oral
health
outcomes.
The
primary oral health care workforce is going through a process of rapid
change.
CRE role.
OverviewSlide53
The Federal Government is interested in oral health.
Primary oral health care planning is becoming less ad hoc.
Siloing of dental care out of primary health care continues.
Supplying primary oral health care will be expensive.
ConclusionsSlide54
Will Australia move towards
Primary oral health care?Slide55
Where are we heading?
Crisis of oral health care for the aged