1. Dental hospitalisation of Victorian children – distribution, determinants, impacts and policy implications
John Rogers
September 2016

2. Impact of oral disease

3. Outline of presentation
Background
Research questions, conceptual model & methodology
Results
Fit with social determinants model
Key messages

4. 1. Background Dental general anaesthetic (DGA) care
Potentially Preventable Dental Hospitalisations (PPDHs)

5. Rate of dental hospitalisations (DGA) per 1,000 population by age group in Australia, 2013-14

6. Rate of PPDHs per 1,000 population by age group in Australia, 2013-14

7. Rates of potentially preventable hospitalisations in Victoria, 2013-14

8. Relevance
PPDHs highest cause of all PPHs in under 25yr olds
Costly to families and the health system with some risk
PPDHs rate used as an indicator of health system performance
Policy and practice implications

9. 2. Research questions
1. What is the extent of dental hospitalisation of Victorians?
What was the distribution by frequency, rates, diagnosis and treatment patterns in ?
What were the trends from to ?
What are the determinants (contributing factors)?

10. Research questions 2. What are the impacts on Victorian children?
What are the risks and complications – mortality and morbidity?
What are the costs – financial impacts?
3. What are the policy implications?

11. Child intermediary factors
Age
Gender
Dental treatment needs
Behaviour and ability
Socioeconomic and cultural context of family
Family income, parents’ education, concession card status
Food availability
Health insurance
Country of birth
Child’s Aboriginal background
Language spoken at home
Dental Hospitalisation
Environmental structural factors
Public health policy
Access to fluoridation
Dental care system
Access to dental services
Dental provider factors
Health care system
Access to primary care/geographic remoteness
Family function
Access to general anaesthetic facilities
General parent factors
   
Conceptual social determinants model for dental hospitalisation of young children

12. How impact on PPDH measured and data sources
Methodology
DGA factors
How impact on PPDH measured and data sources
Dental system
1. Access to primary dental services
Public dental data
Dental provider: population ratios
AHPRA and ABS data linked to Victorian Admitted Episode Dataset (VAED)
2. Dental provider factors
Literature review
Qualitative research with dental providers
Health system
3. Access to ph care – remoteness
Remoteness category; Parents perception
VAED, ABS, 2009 Victorian Child Health and Welfare Survey (VCHWS)
4. Access to GA facilities
Policy makers
DH & DHS policy documents
Public health policy
5. Access to community water fluoridation
Fluoridation status linked to VAED

13. How impact on PPDHs measured
DGA factors
How impact on PPDHs measured
6. Families socioeconomic status
Income; Education level;
Concession card status; IRSID;
Public or private admission
7. Aboriginal or Torres Strait Islander background
VAED; VCHWS
8. Cultural background
Country of birth
Language other than English
9. Dental treatment needs
Emergency treatment data
Literature
10. Age.
11. Gender
12. Anxiety/disability
VCHWS
13. Aboriginal or Torres Strait Islander background of child
14. Cultural background

14. Qualitative research
In-depth semi-structured interviews
Purposive & snowballing sampling
Thematic analysis
Data saturation
Open approach

15. 3. Results

16. PPDHs by proportion of principal diagnosis by age group, 2013-14

18. Rate of PPDHs by age group from 2001-02 to 2013-14

19. Rate of PPDHs for 0-4 year olds living in metropolitan and rural areas from 2001-02 to 2013-14

20. Standardised PPDH admission rate ratios comparison by SES quintile (IRSED) for 0-4 year olds, Victoria,

21. Descriptive statistics of 0–4 year olds admitted for PPDHs by postcode in Victoria in 2012–13
Postcodes
n=344
No. (%)
PPDHs
n = 1,297
Weighted
PPDH rate:1,000
Access to DHPs
Lowest
113 (32.8)
252 (19.4)
6.4
Medium
114 (33.1)
602 (46.4)
3.6
Highest
117 (34.0)
443 (34.2)
3.3
Fluoridation status
Fluoridated
210 (61.0)
907 (69.9)
3.2
Not fluoridated
134 (39.0)
390 (30.1)
6.2
SES status Q1
51 (14.8)
302 (23.3)
5.9 Q2
61 (17.7)
227 (17.5)
4.3 Q3
53 (15.4)
242 (18.7)
4.0 Q4
88 (22.6)
281 (21.7)
3.0 Q5
91 (26.5)
245 (18.9)
2.9

22. Poisson regression between PPDHs, access to DPHs and water fluoridation, and SES for 0–4 year old children by postcode, Victoria, 2012–13
Unadjusted
Model 1
Model 2
IRR/p
Access to DHPs
Lowest
Medium
Highest
1.96****
1.08
1.00
1.47****
Access to fluoridation
Yes No
1.92****
1.59****
1.75****
SES status Q1
2.04****
1.70**** Q2
1.48****
1.28*
1.37** Q3
1.39****
1.23*
1.22* Q4
1.02
0.95
0.96* Q5

24. Variables statistically significantly associated with child DGA, VCHWS 2009 Multivariate analysis
1-8 years old
9-12 years
1-12 years
Rural dweller ✔
High dental treatment needs
Behavioural difficulties
Parent not university trained
Bivariate analysis
Child is restless and overactive; parent with a health card; family with low level of income and with low level of food security; parent who perceives that the family does not have good access to primary health care.

25. Qualitative results - Dental provider factors
Paediatric dentists
model of care – lower threshold for DGA
supply
Dentists
reluctance to treat children
Dental therapists
specialists in child management

26. Qualitative results - Parent and child factors
Increase in child focus
Behavioural/disability
Parent
Convenience of DGA
Oral health literacy
Guilt

27. Impact of DGA
Mortality and morbidity
Qualitative findings
NCIS - one DGA death in Australia between 2000 and 2012
DGA side effects common but are lessening
Financial impact considerable

28. Child intermediary factors
Age
Gender
Dental treatment needs
Behaviour and ability
Socioeconomic and cultural context of family
Family income, parents’ education, concession card status
Food availability
Health insurance
Country of birth
Child’s Aboriginal background
Language spoken at home
Dental Hospitalisation
Environmental structural factors
Public health policy
Access to fluoridation
Dental care system
Access to dental services
Dental provider factors
Health care system
Access to primary care/geographic remoteness
Family function
Access to general anaesthetic facilities
General parent factors
   
Conceptual social determinants model for dental hospitalisation of young children

29. 4. Fit with the social determinants model
Environmental structural determinants
SES and cultural context of family
Child intermediary determinants
DGA
(PPDH)
Dental system
Access to dental care
Dental provider
Health system
Access to ph care
Access to GA
Public health policy
Access to community water fluoridation
SES
ATSI background
Cultural background
Social and family oral health literacy and norms
Social support
Dental treatment needs
Age/Gender
Behaviour/dental care anxiety/disability

30. 5. Key messages
Potentially preventable dental hospitalisations (PPDHs) can be prevented by extending evidence-based initiatives that prevent tooth decay.
Further initiatives are required to train oral health students and providers in alternatives to dental general anaesthetics (DGA), and to increase parents' and young adults' oral health literacy about prevention and alternatives to DGA.
Australian guidelines for DGA need to be established.

31. Acknowledgements Supervisors Advisory Committee members
The interviewed
Colleagues

32. Thank you jgrogers@unimelb.edu.au