Australian Journal of Primary Health Australian Journal of Primary Health Society
The issues influencing community health services and primary health care
RESEARCH ARTICLE

Hospital admissions and emergency department presentations for dental conditions indicate access to hospital, rather than poor access to dental health care in the community

Matthew Yap A , Mei-Ruu Kok A , Soniya Nanda B , Alistair Vickery A and David Whyatt A C
+ Author Affiliations
- Author Affiliations

A School of Medicine, Faculty of Health and Medical Sciences, University of Western Australia, M706, 35 Stirling Highway, Crawley, WA 6009, Australia.

B Department of Health, Western Australia, 189 Royal Street, East Perth, WA 6004, Australia.

C Corresponding author. Email: david.whyatt@uwa.edu.au

Australian Journal of Primary Health - https://doi.org/10.1071/PY17044
Submitted: 11 April 2017  Accepted: 29 August 2017   Published online: 21 November 2017

Abstract

High rates of dental-related potentially preventable hospitalisations are thought to reflect poor access to non-hospital dental services. The association between accessibility (geographic and financial) to non-hospital dentists and potentially preventable hospitalisations was examined in Western Australia. Areas with persistently high rates of dental-related potentially preventable hospitalisations and emergency department (ED) presentations were mapped. Statistical models examined factors associated with these events. Persistently high rates of dental-related potentially preventable hospitalisations were clustered in metropolitan areas that were socioeconomically advantaged and had more dentists per capita (RR 1.06, 95% CI 1.04–1.08) after adjusting for age, sex, socioeconomics, and Aboriginality. Persistently high rates of ED presentations were clustered in socioeconomically disadvantaged areas near metropolitan EDs and with fewer dentists per capita (RR 0.91, 0.88–0.94). A positive association between dental-related potentially preventable hospitalisations and poor (financial or geographic) access to dentists was not found. Rather, rates of such events were positively associated with socioeconomic advantage, plus greater access to hospitals and non-hospital dental services. Furthermore, ED presentations for dental conditions are inappropriate indicators of poor access to non-hospital dental services because of their relationship with hospital proximity. Health service planners and policymakers should pursue alternative indicators of dental service accessibility.


References

Australian Bureau of Statistics (2011) Australian Statistical Geography Standard (ASGS) Volume 1 – main structure and greater capital city statistical area. Catalogue number 1270.0.55.001, ABS, Canberra, ACT, Australia.

Australian Bureau of Statistics (2013) Socio-Economic Indexes for Areas (SEIFA), 2011 Catalogue number 2033.0.55.001. ABS, Canberra ACT, Australia.

Australian Bureau of Statistics (2016) NACDC: population projections, 2012 (base) to 2027 for all states and territories at Statistical Area Level 2 (SA2) by sex and age. (ABS: Canberra, ACT, Australia) Available at http://webarchive.nla.gov.au/gov/20170818144806/http://www.aihw.gov.au/nacdc/population-projections/ [Verified 13 November 2017]

Australian Institute of Health and Welfare (2013) Australian hospital statistics 2011–12. Health services series number 50. Catalogue number HSE 134, ABS, Canberra, ACT, Australia.

Australian Institute of Health and Welfare (2015) National Healthcare Agreement: PI 18-Selected potentially preventable hospitalisations. (AIHW: Canberra, ACT, Australia) Available at http://meteor.aihw.gov.au/content/index.phtml/itemId/559032 [Verified 19 August 2016]

Australian Institute of Health and Welfare (2017) My Healthy Communities: Potentially preventable hospitalisations interactive data table. (AIHW: Canberra, ACT, Australia) Available at http://www.myhealthycommunities.gov.au/interactive/potentially-preventable-hospitalisations [Verified 11 July 2017]

Breslow NE, Day NE (1987) ‘Statistical Methods in Cancer Research: Volume II – the Design and Analysis of Cohort Studies.’ (World Health Organization: Lyon, France)

Caffery L, Bradford N, Meurer M, Smith A (2017) Association between patient age, geographical location, Indigenous status and hospitalisation for oral and dental conditions in Queensland, Australia. Australian Journal of Primary Health 23, 46–52.
Association between patient age, geographical location, Indigenous status and hospitalisation for oral and dental conditions in Queensland, Australia.CrossRef |

Christian B, Blinkhorn AS (2012) A review of dental caries in Australian Aboriginal children: the health inequalities perspective. Rural and Remote Health 12, 2032

COAG Health Council (2015) ‘Healthy Mouths, Healthy Lives: Australia’s National Oral Health Plan 2015–2024.’ (South Australian Dental Service: Adelaide, SA, Australia)

Coles E, Kruger E, Anjrini AA, Tennant M (2017) The Urban Dental Index: a method for measuring and mapping dental health disparities across urban areas. Journal of Urban Health 94, 211–219.
The Urban Dental Index: a method for measuring and mapping dental health disparities across urban areas.CrossRef |

Duckett S (2016) ‘Perils of Place: Identifying Hotspots of Health Inequality.’ (Grattan Institute: Melbourne, Vic., Australia)

Eayres D (2008) Common used public health statistics and their confidence intervals. Association of Public Health Observatories, York, UK.

George R, Tennant M, Kruger E (2012) Hospitalisations for removal of impacted teeth in Australia: a national geographic modelling approach. Rural and Remote Health 12, 2240

Katterl R, Anikeeva O, Butler C, Brown L, Smith B, Bywood P (2012) Potentially avoidable hospitalisation in Australia: Causes for hospitalisations and primary health care interventions. Primary Health Care Research & Information Service, Adelaide, SA, Australia.

Kruger E, Tennant M (2016) Ten years of hospitalisation for oral health-related conditions in Western Australia: an unjust dichotomy. Australian Journal of Primary Health 22, 153–158.
Ten years of hospitalisation for oral health-related conditions in Western Australia: an unjust dichotomy.CrossRef |

Levesque JF, Harris M, Russell G (2013) Patient-centred access to health care: conceptualising access at the interface of health systems and populations. International Journal for Equity in Health 12, 18
Patient-centred access to health care: conceptualising access at the interface of health systems and populations.CrossRef |

Longman JM, Passey ME, Ewald DP, Rix E, Morgan GG (2015) Admissions for chronic ambulatory care sensitive conditions – a useful measure of potentially preventable admission? BMC Health Services Research 15, 472
Admissions for chronic ambulatory care sensitive conditions – a useful measure of potentially preventable admission?CrossRef |

National Health Performance Authority (2015) ‘Healthy Communities: Potentially Preventable Hospitalisations in 2013–14.’ (NHPA: Sydney, NSW, Australia)

Page AC, Ambrose SJ, Glover JD, Hetzel D (2007) Atlas of avoidable hospitalisations in Australia: ambulatory care-sensitive conditions. Public Health Information Development Unit, University of Adelaide, Adelaide, SA, Australia.

Petersen PE, Kwan S (2011) Equity, social determinants and public health programmes – the case of oral health. Community Dentistry and Oral Epidemiology 39, 481–487.
Equity, social determinants and public health programmes – the case of oral health.CrossRef |

Pink B (2013) Socio-Economic Indexes for Areas (SEIFA) 2011. Technical paper. Catalogue number 2039.0.55.001. Australian Bureau of Statistics. Canberra, ACT, Australia.

Spencer J, Harford J (2008) Improving oral health and dental care for Australians. (ARCPOH, the University of Adelaide: Adelaide, SA, Australia) Available at http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=10737421983 [Verified 16 February 2017]



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