- Title
- An investigation into clinical preventive care provided to adolescents accessing public oral health services New South Wales, Australia
- Creator
- Masoe, Angela Vaetoefaga Talamaivao
- Relation
- University of Newcastle Research Higher Degree Thesis
- Resource Type
- thesis
- Date
- 2015
- Description
- Research Doctorate - Doctor of Philosophy (PhD)
- Description
- Background: Despite water fluoridation and well established media promotion of the use of fluoride toothpaste twice a day, many adolescents are still at risk of dental caries and periodontal disease due to poor dietary and toothbrushing behaviours. However, these oral health problems can be moderated by providing individuals with preventive care and advice. In New South Wales (NSW) dental therapists and oral health therapists (Therapists) working in the public health system can help this vulnerable group by providing free dental care including advice on preventing dental caries and periodontal disease. This study used both quantitative and qualitative methodology to investigate the provision of preventive care by Therapists to adolescents who chose to attend NSW Public Oral Health Services. Methods/Methodology: The quantitative studies undertaken included: (i) obtaining clinical and preventive data from the NSW Health Information System of Oral Health database for all Therapists across all the Local Health Districts (LHDs) for interrogation and analysis; (ii) a reliability study of Therapists clinical and preventive care data as recorded in the electronic health record and paper record; and (iii) two cross-sectional postal questionnaire surveys; with one survey using three clinical vignettes to ascertain how Therapists structure their preventive care health plans for adolescents. The questionnaire survey also included items which explored Therapists’ patterns of participation in continuing professional development on clinical preventive care for adolescents. The qualitative studies included: (i) three two hour structured focus group sessions with 16 Therapists; and (ii) two separate studies using in-depth face to face interviews with clinical directors and health service managers; and Senior Therapists. The qualitative studies explored the participants’ perceptions and views on the influencing factors that enable or inhibit Therapists offering clinical preventive care to adolescents; and what strategies they used to enhance Therapists’ ability to facilitate preventive care in their day to day care for patients. Results: Preventive ca:re provided for adolescents accessing NSW Public Oral Health Services across all the Local Health Districts varied considerably from approximately 32% to 55% of Therapists clinical activity over a one year period. The reliability study demonstrated that the current dual system using the electronic health record and paper records to record and account for Therapists’ clinical and preventive care activities for adolescents had deficiencies, indicating an area for infrastructure improvement. The cross-sectional surveys using the clinical vignettes demonstrated that there were considerable variations noted in Therapists recommendations for stabilising and managing dental disease for their adolescent patients, suggesting a need for Clinical Directors to improve models of preventive care delivery based on scientific evidence. Therapists responded to the continuing professional development items in the survey and noted that they received most of their education from the Local Health District, suggesting opportunities for interprofessional learning from visiting dental paediatric specialists, dentists and supported by health service managers. The qualitative studies provided common themes at multiple levels of the oral health organisation, highlighting the factors that can enhance and assist Therapists operationalise scientific based preventive care into their day to day clinical practice. These include resourcing efficient clinical access pathways to preventive care; adequate workforce mix; efficient and effective administrative processes to support preventive clinical care activities; provision of oral health products and age appropriate information to support adolescents’ homecare regimes. Conclusion: Therapists in this study stated it was their professional clinical ethos to embed scientific based preventive care into day to day clinical practice to improve adolescents’ long term oral health outcomes. To improve preventive models of care for adolescents requires the overarching administrative authority, NSW Health to accept that the scientific evidence relating to dental care has changed, and that management monitoring information should be incorporated into health reforms; thus assisting clinical directors, Therapist clinical leaders and health service managers to collaborate more effectively with sponsored support ‘pillars’ in the redesign of sustainable, cost effective evidenced based care pathways for all adolescents.
- Subject
- prevention; adolescents; public oral health services; dental therapists; oral health therapists; thesis by publication
- Identifier
- http://hdl.handle.net/1959.13/1309713
- Identifier
- uon:21934
- Rights
- Copyright 2015 Angela Vaetoefaga Talamaivao Masoe
- Language
- eng
- Full Text
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| Thumbnail | File | Description | Size | Format | |||
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| View Details Download | ATTACHMENT01 | Abstract | 760 KB | Adobe Acrobat PDF | View Details Download | ||
| View Details Download | ATTACHMENT02 | Thesis | 13 MB | Adobe Acrobat PDF | View Details Download |