Patterns of dental service use among homeless people using a targeted service

Abstract

Objective: The objective of this study was to describe the patterns of dental service use among homeless people using a targeted dental service from 1992 to 2001. Method: A case-note review of a selection of patients (n = 204) was undertaken using a pre-designed data abstraction form. Results: For those presenting at their first contact, 40 percent (n = 68) expressed need in relation to oral pain and disease/tissue damage, and 28 percent (n = 33) in relation to dental checking and oral prophylaxis. Most homeless people had normative need for dental treatment (93 percent: n = 153). The dental service was delivered using a mix of outreach and fixed site clinics, with 75 percent (n = 153) of all first contacts made at outreach clinics. The targeted service was moderately successful at getting people to attend the fixed site service for continuing care, with 51 percent (n = 87) attending for subsequent visits. Location of first contact with the targeted dental service did not predict subsequent attendance. Those who did attend for further care tended to have normative needs for periodontal disease and dental decay and have their presenting complaint met. Only 23 percent (n = 46) of people completed a treatment plan, over a mean of 8.2 (standard deviation Ϯ 9.4) visits. No factors appeared to predict completion of treatment. Conclusions: While the small sample limits the findings in this study, it is hypothesized that the presence of the dental service promoted uptake of dental care. Flexible attendance tended to result in multiple visits and delayed outcomes, which themselves could have acted as barriers to care.

Developing dental services for homeless people in East London

“…Daly et al 9 found in their study that 18% of patients completed treatment as judged by the dentist; a further 4% required some minor further work and two people had completed primary dental care and were awaiting referral to a specialist. In all, 68% of the 204 patients in the sample in South London did not complete treatment.…”

“…'Treatment completed' was defined as completion of the patient's treatment plan as determined by the dentist. 9 The level of statistical significance was set at 0.05 and SPSS version 17 was used.…”

“…A data form was developed to allow consistent abstraction of data from the case notes and allow comparison with other studies. 9 Predisposing variables 9 collected were age, gender, ethnicity and homelessness. Three broad categories of homelessness were used in the study.…”

“…Some anecdotal evidence suggests that homeless people are unreliable attendees and do not complete treatment, although 60% of attendees using a mobile dental service (MDS) in Glasgow were reported to attend for continuing care. 8 Daly et al 9 provided a targeted dental service for homeless people offering a mixture of fixed site and outreach clinics. The fixed site clinic offered a full range of dental treatment and was located in an open access day centre catering for homeless people.…”

“…10 Community dental services (CDS), the salaried dental service run by primary care trusts (PCTs), are the most likely source of dental care for homeless people. 9 These services are designed to provide the full range of treatment to patient groups who may not otherwise seek treatment from general dental services (GDS) or those who have experienced difficulty in doing so. The CDS was previously free at the point of delivery, but since 2006, began charging under the NHS regulations.…”