Specialist Networks Influence Clinician Willingness to Treat Individuals with Special Needs

Abstract

Background: The South Australian Dental Service’s Special Needs Network was established to support oral health professionals working within their statewide government-funded dental service to treat patients with special needs. This study aimed to investigate how a structured network relationship with specialists in special needs dentistry influenced the willingness of dentists to treat this group of patients. Methods: Semi-structured interviews were used to explore the views of specialists and dentists involved in the South Australian Dental Service’s Special Needs Network. Inductive thematic analysis identified emerging themes enabling completion of a SWOT (strengths, weaknesses, opportunities, threats) analysis. Results: Dentists felt that a strength of the Network was a greater sense of collegiality, particularly for those working in rural areas. Although the inability to get immediate advice was seen as a weakness, dentists felt a more structured relationship with specialists improved communication pathways and resulted in more timely care. The aging workforce, systemic barriers in the public dental system, such as productivity pressures and infrastructure, and the lack of support from other health professionals were seen as ongoing barriers and threats. Regardless, dentists identified the use of telehealth and visiting specialists as future opportunities. Specialists felt that the Network was a valuable resource but were skeptical about its effectiveness, feeling that a limitation was the ability of dentists to recognize the complexity of cases. Conclusions: Ongoing support from and communication with specialists in special needs dentistry through a structured network improved the perceived ability and willingness of dentists to treat patients with special needs. Knowledge Transfer Statement: This research suggests that providing support to dentists through a hub-and-spoke network that facilitates additional training, professional interaction, and improved communication with specialists in special needs dentistry may help overcome some of the current barriers to access to care experienced by individuals with special needs, particularly those associated with the willingness and capability of clinicians treat them.

Association between disability status and dental attendance patterns in Australian children: A national survey

“…A previous study examining dental service utilization outlined that lower dental attendance patterns were associated with adults who were medically compromised and functionally dependent 24 . It is recognized that the oral management of dependent individuals and, in particular, those with severe disabilities should be supported by specialists in Special needs Dentistry 25 . Although a similar consequence could be expected for children with disabilities, it should be noted that access to appropriate dental services varies between the adult and child populations in Australia 10 .…”

“…32 Thus, the burden is placed on dentists to be trained correctly to manage these patients in order to develop early oral hygiene habits and educate on oral health to prevent poor dental attendance in the future. 25,31 The study has multiple strengths, this is first to investigate the relationship between disability status and dental attendance patterns using LSAC, which has a large population-based and nationally representative sample of children and contains comprehensive data collected from standardized questions on a diverse range of topics on the children and their families in Australia.…”

Mentoring of oral health professionals is crucial to improving access to care for people with special needs

“…Dental services have taken different approaches to trying to address this issue with many providing additional support to their clinicians to try and reduce a reliance on specialist referral. A common theme from discussions with oral health professionals has been a desire to work closely or alongside specialists in special needs dentistry or for opportunities for mentoring [ 5 , 6 , 30 ]. This was the approach taken by the clinics involved in this study.…”

“…A significant opportunity of working alongside specialists or specialist trainees, over other forms of interactions, was the ability for clinicians at the community clinic to experience direct mentoring and see how more-experienced clinicians worked in their local setting. From other initiatives discussed in the literature, a reported limitation has been a sense that specialists may not appreciate the challenges faced by clinicians at the community level because of limitations in local infrastructure, such as clinic design, equipment, and facilities with these commonly identified by oral health professionals as a barrier to treating individuals with special needs [ 5 , 6 , 30 ]. However, in this study, and particularly for those in Melbourne clinics working with training specialists, being able to see specialists work with them and with equal constraints allowed the local clinicians to see how they could adapt their own ways of managing patients; something more difficult to achieve through remote support.…”

“…In doing so, they raised concerns about the ability of the clinicians they were supporting to appreciate the true complexity of cases and their management and discussed the need for them to intervene and ensure patients received an appropriate level of care. Previous studies into support provided by specialists in special needs dentistry have raised similar concerns about finding an appropriate balance between encouraging clinicians to attempt treatment when they may not fully appreciate the complexity, ensuring that these vulnerable patients are receiving the standard of care they deserve, and ensuring adequate access to this case [ 30 ].…”