Acces & Barriers

Question 1

What is access?

Answer 1

5 A's
Availability : inverse care law
Accessibility: transport and spatial
Affordability: direct and indirect cost
Acceptability: expectations 
Accommodation: opening hours

Question 2

What is the inverse care law?

Answer 2

TUDOR HART 1971

Good medical or dental care tends to vary inversely with the needs of the population it serves

Question 3

What are the problems associated with access in dentistry with the old contract what situation did this leave dentistry in at the end of the old contract?

Answer 3

Registration system: closed books
Shift to private care 
reduced  training numbers 
more females
career breaks
shorter working hours
early retirement
changing public expectations
locations chosen by dentist

Only 45% adults having checkups, 60% kids, steady fall since 1991
Overall 48% reduction

Question 4

Does the inverse care law operate in dentistry?

Answer 4

Macintyre et al 2008 Glasgow

no clear pattern regarding dental services in affluent and deprived areas

Question 5

What are the 3 barriers to oral care?

Answer 5

Physical
Social
Psychological

Question 6

What are the physical barriers to oral care?

Answer 6

distance to practice, public transport, wheelchair access, stairs

Question 7

What are the social barriers to oral care?

Answer 7

Cost, perception of need

Question 8

What are the psychological barriers to oral care?

Answer 8

Fear, apprehension, smell

Question 9

What are the reasons people attend the dentist?

Answer 9

preventative measure
attend out of a habit
set an example for their children
aware they may have some dental problems

Question 10

What barriers can be removed to improve access to oral care?

Answer 10

Reduce fees
Estimate costs of treatment and discuss with patient
clearer charging system
Extend opening hours
Improve location of surgeries
improve the image of the dentist
Contact agreed value and UDA
No registration
Recall time increased due to NICR

Question 11

What law prevents discrimination of those with disabilities??

Answer 11

Disability discrimination act 1995

Became applicable to dentists since oct 2004

Question 12

What does the disability discrimination act 1995 enable for those with disabilities?

Answer 12

access to services regardless of their disability

Question 13

What changes to the practice could be put in place to help those with disabilities?

Answer 13

Hearing loops
Clear markers
Ramps
stair lift
change width of corridr

Question 14

What problems have arisen with the new contract? And then did it come into action?

Answer 14

Came into action April 2006

1 million fewer patients can access NHS dentistry
45% fewer RCT
50% less treatment carried out that involves the lab
CHange in treatment receiving

Health select committee 2008

Question 15

Have there been an improvement on the problems seen with the new contract since 2008?

Answer 15

Yes

Feb 2011
-Number of patients seen has exceeded the March 206 baseline by 2.7%

Question 16

How has the structure of the workforce and dental training changed to improve access?

Answer 16

More training places and training in primary care settings
Outreach programmes
More emphasis on communication skills and public health approach

Question 17

What were et aims of the new NHS contract had on dental care?

Answer 17

New contract 2006 aims were
1. More time to treat
2. simplify charging system 3 +1 band
separate dentist income from treatment cost
3. Make patient charges simpler banding treatment
4. Focus on prevention and quality
5. Encourage to use DCP
6. Treatment delivered is EBD
BUT DoH on year on report showed that less complex treatments were being carried out and that less lab work too.

Question 18

What are the key changes to NHS Dentistry is the professor Steele report published in 2009 goes through?

Answer 18

bring back registration
improve access and info for pt
clinical guidelines
free replacement up to 3 years and dentist to bear costs
incentives for improving health, access and quality

Question 19

What are the four times people attend the dentist?

Answer 19

Child hood: past
Leaving school: unlikely to go
Ressume attendance: children, fear of problems

Question 20

Hat are the main reasons people do not go to the dentist?

Answer 20

Main: Apprehension and cost

Perceptions of need
Difficult finding a dentist
Journey time 
Cost
Time of work
Smell notice
Personality do dentist