Special care: people with disabilities Flashcards
“Special Care” for (1)
a physical, sensory, intellectual, mental, medical, emotional or social impairment or disability or, more often, a combination of a number of these factors.
Patients are people! (5)
Patients with a disability do not have a decreased need or entitlement to quality, sensitively delivered dental care
All dental professionals have an obligation to ensure their patients have the best possible care
Human Rights Act 1998
Disability Discrimination Act (DDA) 2005
Holistic approach to dentistry
Delivery of Special Care Dentistry (3)
Salaried Primary Dental Care Services
Hospital Services
General Dental Services
Salaried Primary Dental Care Services (2)
Community Based Specialist Practitioners -consultants -specialists -senior Community Dentists -community Dentists -DCT2
Case Mix (6)
Divided into 6 domains 4 categories to each domain 0 A, B, C Each category carries a weighting Total weighting and Complexity Grade
Case Weight 35: Grade 5
Case Mix domains (6)
Communication Co-operation Medical status Oral RIsk Factors Access Legal and ethical barriers
Case Mix: Communication (3)
A: Mild restriction
B: Moderate restriction
C: Severe restriction
Case mix: community - mild restriction (4)
Some difficulty in communication but can overcome with or without use of aids. In most situations patient can communicate for themselves without intervention of 3rd party.
Patient speaks English but not as first language.
Patient has mild learning difficulty.
Patient has hearing impairment e.g. Lip reads
Case mix: community - moderate restriction (6)
Patient does not speak English and requires services of interpreter to communicate.
Limited communication possible. Problems with communication not able to be completely overcome.
Patient requires communication in writing; using sign language/Makaton or other communication aids.
Patient communication requires carer as interpreter.
Patient has moderate learning difficulty.
Patient has mild dementia
Case mix: community - severe restriction (5)
No ability to communicate. All discussions regarding treatment conducted through a 3rd party.
Patient has profound learning disability.
Patient has advanced dementia.
Patient with advanced Huntingdon’s disease.
Patient with severely debilitating brain injury.
Overcoming the communication barriers (a lot)
Facilitating lip reading
Sound loops
Interpreters - Sheffield Community Access & Interpreting Service SCAIS
Carers/relatives – experienced in communicating with patient
Sign Language
Speech boards
Pen & paper
Use of appropriate language
Pictures for patients
Living Wills
Independent Mental Capacity Act Advocates IMCA’s
Case Mix - co-operation (3)
A: Some Difficulty
B: Considerable Difficulty
C: Severe Difficulty
Case Mix - co-operation - some difficulty (4)
Able to complete examination but not all other procedures required in episode of care.
Treatment completed with a limited amount of interruption.
Patient requires up to 50% longer appointment length to complete treatment (in comparison to code 0).
Patient requires up to 2 behaviour modification/acclimatisation visits before treatment commences.
Case Mix - co-operation - considerable difficulty (6)
Limited examination only possible.
Formal risk assessment relating to any physical intervention that maybe required.
Considerable interruption disrupts provision of treatment.
Additional precautions required because of violent or inappropriate behaviour.
Patient requires more than 50% longer appointment length to complete treatment (in comparison to code 0).
Patient requires 3 or more behaviour modification/acclimatisation visits.
Case Mix - co-operation - severe difficulty (3)
Unable to examine without a GA
Sedation or GA required for treatment
Patient requires 5 or more behavioural modification/acclimatisation visits prior to treatment
