Abstract
Background and objectives: Some hospital dental departments offer treatment such as full dental clearance to low income, high health needs patients, as capacity allows. Many patients accessing this pathway have chronic health conditions. This study describes an interdepartmental quality assurance initiative, which included a clinical audit focussed on measuring equity of access to a hospital dental clearance pathway. This study’s secondary focus on diabetes was because it is an example of a chronic health condition associated with high health needs and suboptimal oral health.
Methods: This retrospective clinical audit reviewed e-health records of consecutive patients accessing Te Whatu Ora Waitaha’s dental clearance pathway over eighteen months. Demographic data included prioritised ethnicity and NZDep2018. Clinical data included clinical diagnoses, medications, and for patients with diabetes, HbA1c (glycated haemoglobin).
Results: Dental and medical records of 220 patients were reviewed. 23% were Māori and 17% had diabetes. Patients undergoing dental clearance had a higher NZDep2018 score, when compared to the local adult population (p<0.001). Summarising clinical data from those with diabetes (N=37), and without diabetes (N=183), showed that diabetes was associated with a greater number of diagnoses (p<0.001), and more prescribed medications (p<0.001). Most people with diabetes had an HbA1c above target.
Conclusions: This study showed that it is possible to develop a pathway for publicly funded dental clearance so that barriers to access are minimised for patients with high social deprivation, Māori, and those with long-term conditions such as diabetes. This approach allowed the hospital dental service to focus on patients with the highest health needs.