Relationship of dental practitioners to the primary care network in rural and remote Queensland and the application of technology in the management of dental problems

Oral health and access for oral health services for residents in rural and remote Australian communities is often poorer than for those living in capital cities. People who have difficulty in accessing timely oral health care often present to non-dental primary care providers in hospital emergency departments, medical practices, pharmacies and Indigenous health centres for management of dental problems. However, these non-dental primary health care providers may not have the skills to deal with dental issues and can often only provide temporary, palliative relief. This study examined the extent to which oral health problems impact on service provision by non-dental primary health care providers in eight rural and remote Queensland communities. The study identified the challenges that residents face to timely oral health care access and the strategies most likely to be effective in improving oral health care access for these people. The effects on patient oral health outcomes of interprofessional relationships between the non-dental primary care networks and oral health care practitioners were explored, and the interest in the use of technology by non-dental primary care providers to manage oral health issues is assessed. Eight Queensland communities were purposively selected as they did not have a resident dental practitioner but had an active non-dental primary care network. Three different models of oral health care delivery service were examined in three descriptive case studies. Semi-structured face to face and telephone interviews were conducted with 12 dental and 55 non-dental primary care providers. The transcribed interviews were analysed using thematic analysis with the assistance of a computer software package Nvivo 10. This study found that the barriers to effective oral health care access include: (1) dental workforce shortages; (2) the patient costs of accessing oral health care in relation to travel, time off work and the actual cost of the treatment itself; (3) the lack of oral health awareness of residents; (4) poor oral health preventative strategies; (4) poor oral health promotional strategies; and (5) lack of oral health funding. Each of the three examined oral health care service models had challenges which were specific to their situations and strategies to overcome these barriers were explored. The nature of the relationships between non-oral health care practitioners and oral health care practitioners were generally described as poor at best‚ÄövÑvp and often non-existent‚ÄövÑvp. This was attributed in part to high staff turnovers and the transient nature of locum medical practitioners and pharmacists. The siloed behaviours of both the dental and non-dental care providers further contributed to the divide that exists between oral health and medical health. The interest of both dental and non-dental primary care providers, for the potential of intraoral cameras in medical practice to allow remote diagnosis of dental images by dental practitioners was explored. A number of practicalities were identified such as poor internet speed capabilities, personnel training requirements and the time constraints experienced by rural and remote primary health care providers. Strategies to improve access to oral health services included: (1) increasing the dental workforce; (2) building the oral health care provision capacity of non-dental primary care providers; (3) providing alternative oral health service delivery models; (4) providing preventative oral health care; and (5) encouraging better interprofessional communication and collaborations between non-dental rural primary care networks and oral health care practitioners. As the internet and telecommunications networks improve in rural and remote Queensland, further research should be undertaken to re-examine the interest in the applications for teledentistry to improve rural and remote oral health services. Further research could explore patient experiences around the issues of poor access to oral health services, including low socio-economic and Indigenous peoples' oral health access experiences. Revisiting the communities examined in this project into the future, with a study that uses a co-design intervention approach, would be an area for future research. It would also be of value to also explore the effects that the expected surplus of dental graduates towards 2020 might have on oral health in rural and remote Queensland into the future.