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Abstract:
Following publication of our study comparing the costs of two models of care intended for rural Aboriginal communities in New South Wales, Australia, we have analysed the data comparing scope of practice between the two models. By way of background, Aboriginal people are less likely to access dental services than other Australians. It is well established in the literature that enhancing access to and use of services by Aboriginal Australians requires tailoring to local needs, customs and language; ensuring staff are culturally competent; and having explicit strategies to promote and sustain participation. Our retrospective study of 2 years of patient data compared two models of service delivery designed exclusively for Aboriginal people. Model A (fly in, fly out) included a fixed clinic in a major city and visiting services to rural areas. Model B (community based) located clinicians within rural communities and existing community facilities (health clinics, schools, Aboriginal health services). We previously reported the cost and outputs comparison, which found model B provided 47% more treatment at 25.2% of the cost. We are now reporting on the scope of practice differences between the two models. Scope of practice has been selected as a proxy for effectiveness because treatment that requires several service visits over time enables behavioural change and implies patient engagement in the service. This study compared the scope of practice, measured in grouped dental item numbers using the Australian Dental Association schedule of services, for the two models. De-identified patient dental item numbers for models A and B related to the provision of dental services to Aboriginal public patients were clustered according to typical service groupings and analysed for the period 1 January 2014 to 31 December 2015. Data were recorded for nine clusters of care as shown in Table 1.
