As emphasised in the recent Australia’s National Oral Health Plan 2015-2024, rural and regional residents in Australia have been identified as one of the priority populations who continue to experience poorer oral health than other population groups. Residents in these areas have poorer health outcomes and less access to health care services than people living in major cities. They are also at risk of poorer oral health outcomes, experience higher rates of dental caries than their city counterparts and are more likely than residents of major cities to present to dentists for problems such as pain. There is no single factor that completely explains this however access to dental services is a key factor. Australia has a maldistribution of dental practitioners. There are more than three times as many dentists practicing per 100,000 population in major cities (59.5) than in remote/very remote areas (17.9). The proportions of other types of dental practitioners including dental therapists and prosthetists are also the lowest in remote/very remote areas.
Dental services in Australia are largely provided within the private sector (85%) and public (low cost or fully subsidised) oral health services are only provided for children up to 18 years old, and adults with health care concession cards (HCC). In 2010, about 50% of all people aged five years and over had some level of private health insurance cover for dental services. In the absence of a dental practice in their own or a nearby community, rural and remote residents’ dental needs may be met, in part, by visiting mobile facilities or periodic “fly-in-fly-out” services. Residents may also access a dental practitioner by travelling to a larger population centre though regular attendance can be difficult. This is due to costs associated with travel (which can be many hundreds of kilometres), time off work, juggling the responsibilities associated with caring for dependents and, for those with less than adequate health insurance cover, the fees involved especially when return visits are required for optimal treatment.
Towns in many rural and remote areas in Australia are often widely dispersed and lack the population base to warrant a full-time dentist. In the absence of a resident dentist, patients with an acute oral health problem may present to other primary care providers located in general medical practices, hospital emergency departments (ED), pharmacies or to an Aboriginal Health Centre. Non-dental practitioners are usually able to provide only temporary relief of symptoms and referral rather than definitive treatment . Presentations to an ED may result in admission for treatment, especially where there is concern that the patients’ condition may deteriorate. Over 2012-2013, dental conditions accounted for 63,000 avoidable hospital admissions, the third highest reason for acute preventable hospital admissions in Australia. These admission rates were higher in non-metropolitan areas and highest for very remote areas. This raises the concern that people in these areas may have been hospitalised due to the lack of adequate and timely preventive dental care in community settings.
Consequently, there are strong imperatives to investigate ways in which these communities can be provided with better oral health services in realistic and cost effective ways that draw upon opportunities afforded by recent health and primary health care reform initiatives. Rural communities are served by a range of health care professionals, often working in an extended capacity as a consequence of workforce shortages and limited range of health care professionals in these areas. Such practitioners provide a network of heath care professionals serving rural communities. Stronger links and cooperation between rural health care practitioners and dentists/oral health professionals may improve service provision such that interventions are both timely, effective and result in appropriate follow-up or referral.
Residents of rural and remote communities have poorer oral health and less access to oral health services than people living in major cities. The populations of many rural and remote centres are not large enough to support a resident dentist and, in the absence of community oral health services, rural residents may present to non-dental primary care providers with oral health problems.
The aim of this study was to describe strategies that can be used by primary care practitioners to improve the provision of oral health services to rural and remote communities. The specific objectives were to (i) map oral health services practices in rural communities across primary care providers (ii) assess the extent to which oral health problems impact on service provision by primary health care providers; (iii) assess the extent to which primary care networks could be more effectively utilised to improve the provision of oral health services to rural communities and to identify what interventions/strategies were most likely to be effective.