Masoe Angela V, Blinkhorn Anthony S, Taylor Jane, Blinkhorn Fiona A
Faculty of Health and Medicine, School of Health Sciences, Oral Health, University of Newcastle, Ourimbah.
Department of Population Oral Health, Faculty of Dentistry, University of Sydney, Sydney, NSW, Australia.
J Healthc Leadersh. 2015 Mar 2;7:1-11. doi: 10.2147/JHL.S80011. eCollection 2015.
Oral diseases, particularly dental caries, remain one of the most common chronic health problems for adolescents, and are a major public health concern. Public dental services in New South Wales, Australia offer free clinical care and preventive advice to all adolescents under 18 years of age, particularly those from disadvantaged backgrounds. This care is provided by dental therapists and oral health therapists (therapists). It is incumbent upon clinical directors (CDs) and health service managers (HSMs) to ensure that the appropriate clinical preventive care is offered by clinicians to all their patients. The aims of this study were to 1) explore CDs' and HSMs' perceptions of the factors that could support the delivery of preventive care to adolescents, and to 2) record the strategies they have utilized to help therapists provide preventive care to adolescents.
In-depth, semistructured interviews were undertaken with 19 CDs and HSMs from across NSW local health districts. A framework matrix was used to systematically code data and enable key themes to be identified for analysis.
The 19 CDs and HSMs reported that fiscal accountability and meeting performance targets impacted on the levels and types of preventive care provided by therapists. Participants suggested that professional clinical structures for continuous quality improvement should be implemented and monitored, and that an adequate workforce mix and more resources for preventive dental care activities would enhance therapists' ability to provide appropriate levels of preventive care. CDs and HSMs stated that capitalizing on the strengths of visiting pediatric dental specialists and working with local health district clinical leaders would be a practical way to improve models of preventive oral health care for adolescents.
The main issue raised in this study is that preventive dentistry per se lacks strong support from the central funding agency, and that increasing prevention activities is not a simple task of changing regulations or increasing professional education.
口腔疾病，尤其是龋齿，仍然是青少年最常见的慢性健康问题之一，也是一个重大的公共卫生问题。澳大利亚新南威尔士州的公共牙科服务为所有18岁以下的青少年，特别是那些来自弱势背景的青少年，提供免费的临床护理和预防性建议。这项护理由牙科治疗师和口腔健康治疗师（治疗师）提供。临床主任（CDs）和卫生服务经理（HSMs）有责任确保临床医生为所有患者提供适当的临床预防护理。本研究的目的是：1）探讨临床主任和卫生服务经理对可支持为青少年提供预防护理的因素的看法；2）记录他们为帮助治疗师为青少年提供预防护理而采用的策略。
对新南威尔士州各地地方卫生区的19名临床主任和卫生服务经理进行了深入的半结构化访谈。使用框架矩阵对数据进行系统编码，以便确定关键主题进行分析。
19名临床主任和卫生服务经理报告称，财政问责制和达到绩效目标会影响治疗师提供的预防护理的水平和类型。参与者建议应实施并监测用于持续质量改进的专业临床结构，并且适当的劳动力组合和更多用于预防性牙科护理活动的资源将提高治疗师提供适当水平预防护理的能力。临床主任和卫生服务经理表示，利用来访儿科牙科专家的优势并与当地卫生区临床负责人合作，将是改善青少年预防性口腔保健模式的切实可行方法。
本研究提出的主要问题是，预防牙科本身缺乏中央资助机构的有力支持，增加预防活动并非简单的更改规定或增加专业教育的任务。
