Vertel Nancy, Harrison Rosamund L, Campbell Karen M
J Can Dent Assoc. 2017 Sep;83:h6.
This pilot study at the dentistry department of BC Children's Hospital (DD-BCCH) in Vancouver, British Columbia, Canada, aimed to explore issues of access to dental services for children with special health care needs (CSHCN).
Caregivers of CSHCN, who were patients of record at DD-BCCH, were recruited to participate in this study. We collected sociodemographic characteristics, insurance coverage and medical diagnosis, and information on caregivers' perceptions of enabling factors and barriers to dental services using a pretested survey instrument with 33 closed and open-ended questions. We also obtained referral source, insurance coverage and medical diagnosis from the child's dental record. We analyzed quantitative data descriptively and qualitative comments from caregivers thematically.
Common medical diagnoses among this sample of CSHCN (n = 50) were: genetic disorder/syndrome, developmental delay, sensory impairments and autism. Half of the children were referred by a medical professional; most (90%) had had a dental appointment within the last year that included preventive treatment. Although most caregivers reported some available dental benefits, affordability of dental services was a concern. Lack of dentist's training or comfort treating CSHCN, because of the complexity of the child's medical condition or behavioural challenges was also a reported barrier.
The complexity of the child's medical status, the limited ability of dentists to provide care and financial obstacles were commonly reported barriers to care. Current efforts may best be focused on encouraging the province's health professionals, including dentists, to facilitate early referral to tertiary-level care for CSHCN whom they consider medically or behaviourally complex beyond their skill or comfort level.
本试点研究在加拿大不列颠哥伦比亚省温哥华市的卑诗省儿童医院牙科部（DD - BCCH）开展，旨在探讨有特殊医疗需求儿童（CSHCN）获得牙科服务的相关问题。
招募了作为DD - BCCH在册患者的CSHCN的照料者参与本研究。我们收集了社会人口学特征、保险覆盖情况和医学诊断信息，以及照料者对牙科服务的促成因素和障碍的看法，使用的是一份经过预测试的调查问卷，包含33个封闭式和开放式问题。我们还从孩子的牙科记录中获取了转诊来源、保险覆盖情况和医学诊断信息。我们对定量数据进行描述性分析，并对照料者的定性评论进行主题分析。
该CSHCN样本（n = 50）中常见的医学诊断包括：遗传疾病/综合征、发育迟缓、感觉障碍和自闭症。一半的儿童由医疗专业人员转诊；大多数（90%）在过去一年里进行过包括预防性治疗的牙科预约。尽管大多数照料者报告有一些可用的牙科福利，但牙科服务的可负担性仍是一个问题。由于孩子病情复杂或行为方面的挑战，牙医缺乏治疗CSHCN的培训或意愿，这也是报告中提到的一个障碍。
儿童病情的复杂性、牙医提供护理的能力有限以及经济障碍是常见的护理障碍。目前的努力最好集中在鼓励该省的卫生专业人员，包括牙医，为那些他们认为在医学或行为方面超出其技能或意愿水平的复杂CSHCN促成早期转诊至三级护理。
