ORCID Profile
0000-0003-2798-5850
Current Organisations
Flinders University
,
University of Sydney
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Publisher: CSIRO Publishing
Date: 2016
DOI: 10.1071/AH15040
Abstract: Objectives Overseas-qualified dentists constitute a significant proportion of the Australian dental workforce (approximately one in four). The aim of the present study was to provide a better understanding of the cultural adaptation process of overseas-qualified dentists in Australia, so as to facilitate their integration into the Australian way of life and improve their contribution to Australian healthcare, economy and society. Methods Life stories of 49 overseas-qualified dentists from 22 countries were analysed for significant themes and patterns. We focused on their settlement experience, which relates to their social and cultural experience in Australia. This analysis was consistent with a hermeneutic phenomenological approach to qualitative social scientific research. Results Many participants noted that encounters with ‘the Australian accent’ and ‘slang’ influenced their cultural experience in Australia. Most of the participants expressed ‘fascination’ with the people and lifestyle in Australia, primarily with regard to the relaxed way of life, cultural ersity and the freedom one usually experiences living in Australia. Few participants expressed ‘shock’ at not being able to find a community of similar religious faith in Australia, as they are used to in their home countries. These issues were analysed in two themes (1) language and communication and (2) people, religion and lifestyle. The cultural adaptation process of overseas-qualified dentists in Australia is described as a continuum or superordinate theme, which we have entitled the ‘newness–struggle–success’ continuum. This overarching theme supersedes and incorporates all subthemes. Conclusion Family, friends, community and organisational structures (universities and public sector) play a vital role in the cultural learning process, affecting overseas-qualified dentist’s ability to progress successfully through the cultural continuum. What is known about the topic? Australia is a popular host country for overseas-qualified dentists. Migrant dentists arrive from contrasting social and cultural backgrounds, and these contrasts can be somewhat more pronounced in dentists from developing countries. To date, there is no evidence available regarding the cultural adaptation process of overseas-qualified dentists in Australia or elsewhere. What does this paper add? This study provides evidence to support the argument that the cultural adaptation process of overseas-qualified dentists in Australia can be viewed as a continuum state, where the in idual learns to adapt to the people, language and lifestyle in Australia. The ongoing role of family and friends is primary to a successful transition process. Our research also identifies the positive role played by community and organisational structures, such as universities and public sector employment schemes. What are the implications for practitioners? A potential implication for policy makers is to focus on the positive roles played by organisational structures, particularly universities and the public sector. This can inform more supportive migration policy, as well as strengthen the role these organisations play in providing support for overseas-qualified dentists, thus enabling them to integrate more successfully into Australia’s health care system, economy and society.
Publisher: Research Square Platform LLC
Date: 02-12-2020
DOI: 10.21203/RS.3.RS-119291/V1
Abstract: Background : As the proportion and number of older people in Australia continue to grow, innovative means to tackle primary care and prevention are necessary to combat the in idual, social and economic challenges of non-communicable diseases. Objective : To assess risk factors (or predictors) for oral and general health outcomes and quality of life of older people (75+ yrs.) attending general practice (GP) clinics in South Australia. Methods : Data were collected from older people attending 48 GP clinics in metropolitan South Australia. Age, sex, education, living arrangement, material standards, chronic conditions and nutrition were assessed as risk factors. Global self-rated oral and general health and quality of life (OHIP Severity and EQ-5D Utility) were included as outcome measures. Results : A total of 459 participants completed the study response rate was 78%. In the adjusted models, high satisfaction with material standards and good nutritional health were positively associated with all four oral and general health measures. Sex (β=-0.07), age (β=-0.09) and number of chronic conditions (β=-0.13) were negatively associated with EQ-5D, while living arrangement (β=0.06) was positively associated. Further, education level (PR:0.78), living arrangement (PR:0.75) and chronic conditions (PR:1.54) were significantly associated with self-rated general health. Conclusion : Satisfaction with material standards and nutritional risk were consistent predictors for oral and general health outcomes and quality of life of older people visiting GP clinics. Primary care teams involving general practitioners, nurses and allied health practitioners are well poised to assess risk factors for older people, and work alongside the dental team.
Publisher: Elsevier BV
Date: 02-2015
DOI: 10.1111/IDJ.12141
Publisher: Australasian College of Health Service Management
Date: 07-04-2022
Publisher: Wiley
Date: 03-2010
Publisher: Springer Science and Business Media LLC
Date: 18-02-2022
DOI: 10.1186/S13690-022-00826-1
Abstract: This short communication paper aimed to compile the main determinants of inequality in dental services by distinguishing between access, utilisation, and provision of dental services. Recent findings integrated, and a dedicated conceptual framework entitled “Triangle of inequality in dental services” has been suggested. These can contribute a rich knowledge in this area and open a new window for policymakers and researchers to seek applied interventions to decrease inequality and improve access and utilisation in communities. This paper aims to synthesise the available evidence and add value to the scope. It highlights a dedicated concept for inequality in dental services beyond other areas of public health.
Publisher: Springer International Publishing
Date: 2023
Publisher: Medknow
Date: 2011
Abstract: The purpose of this article is to discuss the ethics involved in the migration of Indian trained dentists to Australia. It develops from interviews of senior oral health leaders in both the countries to provide evidence that ethics in migration is diluted in practice and to suggest that migratory procedures in both the countries should be reconsidered. There is also an urgent need for more organized bilateral communication and negotiation between the concerned organizations of both the countries (dental councils, immigration departments and research centers) in order to prevent the somewhat irreversible and intensive brain drain of top quality dentists from India to Australia. We would suggest as a starting point better monitoring of the migrants' academic and social background, the nature of the educational investment in India and the nature of the stay in Australia. This new information base could possibly lay the groundwork for more restrictive policies to be introduced both in Australia and India.
Publisher: Wiley
Date: 02-08-2016
DOI: 10.1111/ADJ.12373
Abstract: Diagnostic services are the most common area of dental service in Australia. The objective was to investigate differences in services per visit for examinations and radiographs in relation to the characteristics of patients receiving these services in terms of age and gender, aspects of visiting such as dental insurance and reasons for visit, and oral health such as number of teeth and presence of decay. A random s le of Australian dentists was surveyed in 2009-2010. Data on diagnostic services and patient characteristics were collected from a service log. A total of 1148 dentists responded (response rate = 67%). Models adjusted for age and gender of patients showed that rates [Rate Ratio, 95% CI] of examinations were higher for insured patients [1.13 1.06-1.21], while rates of radiographs were higher for emergency visits [1.25 1.11-1.48]. Patients with 20 or more teeth had higher rates for examinations [1.15 1.01-1.32] and radiographs [1.28 1.02-1.60]. Decayed teeth were associated with lower examination rates [0.70 0.65-0.76] but higher rates of radiographs [1.34 1.16-1.55]. The finding that number of teeth was associated with higher rates of examinations and radiographs suggests that retention of teeth could be influencing the increasing rates of diagnostic services in Australia.
Publisher: Springer International Publishing
Date: 2018
Publisher: Wiley
Date: 27-05-2016
DOI: 10.1111/ADJ.12370
Abstract: Migrants occupy a significant proportion of the dental workforce in Australia. The objectives of this study were to assess the level of job satisfaction of employed migrant dentists in Australia, and to examine the association between various migrant dentist characteristics and job satisfaction. All migrant dentists resident in Australia were surveyed using a five-point Likert scale that measured specific aspects of job, career and satisfaction with area and type of practice. A total of 1022 migrant dentists responded to this study 974 (95.4%) were employed. Responses for all scales were skewed towards strongly agree (scores ≥4). The overall scale varied by age group, marital status, years since arrival to Australia and specialist qualification (chi-square, p < 0.05). In a multivariate logistic regression model, there was a trend towards greater satisfaction amongst older age groups. Dentists who migrated through the examination pathway (mainly from low- and middle-income countries) had a lower probability of being satisfied with the area and type of practice (OR = 0.71 0.51-0.98), compared with direct-entry migrant dentists (from high-income countries). The high level of job satisfaction of migrant dentists reflects well on their work-related experiences in Australia. The study offers policy suggestions towards support for younger dentists and examination pathway migrants, so they have appropriate skills and standards to fit the Australian health care environment.
Publisher: MDPI AG
Date: 21-01-2021
DOI: 10.20944/PREPRINTS202101.0418.V1
Abstract: Over the last decade, there has been a renewed interest in oral health workforce planning. The purpose of this review is to examine oral health workforce planning models on supply, demand and needs, mainly in respect to their data sources, modelling technique and use of skill mix. A search was carried out on PubMed, Web of Science, and Google Scholar databases for published scientific articles on oral health workforce planning models between 2010 to 2020. No restrictions were placed on the type of modelling philosophy, and all studies including supply, demand or needs based models were included. Rapid review methods guided the review process. Twenty-three studies from 15 different countries were included in the review. A majority were from high income countries (n=17). Dentists were the sole oral health workforce group modelled in 13 studies only five studied included skill mix (allied dental personnel) considerations. The most common application of modelling was a workforce to population ratio or a needs-based demand weighted variant. Nearly all studies presented weaknesses in modelling process due to the limitations in data sources and/or non availability of necessary data to inform oral health workforce planning. Skill mix considerations in planning models were also limited to horizontal integration within oral health professionals. Planning for the future oral health workforce is heavily reliant on quality data being available for supply, demand and needs models. Integrated methodologies that expand skill mix considerations and account for uncertainty are essential for future planning exercises.
Publisher: Australian Institute of Health and Welfare
Date: 2010
Publisher: SAGE Publications
Date: 05-06-2017
Abstract: The objective of this study was to verify whether oral conditions (tooth loss, periodontal disease, dental caries) are negatively associated with health-related quality of life (HRQoL) in adults. A search was carried out on PubMed, EMBASE, Web of Science, Scopus, SciELO, and LILACS databases until the end of July 2016 with no date restrictions. Quantitative observational studies written in English were included and data extraction was performed independently by 2 reviewers. HRQoL was investigated as the outcome, and tooth loss, periodontal diseases, and dental caries were exposures. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used and the quality of the selected studies was assessed by using the Joanna Briggs Institute Meta-Analysis of Statistics assessment and review instrument (JBI-MAStARI). Twenty-one studies were included. The s le sizes ranged from 88 to 15,501 subjects 20 studies were cross-sectional designs, while 1 was a case-control study. Case definitions of the exposures were different across the studies, mainly for tooth loss, which was defined according to 11 different criteria. Fifteen studies were of “high” and 6 of “medium” quality. Eight HRQoL instruments were identified, and the most frequent was the EuroQol ( n = 8). Ten of 16 studies reported a negative impact of tooth loss on HRQoL. Four of 7 studies reported that periodontal disease impairs HRQoL, and 1 study showed that periodontal disease is positively associated with HRQoL. All studies that assessed dental caries reported a negative association between this condition and HRQoL. Despite the different definitions and measures of tooth loss and dental caries, the majority of the available evidence reported a negative impact of these conditions on HRQoL. Mixed and inconclusive findings were observed for the association between periodontal disease and HRQoL. Longitudinal prospective studies are suggested to improve the strength of the findings.
Publisher: MDPI AG
Date: 12-03-2021
Abstract: Over the last decade, there has been a renewed interest in oral health workforce planning. The purpose of this review is to examine oral health workforce planning models on supply, demand and needs, mainly in respect to their data sources, modelling technique and use of skill mix. A limited search was carried out on PubMed and Web of Science for published scientific articles on oral health workforce planning models between 2010 to 2020. No restrictions were placed on the type of modelling philosophy, and all studies including supply, demand or needs based models were included. Rapid review methods guided the review process. Twenty-three studies from 15 countries were included in the review. A majority were from high-income countries (n = 17). Dentists were the sole oral health workforce group modelled in 13 studies only five studies included skill mix (allied dental personnel) considerations. The most common application of modelling was a workforce to population ratio or a needs-based demand weighted variant. Nearly all studies presented weaknesses in modelling process due to the limitations in data sources and/or non-availability of the necessary data to inform oral health workforce planning. Skill mix considerations in planning models were also limited to horizontal integration within oral health professionals. Planning for the future oral health workforce is heavily reliant on quality data being available for supply, demand and needs models. Integrated methodologies that expand skill mix considerations and account for uncertainty are essential for future planning exercises.
Publisher: Wiley
Date: 13-11-2017
DOI: 10.1111/AJAG.12475
Abstract: Our aim was to examine the associations between general health and well-being with living conditions, oral health and degree of dependency. We surveyed people from a primary care service and collected data on sociodemographic characteristics, general health, health utility, well-being, activities, living conditions and oral health impact. Overall, 459 participated (78% response rate). Poor general health was associated with decreased instrumental activities of daily living scores (18% of those with poor general health were independent vs 60% with good general health). Greater oral health impact was also related to poor general health. Health utility was lower for some dependency, for renting and oral health impact. Well-being was also lower for some dependency, for renting, not speaking English and oral health impact. In addition to the well-known association of poor general health with dependency, our results also illustrate the potential importance of living conditions and oral health.
Publisher: Elsevier BV
Date: 2015
DOI: 10.1016/J.JDENT.2014.10.009
Abstract: To date there is little evidence of minimum intervention in relation to treatment patterns, particularly for initial carious lesions. The objective of this study was to investigate treatment provided to patients with a main diagnosis of coronal caries in relation to the severity of the caries lesion. A random s le of Australian dentists was surveyed by mailed questionnaires in 2009-2010 (response rate 67%). Data on services, patient characteristics and main diagnosis were collected from a service log. Models of service rates adjusted for age, sex, insurance status and reason for visit showed that compared to the reference category of gross caries lesions, there were higher rates [rate ratio, 95% CI] of restorative services for initial [1.63, 1.31-2.03] and cavitated [1.69, 1.39-2.05] lesions, higher rates of prophylaxis for initial [3.77, 2.09-6.79] and cavitated [3.88, 2.29-6.58] lesions, lower rates of endodontic services for initial [0.07, 0.02-0.30] and cavitated [0.11, 0.04-0.30] lesions, and lower rates of extraction for initial [0.15, 0.06-0.34] and cavitated [0.15, 0.07-0.31] lesions. Treatment of coronal caries was characterized by high rates of restorative services, but gross lesions had lower restorative rates and higher rates of endodontic and extraction services. There was little differentiation in treatment of coronal caries between initial and cavitated lesions, suggesting scope for increased management of initial carious lesions by the adoption of more minimum intervention approaches.
Publisher: Wiley
Date: 30-08-2016
DOI: 10.1111/ADJ.12388
Abstract: Treatment patterns for caries have been shown to reflect high rates of restorative services. The objective of this study was to investigate types of restorative treatment provided to patients with a main diagnosis of coronal caries in relation to the severity of the caries lesion. A random s le of Australian dentists was surveyed by mailed questionnaires in 2009-2010 (response rate 67%). Data on types of restorative treatment, patient characteristics and main diagnosis were collected from a service log. Models of service rates adjusted for age, gender, insurance status and reason for visit showed that compared to the reference category of initial caries lesions, there were lower rates [Rate Ratio, 95% CI] of adhesive anterior restorative services [0.57, 0.34-0.95] and lower rates of adhesive posterior restorations [0.56, 0.40-0.79] for gross lesions. Treatment of coronal caries was characterized by high rates of adhesive posterior restorative services, but gross lesions had lower rates of both anterior and posterior adhesive restorations. Types of restorative treatment for coronal caries were similar between initial and cavitated lesions. This could indicate scope for the adoption of more minimum intervention approaches to the management of initial carious lesions.
Publisher: Wiley
Date: 26-03-2018
DOI: 10.1111/ADJ.12583
Abstract: This study evaluated the associations between oral and general health behaviours, self-reported health and quality of life of adults aged 75 years or older living independently in South Australia. A cross sectional study based on a self-report mailed questionnaire was conducted in 590 independently living adults aged 75 years or older. Self-ratings of oral health and general health were assessed using single-item global ratings. Quality of life was measured using the Oral Health Impact Profile and the EuroQol instrument for health utility. The overall response rate was 78%. The current analyses were restricted to 354 dentate older adults. Increasing age and being female were negatively associated with EuroQol scores. Good self-rated oral and general health were more prevalent in participants with higher social status who also had lower oral health impact and higher EuroQol scores. Good self-rated oral and general health were less prevalent while oral health impact was greater in participants who ate few fruits, vegetables or dairy products. Self-rated health and quality of life were poor in older adults with inadequate fruit/vegetables/dairy intake and lower social status. These findings suggest that nutrition and socioeconomic factors may be important to the oral and general health of adults aged 75 years or older.
Publisher: Wiley
Date: 21-01-2021
DOI: 10.1111/GER.12534
Abstract: As the proportion and number of older people in Australia continue to grow, innovative means to tackle primary care and prevention are necessary to combat the in idual, social and economic challenges of non‐communicable diseases. To assess risk factors (or predictors) for oral and general health outcomes and quality of life of older people (75+ years.) attending general practice (GP) clinics in South Australia. Data were collected from older people attending 48 GP clinics in metropolitan South Australia. Age, sex, education, living arrangement, material standards, chronic conditions and nutrition were assessed as risk factors. Global self‐rated oral and general health and quality of life (OHIP Severity and EQ‐5D Utility) were included as outcome measures. A total of 459 participants completed the study response rate was 78%. In the adjusted models, high satisfaction with material standards and good nutritional health were positively associated with all four oral and general health measures. Sex (β = −0.08), age (β = −0.09) and number of chronic conditions (β = −0.12) were negatively associated with EQ‐5D, while living arrangement (β = 0.07) was positively associated. Further, having four or more chronic conditions (RR:1.47) was significantly associated with self‐rated general health. Satisfaction with material standards and nutritional risk were consistent predictors for oral and general health outcomes and quality of life of older people visiting GP clinics.
Publisher: MDPI AG
Date: 11-03-2021
Abstract: The health workforce is a vital aspect of health systems, both essential in improving patient and population health outcomes and in addressing contemporary challenges such as universal health coverage (UHC) and sustainable development goals (SDGs) [...]
Publisher: Wiley
Date: 28-10-2022
DOI: 10.1111/ADJ.12942
Abstract: Oral health service utilization contributes to positive oral health and indicates realised access to services. The study aimed to describe patterns of oral health service use among overseas‐born and Australian‐born populations and assess equity in access to services. The study used data from Australia's National Study of Adult Oral Health 2017–2018 and was guided by the Aday and Andersen framework of access to health and Australia's National Oral Health Plan. Descriptive analyses of service use by perceived need, enabling and predisposing factors were compared between four groups: Australian‐born and overseas‐born who mainly speak English and Australian‐born and overseas‐born who mainly speak a language other than English. Overseas‐born who mainly speak a language other than English experienced greater oral health care inequity, largely driven by financial difficulty (avoided care due to cost: 42% vs 27%–28% avoided/delayed visiting due to cost: 48% vs. 37%–38% cost prevented treatment: 32% vs. 18%–24%). The most favourable visiting patterns were among the Australian‐born population who speak a language other than English. The study shows clear inequity experienced among immigrants in accessibility as measured through indicators of oral health care utilization and factors related to inequity, such as the ability to pay for services.
Publisher: Wiley
Date: 20-02-2011
Publisher: Research Square Platform LLC
Date: 17-05-2021
DOI: 10.21203/RS.3.RS-530191/V1
Abstract: An inclusive research culture is vital towards the maturity of Health and Education Precincts into an active innovation ecosystem. To date, substantial investments have been made in 13 upcoming Health and Education Precincts in varying stages of development in the Greater Sydney region, New South Wales. The political commitment to create an innovative environment for teaching and a vibrant research culture is noticeable. However, it is unclear to what extent government policy engages the breadth of clinical personnel in teaching and research-related activities and contributes towards improving research culture. Based on a study conducted at the central river district of the Greater Sydney region, we argue that better engagement of clinical personnel in teaching/research-related activities and inclusion of research-related roles within the job description of clinical personnel can substantially drive a positive research culture and thereby contribute towards the overall development of Health and Education Precincts. Opportunities for continued education and training of clinical personnel and involvement in graduate research programs also substantially drives research culture. We argue that future policy and practice solutions for upcoming Health and Education Precincts need to foster an inclusive research culture and should be tailored to meet the needs of an innovative ecosystem. Future solutions will need to contribute towards improving research culture as well as the health and wellbeing of people in the region.
Publisher: Elsevier BV
Date: 12-2021
Publisher: Springer Science and Business Media LLC
Date: 17-08-2021
DOI: 10.1186/S12903-021-01765-Z
Abstract: Improving access to health services is a way towards achieving universal health coverage (UHC) in oral health. The purpose of this review was to map the determinants of access to dental services within a UHC framework. Scoping review methods were adopted for the review. PUBMED, Scopus, ISI Web of Science and ProQuest were searched for academic literature on determinants of access to dental services in OCED countries. Articles published in the last 20 years were included. No restriction was placed on study methods only articles in English language were included. Qualitative synthesis was conducted, along with a trend analysis and mapping exercise. A total of 4320 articles were identified in the initial search 57 articles were included in the qualitative synthesis. The results indicate 7 main themes as the determinants of access to dental services: family condition, cultural factors, health demands, affordability of services, availability of services, socio-environmental factors, geographical distance. Defined determinants of access to dental services, family condition, cultural factors and geographical access to dental services can fill the population axis of the UHC cube. Health demands and affordability of services fill the gap of financial protection as another axis of the UHC cube and finally, availability of dental services and socio-environmental factors are aligned with the appropriateness of services, the third axis of the UHC cube. According to the results, family condition and cultural, health demands, affordability and availability of services, social environment, and geographic factors can affect dental health access and equality. Socio-cultural determinations also need to be considered in applied planning. Addressing these factors to improve access to dental services can pave the way for achieving universal health coverage in oral health and should be considered in different levels of policymaking.
Publisher: Springer Science and Business Media LLC
Date: 07-2018
Abstract: As we debate shaping the future oral health workforce within the UK, to meet the needs of current and future populations, it is helpful to take an international perspective on this very important issue. Globally, there is a strong recognition that human resources for health (HRH) are fundamentally important to deliver effective care, accessible to all people. This paper reviews the outcome of the fourth global forum held by the World Health Organisation (WHO) in Dublin which highlighted the urgency for action. The main objectives of the forum were to advance the implementation of (i) the WHO Global Strategy on HRH 2030 and (ii) the United Nations High-Level Commission's Health Employment and Economic Growth recommendations. From an oral health perspective, the global burden of oral disease remains huge with untreated dental caries, periodontal disease and tooth loss ranking among the most prevalent conditions worldwide. Major considerations are how dental education, practice delivery and/or oral health systems as a whole could and should innovate to accommodate the growing needs of the population. As dental professionals, it also becomes necessary for us to engage and play a proactive role in this change process. Due to growing differences between population needs and available services, it is necessary for oral health personnel to work more closely with the broader health workforce so as to identify solutions that are in the best interests of the patients and populations at large.
Publisher: Elsevier BV
Date: 12-2016
DOI: 10.1111/IDJ.12246
Publisher: Elsevier BV
Date: 02-2021
Publisher: Springer Science and Business Media LLC
Date: 07-11-2021
DOI: 10.1186/S13690-021-00719-9
Abstract: Access to healthcare and service utilization are both considered essential factors for improving the general health and wellbeing of older people, especially at the time of COVID-19 pandemic. The aim of the study is to explore factors affecting healthcare access and health service utilization for older people during the pandemic. PubMed, Web of Science, Scopus and Embase were systematically searched for relevant articles. Access, utilization, health, elderly and COVID-19 were used as keywords in the search strategy. A total of 4308 articles were identified through the initial database search 50 articles were included in the review as passing the eligibility criteria. The searches were conducted up to August 2021. Data extraction was performed, and evidence was descriptively illustrated. Thematic analysis was used to explore factors influencing the elderly’s access and utilization of healthcare services, using Max QDA 10 , a qualitative analysis software. Among articles included in the review ( n = 50), a majority of the studies were from the United States (36%), followed by India (8%). According to the main healthcare services, a large number of articles (18%) were related to mental health services, followed by digital health services (16%). Factors were identified at an in idual, provider and systems level. Seven main themes emerged from the thematic analysis, as determinants of elderly’s access and utilization of healthcare services during COVID-19 pandemic. These included: access to non-COVID related services, access to COVID-related services, literacy and education, accommodation challenges, perceived attitudes of aging, and policies and structures, and social determinants. Mental health and digital health services were identified as major issues influencing or contributing to or influencing older people’s health during the COVID-19 pandemic. We also argue on the importance of a rounded view, as attention to a range of factors is vital for policy decisions towards sustainable care and equitable interventions for improving the health of older people.
Publisher: Springer Science and Business Media LLC
Date: 03-2015
Abstract: The international migration of dentists is an issue of pressing significance that poses several complex policy challenges. Policy-making is mainly constrained by the lack of workforce surveillance, research evidence and political advocacy - all three are required to work together, yet with different purposes. We first discuss the inconsistencies in migrant dentist surveillance in major country-level governmental systems (immigration departments, dentist registration authorities and workforce agencies). We argue that the limitations in surveillance collections affect independent research and in turn scholarly contributions to dental workforce policy. Differences in country-level surveillance collections also hinder valid cross-country comparisons on migrant dentist data, impeding global policy efforts. Due to these limitations, advocacy, or the political process to influence health policy, suffers, but is integral to future challenges on dentist migration. Country-level advocacy is best targeted at improving migrant dentist surveillance systems. Research interest can be invigorated through targeted funding allocations for migration research and by improving the availability of dentist surveillance data for research purposes. At the global level, the WHOs global code of practice for international recruitment of health personnel (a crucial advocacy tool) needs to be strengthened. Global organisations such as the FDI World Dental Federation have an important role to play in advocating for improved migrant dentist workforce surveillance and research evidence, especially in low- and middle-income countries.
Publisher: Wiley
Date: 27-03-2022
DOI: 10.1111/CDOE.12745
Abstract: Culturally and linguistically erse (CALD) communities experience widespread inequalities in dental care utilization. While, several studies have reported factors contributing to such inequalities, a synthesis of evidence is lacking for CALD carers. This review examined the barriers and facilitators to dental care utilization among CALD carers. Medline, CINAHL, ProQuest, Scopus and Web of Science were searched for dental utilization and related factors, without geographic limitations. An integrated mixed‐method design was adopted, where both qualitative and quantitative findings were combined into a single synthesis. Critical appraisal was conducted using JBI tools, and a Universal Health Coverage (UHC) framework guided the synthesis approach. Reliability and researcher triangulation occurred throughout the conduct of this review. A total of 20 papers were included: qualitative ( n = 8), quantitative ( n = 8) and mixed method ( n = 4). Studies were from Australia, Canada, South Korea, Trinidad and Tobago, United Kingdom and the United States. Three studies insufficiently reported confounding variables and nine qualitative papers lacked philosophical perspectives. Affordability was the foremost barrier at the system level, followed by psychosocial negative provider experiences and language/communication issues at the provider level. Cultural, knowledge, attitudes and beliefs were in idual‐family level factors. Utilizing a UHC framework, the barriers and facilitators were aggregated at three levels financial‐system, provider and in idual‐family levels and illustrated in the rainbow model of CALD oral health. The review strengthens evidence for multilayered, system‐related policies and culturally sensitive provision of services for reducing oral healthcare inequalities in CALD carers.
Publisher: Research Square Platform LLC
Date: 08-04-2020
DOI: 10.21203/RS.3.RS-19772/V2
Abstract: The authors have requested that this preprint be withdrawn due to author disagreement.
Publisher: Research Square Platform LLC
Date: 02-04-2020
DOI: 10.21203/RS.3.RS-19772/V1
Abstract: Introduction: Overseas-trained dentists comprise a significant proportion of the Australian dental workforce. The aim of the study was to examine characteristics and practice variations between Australian- and overseas-trained dentists, with an intent to identify key predictors that best differentiates Australian- and overseas-trained dentists’ practice of dentistry in Australia. Methods: Data for the study were from the Longitudinal Study of Dentist Practice Activity (LSDPA), a survey of a nationally representative random s le of dentists in Australia commencing 1983-84 and followed every five years. Dentists were surveyed on a wide range of items including participant characteristics, practice patterns, practice inputs, direct demand and productivity measures. Data were weighted to national estimates by age, sex and practice type. Discriminant function analysis was used to examine the effects of predictor variables that best separated dentists to Australian- or overseas-trained. Results: A total of 1148 dentists (response rate =67 %) responded to the survey in 2009-10 648 complete cases were available for the discriminant analysis. The discriminant functions for the full s le, and each of the three age groups ( yrs 35-50 yrs & 50+ yrs) were found effective to seperate dentists into two groups (Australian and overseas), with the proportion of cases correctly classified being highest for the oldest age group (89.7% for 50+yrs). Gender (being female), type of practice (working in public sector), and SEIFA (working at disadvantaged areas) were significant predictors, with more prominence in the 35-50 yrs age group. Practice inputs, demand and productivity measures offered less discriminative capacity between Australian- and overseas-trained dentists. Conclusion: Overseas-trained dentists contribute towards providing dental care to underserved population, public sector and in rural and remote locations. This study provided some basis to argue that policies to encourage overseas-trained dentists to contribute towards areas of need locations in Australia have been successful. Key productivity measures of overseas trained dentists mimicked those of Australian-trained dentists.
Publisher: Elsevier BV
Date: 11-2019
DOI: 10.1016/J.HEALTHPOL.2019.07.010
Abstract: Oral health workforce policy has often lacked systematic connections with broader health policy, and system-based reforms that would enable more effective responses to future needs of the population. The aim of the study was to better understand challenges facing oral health workforce policy and planning and identify potential solutions. In-depth interviews of 23 senior oral health leaders and/or health policy experts from 15 countries were conducted in 2016-17. Grounded theory principles using the Straussian school of thought guided the qualitative analysis. The findings identified: (i) narrow approach towards dental education, (ii) imbalances in skills, jobs and competencies, and (iii) geographic maldistribution as major challenges. An overarching theme -"strife of interests" - shed light on the tension between the profession's interest, and the needs of the population. A key aspect was the clash for power, dominance and authority within the oral health workforce and across health professions. This study argues that appreciating the history of health professions and recognising the centrality of the strife of interests is necessary in developing policies that both address professional sensitivities and are in line with the needs of the population. Integration and closer collaboration of oral health professionals with the mainstream medical and health professions has emerged as the key issue, but the solutions will be erse and dependent on country- or context-specific scenarios.
Publisher: Elsevier BV
Date: 10-2011
Publisher: Wiley
Date: 16-03-2016
DOI: 10.1111/CDOE.12223
Abstract: In 2010, the World Health Organization Global Code of Practice for International Recruitment of Health Personnel (the WHO Code) was adopted by the 193 Member States of the WHO. The WHO Code is a tool for global diplomacy, providing a policy framework to address the challenges involved in managing dentist migration, as well as improving the retention of dental personnel in source countries. The WHO Code recognizes the importance of migrant dentist data to support migration polices minimum data on the inflows, outflows and stock of dentists are vital. Data on reasons for dentist migration, job satisfaction, cultural adaptation issues, geographic distribution and practice patterns in the destination country are important for any policy analysis on dentist migration. Key challenges in the implementation of the WHO Code include the necessity to coordinate with multiple stakeholders and the lack of integrated data on dentist migration and the lack of shared understanding of the interrelatedness of workforce migration, needs and planning. The profession of dentistry also requires coordination with a number of private and nongovernmental organizations. Many migrant dentist source countries, in African and the South-Asian WHO Regions, are in the early stages of building capacity in dentist migration data collection and research systems. Due to these shortcomings, it is prudent that developed countries take the initiative to pursue further research into the migration issue and respond to this global challenge.
Publisher: Wiley
Date: 08-2019
DOI: 10.21815/JDE.019.089
Publisher: Springer Science and Business Media LLC
Date: 28-11-2022
Publisher: Maad Rayan Publishing Company
Date: 10-10-2016
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 02-11-2021
Publisher: CSIRO Publishing
Date: 2014
DOI: 10.1071/AH14022
Abstract: Objective The Australian Dental Council is responsible for the assessment of overseas-qualified dentists seeking to practice dentistry in Australia. The aim of this paper is to reflect on the Council’s assessment and examination process through the experiences and perceptions of overseas-qualified dentists in Australia. Methods Qualitative methods were used. Life stories of 49 overseas-qualified dentists from 22 nationalities were analysed to discern significant themes and patterns. We focused on their overall as well as specific experiences of various stages of the examination. The analysis was consistent with a hermeneutic phenomenological approach to social scientific research. Results Most participants referred to ‘cost’ of the examination process in terms of lost income, expenses and time. The examination itself was perceived as a tough assessment process. Some participants seemed to recognise the need for a strenuous assessment due to differences in patient management systems in Australia compared with their own country. Significantly, most of the participants stressed the importance of support structures for overseas-qualified dentists involved in or planning to undertake the examination. These considerations about the examination experience were brought together in two themes: (1) ‘a tough stressful examination’ and (2) ‘need for support.’ Conclusion This paper highlights the importance of support structures for overseas-qualified dentists. Appropriate support (improved information on the examination process, direction for preparation and training, further counselling advice) by recognised bodies may prevent potential exploitation of overseas-qualified dentists. Avenues that have been successful in providing necessary support, such as public sector schemes, offer policy options for limited recruitment of overseas-qualified dentists in Areas of Need locations. Such policies should also be in line with the local concerns and do not reduce opportunities for Australian-qualified dentists. What is known about the topic? During the past decade there has been a substantial increase in the number of overseas-qualified dentists migrating to Australia. Currently, one in every four dentists in Australia qualified overseas. It is likely that approximately three-quarter of migrating dentists in a given year enter through the Australian Dental Council’s examination process. To date, there is no published scholarly evidence on the experiences of overseas-qualified dentists involved in the Council’s assessment and examination process. Because more overseas-qualified dentists are being examined by the Council, it is important to reflect on the examination process so as to identify areas for future improvement. What does this paper add? This paper highlights the importance of support structures for overseas-qualified dentists involved in or planning to undertake the Australian Dental Council’s examination process. Appropriate support (improved information on the examination process, direction for preparation and training, further counselling advice) by recognised bodies may prevent potential exploitation of overseas-qualified dentists. What are the implications for practitioners? A possible implication of the findings of this study for dentists migrating to Australia and intending to take the Australian Dental Council’s examination process would be to consider the advantages of the public sector dental schemes that have been brought to light in this study. Policy makers should also be certain that although recruitment of overseas-qualified dentists reduces the gap in service provision in rural areas, it does not constrain opportunities for Australian-qualified graduates.
Publisher: Oxford University Press (OUP)
Date: 10-05-2015
Abstract: The migration of dentists is a major challenge contributing to the oral health system crisis in many countries. This paper explores the origins of the dentist migration problem through a study on international dental graduates, who had migrated to Australia. Life-stories of 49 international dental graduates from 22 countries were analysed in order to discern significant themes and patterns. We focused on their home country experience, including stories on early life and career choice dental student life professional life social and political life travels and coming to Australia. Our participants exhibited a commitment to excellence in earlier stages of life and had cultivated a desire to learn more and be involved with the latest technology. Dentists from low- and middle-income countries were also disappointed by the lack of opportunity and were unhappy with the local ethos. Some pointed towards political unrest. Interestingly, participants also carried prior travel learnings and unforgettable memories contributing to their migration. Family members and peers had also influenced participants. These considerations were brought together in four themes explaining the desire to migrate: 'Being good at something', 'Feelings of being let down', 'A novel experience' and 'Influenced by someone'. Even if one of these four themes dominated the narrative, we found that more than one theme, however, coexisted for most participants. We refer to this worldview as 'Global interconnectedness', and identify the development of migration desire as a historical process, stimulated by a priori knowledge (and interactions) of people, place and things. This qualitative study has enriched our understanding on the complexity of the dental migration experience. It supports efforts to achieve greater technical co-operation in issues such as dental education, workforce surveillance and oral health service planning within the context of ongoing global efforts on health professional migration by the World Health Organization and member states.
Publisher: CSIRO Publishing
Date: 2018
DOI: 10.1071/PY17060
Abstract: Annual health assessments by general practices for community-dwelling people aged 75 years and over are important for the early intervention and monitoring of chronic health conditions, including oral disease. Uptake of the health assessment to date has been poor, and little is known of the general and oral health profile of patients. Older patients attending health assessments at general practices in South Australia were s led for this study. Data on demographic and socioeconomic characteristics, and patients’ general and oral health, were collected by mailed questionnaire from 459 respondents. By comparison with national estimates, patients attending health assessments fared worse in many of the measures, such as self-rated general health, quality of life and the prevalence of most chronic conditions, as well as their socioeconomic circumstances. Also identified were a high degree of nutritional risk and clear need for oral health treatment, with poor self-rated oral health being three-fold higher than the national age-eligible population. Patients attending health assessments would likely benefit from nutritional screening (by a validated tool) and specific assessment of their oral health and dentition, supported by appropriate referral or intervention.
Publisher: Elsevier BV
Date: 06-2015
DOI: 10.1111/IDJ.12154
Publisher: Springer Science and Business Media LLC
Date: 04-09-2023
Publisher: Springer Science and Business Media LLC
Date: 08-08-2022
DOI: 10.1186/S12913-022-08299-2
Abstract: Poor oral health has been widely recognised as an ongoing public health issue. Patients with oral conditions may visit either a general practitioner (GP) or a dental practitioner for management. The aims of this study are to report (i) the GP management rate of oral health conditions by patient and GP demographics, (ii) what specific oral conditions were managed, and (iii) how GPs managed oral conditions. Data from the Bettering the Evaluation and Care of Health study (2006 to 2016 inclusive) were analysed. Descriptive statistics with 95% confidence intervals around point estimates were used to summarise data. Multivariate logistic regression was performed to determine the independent effect of patient and GP characteristics. A total of 972,100 GP encounters were included in the dataset, with oral condition-related encounters managed at a rate of 1.19 oral conditions per 100 GP encounters. Patients who were aged 54 years or younger, resided in a socioeconomically disadvantaged area, came from a non-English speaking background or Indigenous background were more likely to have oral conditions managed by GPs. The most commonly reported oral conditions were dental and oral mucosa-related. Over 60% of oral conditions were managed by GPs through prescribed medications. This study provided an overview of management of oral conditions by GPs in Australia. Patients from certain vulnerable demographic groups were more likely to attend a GP for management of oral conditions. Common oral conditions and management approaches were identified. The findings of this study contribute to public health and health policy discussions around optimising primary care provision in oral health.
Publisher: Springer Science and Business Media LLC
Date: 20-02-2023
DOI: 10.1186/S12889-023-15241-6
Abstract: Socioeconomically disadvantaged children are disproportionately affected by oral disease. Mobile dental services help underserved communities overcome barriers to accessing health care, including time, geography, and trust. The NSW Health Primary School Mobile Dental Program (PSMDP) is designed to provide diagnostic and preventive dental services to children at their schools. The PSMDP is mainly targeted toward high-risk children and priority populations. This study aims to evaluate the program’s performance across five local health districts (LHDs) where the program is being implemented. The evaluation will use routinely collected administrative data, along with other program-specific data sources, from the district public oral health services to conduct a statistical analysis that determines the reach and uptake of the program, its effectiveness, and the associated costs and cost-consequences. The PSMDP evaluation program utilises data from Electronic Dental Records (EDRs) and other data sources, including patient demographics, service mix, general health, oral health clinical data and risk factor information. The overall design includes cross-sectional and longitudinal components. The design combines comprehensive output monitoring across the five participating LHDs and investigates the associations between socio-demographic factors, service patterns and health outcomes. Time series analysis using difference-in-difference estimation will be conducted across the four years of the program, involving services, risk factors, and health outcomes. Comparison groups will be identified via propensity matching across the five participating LHDs. An economic analysis will estimate the costs and cost-consequences for children who participate in the program versus the comparison group. The use of EDRs for oral health services evaluation research is a relatively new approach, and the evaluation works within the limitations and strengths of utilising administrative datasets. The study will also provide avenues to improve the quality of data collected and system-level improvements to better enable future services to be aligned with disease prevalence and population needs.
Publisher: Informa UK Limited
Date: 02-2020
DOI: 10.2147/JMDH.S222987
Publisher: Medknow
Date: 2201
Location: India
Location: United Kingdom of Great Britain and Northern Ireland
Location: Australia
No related grants have been discovered for Madhan Balasubramanian.