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Disparities in care access for health conditions where physiotherapy can play a major role are abetting health inequities. Spatial analyses can contribute to illuminating inequities in health yet the geographic accessibility to physiotherapy care across New Zealand has not been examined. This population-based study evaluated the accessibility of the New Zealand physiotherapy workforce relative to the population at a local scale. The locations of 5,582 physiotherapists were geocoded and integrated with 2018 Census data to generate 'accessibility scores' for each Statistical Area 2 using the newer 3-step floating catchment area method. For examining the spatial distribution and mapping, accessibility scores were categorized into seven levels, centered around 0.5 SD above and below the mean. New Zealand has an above-average physiotherapy-to-population ratio compared with other OECD countries; however, this workforce is maldistributed. This study identified areas (and locations) where geographic accessibility to physiotherapy care is relatively low., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Objective This study aimed to map the geographic distribution of tertiary hospitals in Australia's most populous cities. Good access to hospital facilities improves the health and welfare of a community. The use of geographic information system (GIS) technology can assist in understanding spacial accessibility to services. Methods Using Quantum GIS, a geodatabase was constructed to incorporate hospital locations and demographic distribution data throughout Australia's 20 most populous cities. Data on the population's age groups were integrated into the geodatabase to investigate the distribution of age groups and their utilisation of access to emergency departments in tertiary public health care. Overall this study reported the geospatial distribution of 89 tertiary hospitals and the demographics of the population in areas around these hospitals. Results The majority of hospitals were located in the three most populated cities of New South Wales (NSW), Sydney, Wollongong and Newcastle, which contain a total of 32 hospitals, with 23 (72%) of the hospitals in Sydney. There were 7.8, 24.0, 53.4 and 81.0% of the population in NSW within 1.5, 3, 6 and 50 km of the hospitals, respectively. The second-highest number of hospitals was in Victoria (n  = 22), with 18 (82%) hospitals located in Melbourne. This was followed by Queensland (n  = 14), with eight (57%) hospitals located in Brisbane. Conclusions The results indicate that 82.2% of the Australian population lives within a 50 km radius of a tertiary hospital, with NSW having higher age distribution percentages than the other states. The results of this study could be used to locate and improve areas of need with a high burden of disease and low accessibility to healthcare services.

Background: It is impossible to attain good general health without maintaining oral health and this becomes problematic when dental services are located far from the population that needs to utilise them. This study aimed to assess the geographic accessibility of dental clinics located in public primary healthcare clinics (PHCs) and hospitals in the Jazan region of Saudi Arabia and how long it takes to reach them by car and on foot., Methods: The location of clinics and hospitals, maps of road systems, and the governorates' borders (administrative areas) within the Jazan region were downloaded using the QGIS mapping tool. The time taken to travel to the clinics and hospitals, either by driving or walking, was assessed. If the time was 30 min or less, residents in the area were classified as 'serviced'. It was more than 30 min, they were 'underserved'., Results: Only 31% of Jazan residents were found to live in a serviced area if they drove to clinics and hospitals. Residents of Jazan's seven mountainous governorates were more likely to require services. Only 40% could drive less than 30 min to a primary health dental clinic. Only 19% of people could walk to a hospital in less than 30 min. Only two governorates had a majority of residents who lived in serviced areas., Conclusion: The study demonstrates an accessibility issue, as many Jazan inhabitants must drive or walk for an extended period (> 30 min) to reach a healthcare facility, whether a primary health care centre or a hospital. This issue may result in many people not receiving necessary health care, compromising their oral health status. Additional research is needed to identify public, private and other health facilities in the region and the prevalence of oral disease., (© 2022. The Author(s).)

Objective The aim of this study was to identify the gaps in public dental service locations for people living with a disability in Australia, with in-depth analysis of Western Australia (WA). Methods Data from the Survey of Disability, Ageing and Carers and national census data were used to geographically model the prevalence of disability. Private and public dental practice data were integrated using QGIS, and a catchment area of 5km was used for public dental practices. This was then used to identify residential areas outside the 5-km catchment area. Further analysis was then done to determine how a potential service at these sites would improve geographic access for people with a disability residing within the area. Results In this study, 6162 private and 178 public dental practices were geo-coded, covering 39915 Statistical Area Level 1 regions and approximately 16 million people. Overall slightly more than half the people living with any disability resided within the 5-km catchment area of a public dental practice. WA (Perth) had the lowest coverage (48%), whereas New South Wales (Sydney) had the highest (71%). In WA (Perth), four sites were identified that would improve the overall coverage from 48% to 75%. Conclusion This study highlights the areas where there is low access to a dental service, particularly access to a public dental service, for people living with a disability. What is known about the topic? The distribution of people with a disability is associated with area-level measures of socioeconomic disadvantage. Access to dental care is a function of affordability, availability, accessibility, accommodation and acceptability. Previous studies identified problems in relation to access to dental care for people living with a disability, including wait times, costs and physical access to buildings. What does this paper add? This paper shows how geographical access to a dental service can be improved, by locating services in identified areas targeting people living with a disability. What are the implications for practitioners? The results of this study could be used to plan funding targeted at areas of need with a high burden of disease and low accessibility to services.

Aim To investigate the relationship between deprivation and distance to NHS dental providers in Scotland, Wales and Northern Ireland.Methods A total of 1,795 NHS dental practices were located at the smallest geographic areas for Scotland, Wales and Northern Ireland. A geographic information system (GIS) was used to overlay the distribution of dental practices with areas graded by the Index of Multiple Deprivation (IMD) and population census from 2011.Results In Scotland, Wales and Northern Ireland, 15%, 17.8% and 27.5% of the population lived outside 2.5 km of an NHS dental practice, respectively. NHS dental clinics were distributed mostly among people that lived in IMD 1 and 5 areas across the respective deprivation measures of all three nations. There were negligible differences in area-based deprivation measures and NHS dental clinic distribution.Conclusion NHS dental practices in Scotland, Wales and Northern Ireland were not socioeconomically distributed, suggesting an equitable spatial availability of services based on need.

Progressive realisation of equitable access to health services is a fundamental measure of a state's resolve to achieve universal health coverage. The World Health Organization has reprioritised the importance of oral health services as an integral element of the roadmap towards health equity. This study sought to determine whether there is an indication of progressive realisation of equitable spatial access to public dental services for Australians <18 years of age through a comparison of travel times to the nearest public dental clinic at successive census dates. The distribution of children classified by rural remoteness and level of socioeconomic disadvantage, as well as the location of public dental clinics at the 2011 and 2016 Australian Bureau of Statistics censuses, was mapped using geographic imaging software. OpenRouteService software was used to calculate the travel time by car between each statistical census district and the nearest public dental clinic. There has been an improvement in the percentage of the population <18 years of age living within a reasonable travel time of a public dental clinic. The most socioeconomically disadvantaged groups in more densely populated areas have better spatial access to publicly funded dental services than less disadvantaged groups. Children living in very remote areas continue to experience lengthy travel times to access fixed oral health services.

Objective: The aim of this study was to analyse, in detail, the distribution of primary dental clinics in relation to the Malaysian population and relative population wealth, to test the hypothesis that an uneven distribution of dental services exists in Malaysia., Method: This 2016 study located every dental practice in Malaysia (private and public) and mapped these practices against population, using Geographic Information Systems (GIS) tools. Population clusters within 5, 10 and 20 km of a dental clinic were identified, and clinic-to-population ratios were ascertained. Population data were obtained from the Population and Housing Census of Malaysia 2010. Population relative wealth was obtained from the 2014 Report on Household Income and Basic Amenities Survey for Malaysia. The physical address for each dental practice in Malaysia was gathered from the Official Portal of Ministry of Health Malaysia. All data for analysis were extracted from the integrated database in Quantum GIS (QGIS) into Microsoft Excel., Result: The population of Malaysia (24.9 million) was distributed across 127 districts, with 119 (94%) having at least one dental clinic. Sixty-four districts had fewer than 10 dental clinics, and 11.3% of Malaysians did not reside in the catchment of 20 km from any dental clinic. The total dental clinic-to-population ratio was 1:9,000: for public dental clinics it was 1:38,000 and for private clinics it was 1:13,000., Conclusion: Dental services were distributed relative to high population density, were unevenly distributed across Malaysia and the majority of people with the highest inaccessibility to a dental service resided in Malaysian Borneo., (© 2018 FDI World Dental Federation.)

The vast distances across Australia and the uneven population distribution form a challenging environment in providing the population with health and dental care. The Australian dental workforce distribution was analysed by using statistics from the open Census source available on the Australian Bureau of Statistics (ABS) website. This study aimed to construct a detailed analysis of the large differences in the practice-to-population (PtP) ratios across Australia, as well as the effect of maldistribution for rural and remote areas, where economics plays an important role. The national Census data at the level of Statistical Area Level 2 (SA2) (approximating suburbs) from 2011 was integrated with the location of all private dental practices in Australia (collected in late 2015) using modern geographic tools. All private dental practice (n=7597) location coordinates were mapped nationwide, across 2157 statistical areas. The population in Australia without a dental practice in their area was 31.6%. The PtP ratio differed from one practice per 40 people to one practice per 27773 people. The nationwide calculation of the PtP ratio shines light on issues about the dental workforce. The study results confirmed the uneven distribution of dental practices in rural and remote areas and socioeconomically disadvantaged areas.

Objective The aim of this study was to examine the spatial accessibility of the aged and older adult population of the greater Sydney region to the bus public transport network, and the proximity of this transportation route to public and private dental services. Methods This study used geographic information systems (GIS) to examine, at a population level, the spatial accessibility of the public transport network and dental provider locations. The prime focus of the present study was on the aging population residing within 50 km of the General Post Office of metropolitan Sydney. Retirees (aged ≥65 years) and older adults (aged ≥85 years) were the two subsets of the aging population. Results Sydney's bus network is currently supplying bus transport to both older and disadvantaged groups, facilitating the needs of more than half a million older people. Regardless of socioeconomic status, 12% of the entire population, 11.5% of retirees and 10.8% of older adults resided 500 m away from accessible medium-frequency bus stops. Approximately 40% of the overall population consisted of people of lower socioeconomic status living within 500 m of a medium-frequency bus stop, whereas 60% of the population were of a high socioeconomic status and lived within 500 m of a medium-frequency bus stop. Conclusion Metropolitan Sydney has a transport system that is substantial and robust, and appears to offer relatively similar spatial accessibility for all socioeconomic groups. This system is an example of great urban planning, where the distribution of bus stops is evenly positioned in both high-density areas and areas of low socioeconomic status. What is known about the topic? Older adults and disadvantaged people suffer from higher levels of dental disease compared with the rest of the population. Older adults and disadvantaged people are more likely to rely on public transport to access healthcare services, including dental care. The Australian population is aging rapidly. What does this paper add? Although a previous study examined the accessibility to services via the train network, this is the first analysis of the spatial accessibility to dental services via the bus network in Sydney. Most older adults and disadvantaged people in Sydney enjoy acceptable spatial access to the public transport network, and thereby to dental practices. Urban planning, in terms of determining healthcare service locations and the public transport network, needs to consider the distribution of older adults and disadvantaged populations. What are the implications for practitioners? Practitioners are more likely to attract older adult patients to their practices or clinics if these are located within easy access to the public transport network.

Objective: Advances in geospatial technologies have recognized the role of geographic distance as a barrier to healthcare accessibility. Frequent transportation is supposed to buffer issues with distance, while infrequent services impede the uptake of care. The role of public transportation on the accessibility of health care-including oral health care-is not well elucidated in the context of megacities, such as the municipality of São Paulo, Brazil. This study aimed to compare the supply of public transportation to primary dental clinics and the population between advantaged and disadvantaged areas in São Paulo city., Methods: A total of 4101 primary dental clinics in São Paulo city were identified and geocoded. Geographic coordinates were also retrieved for the 19 242 bus stops, 56 commuter rail stations and 64 rapid transit stations. Clinic locations and transport points were integrated with the city's 19 128 constituent census tracts-each containing sociodemographic data on the 11 252 204 residents-using Geographic Information Systems (GIS)., Results: Almost all clinics were located within 0.5 km of public transportation. Half of all clinics were within 0.5 km of high-frequency transport points, and three-quarters were within 1 km. Likewise, 99% of the population resided within 0.5 km of any public transportation. However, only 22% were within 0.5 km of high-frequency options, and half were within 1 km. Those within 0.5 km of high-frequency points had higher average monthly household incomes and lower illiteracy rates, with lower proportions of children and ethnic minorities, and higher proportions of older people., Conclusion: Clinics and populations in sociodemographically disadvantaged tracts have poorer public transportation links in São Paulo city., (© 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Objectives: Brazil is one of the largest countries in the world, in terms of geography and population. Most Brazilians reside in the south and south-eastern regions, with notable numbers in the regions' megacities, such as São Paulo city. Healthcare provision in such a complex environment is difficult. Thus, a clear understanding of the distribution - or rather, the maldistribution - of these services is fundamental for optimising the allocation of human and financial resources to areas of greatest privation. The present study aimed to determine the distribution of primary dental clinics in São Paulo city., Methods: A total of 4,101 primary dental clinics in São Paulo city were identified and geocoded. Clinic locations were integrated with the city's 19,128 constituent census tracts - each containing sociodemographic data for the 11,252,204 residents - using Geographic Information Systems (GIS)., Results: Approximately two-thirds (64.8%) of the population resided within 0.5 km of a primary dental clinic, and a further 23.9% were within 1 km. Populations more than 1 km out were typically characterised as sociodemographically disadvantaged. Primary dental clinics were also more sparsely distributed in the city's peripheral census tracts than central census tracts., Conclusion: Primary dental clinics are maldistributed in São Paulo city, with disadvantaged populations having less spatial access than their advantaged counterparts., (© 2017 FDI World Dental Federation.)

Introduction: Australia is one of the least densely populated countries in the world, with a population concentrated on or around coastal areas. Up to 33% of the Australian population are likely to have untreated dental decay, while people with inadequate dentition (fewer than 21 teeth) account for up to 34% of Australian adults. Historically, inadequate access to public dental care has resulted in long waiting lists, received much media coverage and been the subject of a new federal and state initiative. The objective of this research was to gauge the potential for reducing the national dental waiting list through geographical advantage, which could arise from subcontracting the delivery of subsidised dental care to the existing network of private dental clinics across Australia., Methods: Eligible population data were collected from the Australian Bureau of Statistics website. Waiting list data from across Australia were collected from publicly available sources and confirmed through direct communication with each individual state or territory dental health body. Quantum geographic information system software was used to map distribution of the eligible population across Australia by statistical area, and to plot locations of government and private dental clinics. Catchment areas of 5 km for metropolitan clinics and 5 km and 50 km for rural clinics were defined. The number of people on the waiting list and those eligible for subsidised dental care covered by each of the catchment areas was calculated. Percentage of the eligible population and those on the waiting list that could benefit from the potential improvement in geographic access was ascertained for metropolitan and rural residents., Results: Fifty three percent of people on the waiting list resided within metropolitan areas. Rural and remote residents made up 47% of the population waiting to receive care. The utilisation of both government and private dental clinics for the delivery of subsidised dental care to the eligible population has the potential to improve geographic access for up to 25% of those residing within metropolitan areas and up to 59% for eligible country residents., Conclusions: This research finds that utilisation of the existing network of private dental practices across Australia for delivery of subsidised dental care could dramatically increase geographic reach, reduce waiting lists, and possibly make good oral health a more realistic goal to achieve for the economically disadvantaged members of the community. In addition, this approach has the potential to improve service availability in rural and remote areas for entire communities where existing socioeconomic dynamics do not foster new practice start-up.

With the availability of oral care services very unevenly distributed in rural or remote areas, underserved people seek oral care from non-dental care providers. Against this backdrop, and coupled with the decreasing cost of and innovations in technology, there is a growing interest in the adoption of telemedicine services. Regardless of the lack of good-quality evidence supporting the cost-effectiveness of telemedicine, evidence already indicates that telemedicine, even with extra costs, helps in reducing the inequalities in the provision of primary health care. Telemedicine has the potential to overcome geographical barriers and contribute to closing the rural-urban healthcare gap in Australia and many other regions. Although research examining different teledentistry applications has found that this technology can be successfully integrated into different settings, there is little active teledentistry practice in Australia. The integration of telemedicine into the mainstream oral health system is a complex and collaborative process in which numerous factors at individual, infrastructure and organisational levels are involved. Addressing the barriers that delay the implementation of a teledentistry service can provide valuable insights into its lack of acceptance and establish an evidence base that can help to inform future decisions about the benefits of teledentistry.

Despite great progress in oral health over the past three decades, the rates of caries remain high in Australia, particularly among underserved populations. The reasons for poor oral health amongst underserved populations are multiple, but rests with socio-economic determinants of health. The present review considers international workforce models that have been created to enhance the recruitment and retention of dental providers in rural areas. Several strategies have been developed to address care access problems in rural areas, including the use of telemedicine and mid-level dental providers (MLDPs). Despite ongoing opposition from dentistry organisations, the Alaska and Minnesota workforce models have proven that developing and deploying dental therapists from rural communities has the potential to address the unmet needs of underserved populations. It is more efficient and cost-effective for MLDPs to perform triage and treat simple cases and for dentists to treat complicated cases. The use of MLDPs is intended to increase the capacity of the dental workforce in areas that are too isolated to entice dentists. Telemedicine has emerged as one solution to address limited access to health care, particularly in locations where there is a lack of providers. Telemedicine not only provides access to care, but also offers support, consultations and access to continuing education for practicing dental providers in rural areas. This strategy has the potential to free up resources to increase care access and reduce oral health disparities, thereby contributing to closing the rural-urban oral health gap., (© 2016 FDI World Dental Federation.)

Objective: This study examined the spatial accessibility of the Sydney Dental Hospital, to the people of metropolitan Sydney, using a geographic information systems approach., Background: Sydney, Australia's largest city and the state capital of New South Wales, has 4.6 million people, with one-fifth of the Australian population (4.6 million people). Public dental services exist, but accessibility is limited to some specific population groups, who meet specific eligibility criteria., Methods: All adults (those older than 15 years) were included in the study, and two subsets of this population, retirees (older than 65 years) and elderly (older than 85 years), were also examined according to their proximity to the Sydney Dental Hospital, which is located immediately adjacent to the central train station. Census data (population data) and train station geo-coding data were integrated with high-resolution geographic information systems to analyse population spatial accessibility., Results: Irrespective of the socioeconomic status, it was found that 43% of all the adults, 42.5% of the retirees and 41.6% of elders lived 2 km away from the nearest train station. Two-thirds of those in lower socioeconomic status lived within 2 km of a train station, whilst half of those in the higher socioeconomic status groups lived within 2 km from a train station., Conclusion: Metropolitan Sydney is an example of good urban planning where train stations are appropriately placed in high population density and low socioeconomic areas. The same should be investigated in other major metropolises, especially those still in growth and planning transportation systems., (© 2014 John Wiley & Sons A/S and The Gerodontology Association. Published by John Wiley & Sons Ltd.)

Background: Australia has a significant mal-distribution of its limited dental workforce. Outside the major capital cities, the distribution of accessible dental care is at best patchy., Objective: This study applied geo-spatial analysis technology to locate gaps in dental service accessibility for rural and remote dwelling Australians, in order to test the hypothesis that there are a few key location points in Australia where further dental services could make a significant contribution to ameliorating the immediate shortage crisis., Method: A total of 2,086 dental practices were located in country areas, covering a combined catchment area of 1.84 million square kilometers, based on 50 km catchment zones around each clinic. Geo-spatial analysis technology was used to identify gaps in the accessibility of dental services for rural and remote dwelling Australians. An extraction of data was obtained to analyse the integrated geographically-aligned database. Results: Resolution of the lack of dental practices for 74 townships (of greater than 500 residents) across Australia could potentially address access for 104,000 people. An examination of the socio-economic mix found that the majority of the dental practices (84%) are located in areas classified as less disadvantaged. Output from the study provided a cohesive national map that has identified locations that could have health improvement via the targeting of dental services to that location., Conclusion: The study identified potential location sites for dental clinics, to address the current inequity in accessing dental services in rural and remote Australia.

Australians are one of the healthiest populations in the world but there is strong evidence that health inequalities exist. Australia has 23.1 million people spread very unevenly over -20 million square kilometres. This study aimed to apply spatial analysis tools to measure the spatial distribution of fixed adult public dental clinics in the eight metropolitan capital cities of Australia. All population data for metropolitan areas of the eight capital cities were integrated with socioeconomic data and health-service locations, using Geographic Information Systems, and then analysed. The adult population was divided into three subgroups according to age, consisting of 15-year-olds and over (n = 7.2 million), retirees 65 years and over (n = 1.2 million), and the elderly, who were 85 years and over (n = 0.15 million). It was evident that the States fell into two groups; Tasmania, Northern Territory, Australian Capital Territory and Western Australia in one cluster, and Victoria, New South Wales, Queensland and South Australia in the other. In the first group, the average proportion of the population of low socioeconomic status living in metropolitan areas within 2.5 km of a government dental clinic is 13%, while for the other cluster, it is 42%. The clustering remains true at 5 km from the clinics. The first cluster finds that almost half (46%) of the poorest 30% of the population live within 5km of a government dental clinic. The other cluster of States finds nearly double that proportion (86%). The results from this study indicated that access distances to government dental services differ substantially in metropolitan areas of the major Australian capital cities.

The aim of this study was to develop a method for the analysis of the influence of public transport supply in a large city (Melbourne) on the access to emergency dental treatment. Geographic Information Systems (GIS) tools were used to associate the geographical distribution of patients (and their socioeconomic status) with accessibility (through public transport supply, i.e. bus, tram and/or train) to emergency dental care. The methodology used allowed analysis of the socioeconomic status of patient residential areas and both spatial location and supply frequency of public transport by using existing data from patient records, census and transport departments. In metropolitan Melbourne, a total of 13 784 patients met the inclusion criteria for the study sample, of which 95% (n = 13 077) were living within a 50 km radius of the Royal Dental Hospital of Melbourne. Low socioeconomic areas had a higher demand for dental emergency care in the Royal Dental Hospital of Melbourne. Public transport supply was similar across the various socioeconomic strata in the population, with 80% of patients having good access to public transport. However, when considering only high-frequency bus stops, the percentage of patients living within 400 m from a bus stop dropped to 65%. Despite this, the number of patients (adjusted to the population) coming from areas not supplied by public transport, and from areas with good or poor public transport supply, was similar. The methodology applied in the present study highlights the importance of evaluating not only the spatial distribution but also the frequency of public transport supply when studying access to services. This methodology can be extrapolated to other settings to identity transport/access patterns for a variety of services.

Aim: To investigate the distribution of public and private dental practices in NSW in relation to population distribution and socioeconomic status., Methods: Dental practices (public and private) were mapped and overlayed with Census data on Collection District population and Socio-Economic Indexes for Areas (SEIFA)., Results: Overall, there was an uneven geographic distribution of public and private dental practices across NSW. When the geographic distribution was compared to population socioeconomics it was found that in rural NSW, 12% of the most disadvantaged residents lived further than 50km from a public dental practice, compared to 0% of the least disadvantaged. In Sydney, 9% of the three most disadvantaged groups lived greater than 7.5km from a public dental practice, compared to 21% of the three least disadvantaged groups., Conclusion: The findings of this study can contribute to informing decisions to determine future areas for focus of dental resource development (infrastructure and workforce) and identifying subgroups in the population (who are geographically isolated from accessing care) where public health initiatives focused on amelioration of disease consequences should be a focus.

Australia is the sixth biggest (by area) country in the world, having a total area of about 7.5 million km(2) (3 million square miles). This study located every dental practice in the country (private and public) and mapped these practices against population. The total population of Australia (21.5 million) is distributed across 8,529 suburbs. On average about one-third of the population from each State lives in suburbs without practices and 46% live in suburbs with one to five dentists. Of those living within the study frameset, 86.6% live within 5 km of a private practice and 84.4% live within 10 km of a government practice. Australia's dental practices are distributed in a very uneven fashion across its vast area. Three-quarters of suburbs have no dental practice and over one-third of the population live in these suburbs. This research clearly identified that in a vast and uneven socio-geographically distributed country, service planning, if left to market forces, will end with a practice distribution that is fixed by economic drivers of scale and not that of disease burden. A more population health-driven approach to future design and construction of government safety net services is needed to address these disparities., (© 2013 FDI World Dental Federation.)

Objective: This study examines the cost effectiveness of a model of remote area oral health service., Design: Retrospective financial analysis., Setting: Rural and remote primary health services., Participants: Clinical activity data and associated cost data relating to the provision of a networked visiting oral health service by the Centre for Rural and Remote Oral Health formed the basis of the study data frameset. The cost-effectiveness of the Centre's model of service provision at five rural and remote sites in Western Australia during the calendar years 2006, 2008 and 2010 was examined in the study., Main Outcome Measured: Calculations of the service provision costs and value of care provided were made using data records and the Fee Schedule of Dental Services for Dentists. The ratio of service provision costs to the value of care provided was determined for each site and was benchmarked against the equivalent ratios applicable to large scale government sector models of service provision., Results and Conclusion: The use of networked models have been effective in other disciplines but this study is the first to show a networked hub and spoke approach of five spokes to one hub is cost efficient in remote oral health care. By excluding special cost-saving initiatives introduced by the Centre, the study examines easily translatable direct service provision costs against direct clinical care outcomes in some of Australia's most challenging locations. This study finds that networked hub and spoke models of care can be financially efficient arrangements in remote oral health care., (© 2012 The Authors. Australian Journal of Rural Health © National Rural Health Alliance Inc.)

Objective: The aim of the study was to test the hypothesis that all Australians based on clinical need have equal access to health services for the removal of impacted teeth as hospital in-patients., Methods: Data for the current analysis were obtained from the Western Australian Hospital Morbidity Data System (HMDS) for the six financial years 1999/00 to 2004/05. All cases of in-hospital treatment for impacted teeth were analysed and then correlated with socioeconomic status, geographic location of the patients, place of primary residence, and age., Results: In-patient extraction rates are significantly higher in the 10- to 19-year-old and the 20- to 29-year-old age groups when compared to the other age groups. A young adult from a higher socioeconomic group is 4 times more likely to have an impacted tooth removed in a hospital than his or her counterpart from a lower socioeconomic group, which is significant. Similarly, people living in highly accessible metropolitan areas have a 3 times greater chance of being hospitalised for this procedure than those from the remote and rural areas., Conclusion: There are significant differences among different groups based on socioeconomic status and access to health services for in-hospital removal of impacted teeth, thus rejecting the hypothesis. This raises doubts over the nature of the procedure, considering that most patients are young, non-Indigenous, and live in metropolitan areas. This implies that some of the procedures seem to be elective and there is a need for introduction of guidelines in Australia for removal of impacted teeth, which could reduce expenditures significantly. However, further research is required in this area.

Introduction: Western Australia (WA), Australia's largest state, consists of approximately one-third of the country's landmass and has a population of approximately 2 million people. However, over 85% of this population live in a handful of urban centres with the majority (1.6 million) living in the state capital, Perth. Healthcare provision in this complex environment is difficult and a clear understanding of the distribution of the population and health service suppliers is critical to understanding and addressing the problem. The vast majority (80% or more) of oral health care in WA is provided by private practitioners on a fee-for-service basis. Although previous studies have examined the macro-level distribution of dentists, this study utilized a high acuity examination to examine the distribution of private dental practices in WA, especially in rural and remote areas., Methods: Dental practice locations were collected from open access sources and geo-coded. Population data were obtained from the Australian Bureau of Statistics and divided by census districts. The Index of Relative Socio-Economic Disadvantage (IRSD) was aggregated to census district level. Population and socio-economic data were then geo-coded using ArcGIS v9 (ESRI; Redlands, CA, USA). With Perth primary post office used as a central datum point, a sequence of maps at differing magnification was overlayed with a grid of latitude and longitude lines, or graticules., Results: Of the 602 dental practices mapped, 75% were within 32 km of the Perth General Post Office, and 95% were within 256 km. In metropolitan Perth, fewer dental practices were located in areas that have residents of lower socioeconomic status and the density of distribution of these practices was greatest in the inner city region., Conclusion: This study highlights the complex nature of providing care to irregularly distributed populations in economic environments that are driven by factors not purely related to disease burden.

Background: Oral health is a critical component of overall well-being. However, students with disabilities (SWDs) face unique challenges in maintaining oral hygiene and accessing dental care. This study aims to explore oral health behaviours, dental care utilisation, and barriers to accessing dental care among SWDs in Al-Ahsa, Saudi Arabia, from the perspectives of their parents. Methods: A descriptive cross-sectional study was conducted among parents of SWDs in Al-Ahsa, Saudi Arabia. Data were collected using a validated questionnaire covering oral health behaviours, dental care utilisation, and barriers to care. The sample size was determined based on the SWDs population in the region. Data were analysed using descriptive and analytical statistics, with significant associations identified at p < 0.05. Results: Findings revealed that 45.7% of SWDs brushed irregularly, with only 16.8% brushing twice a day or more. Dental flossing was reported by just 4.3% of SWDs. Emergency-based dental visits were common (51.9%), and 29.5% of SWDs had never visited a dentist. Significant associations were found between maternal education and tooth brushing frequency (p = 0.004) and between parental education and the frequency of dental visits (p = 0.035). The most reported barriers included fear of treatment (47.1%), difficulty finding willing dentists (45.5%), and long wait times for appointments (44.7%). Conclusions: The study emphasises the pressing need for targeted interventions to improve oral hygiene practices and enhance accessibility to dental services for SWDs. [ABSTRACT FROM AUTHOR]

Objective. The Child Dental Benefits Schedule (CDBS) was introduced in 2014, and its aim was to support access to dental care for eligible children in Australia. Dental caries, and pulp and periapical diseases were the major dental reasons for children’s hospitalisations. This study investigated if the availability of the CDBS had any effects on hospitalisation rates in Australian children. Methods. This study was a retrospective analysis of Medicare data from the Australian Government and the hospitalisation data from The Australian Institute of Health and Welfare (AIHW) from 2008 (6 years before the commencement of the CDBS) to 2020 (6 years after the commencement of the CDBS). Results. Although the hospitalisation rate trend was reducing before the CDBS started (2008–14), this reduction was not statistically significant. The reduction of hospitalisation rates was higher after the commencement of the CDBS (2014–20) and was statistically significant, but the regression model analysis showed a positive correlation between the CDBS and hospitalisation rate. The analysis without ‘abnormal’ year data (2019–20, COVID-19 pandemic year) supported no statistically significant decrease in hospitalisation rate after the commencement of the CDBS in 2014 until 2019. Conclusion. Although the CDBS is improving access to dental care for eligible children, any possible effects the CDBS might have on hospitalisations are not yet evident. [ABSTRACT FROM AUTHOR]

Objectives: It is well known that there are associations between overall health, age, socioeconomic status and rural residency. The objective of this study was to determine the distribution of Australia's aged population by socioeconomic status, as well as remoteness. Methods: The study employed the Australian Statistical Geography Standard (Statistical Area Level 1 and Remoteness Areas). The database of the geographic boundaries was integrated into the ageing population and socioeconomic data using the Geographic Information System. The socioeconomic data was analysed through the Index of Relative Socioeconomic Disadvantage. Results: Over a decade, the older population in Australia has increased noticeably. In 2016, there was a high percentage of older people (≥65 years) in Tasmania (Tas), 19%, while the lowest percentage was recorded in the Northern Territory (NT), 7%. Across the country, Tasmania had the highest percentage of older citizens living in the most disadvantaged areas since 2006, with 48% recorded in 2016. There was an association between the remoteness areas and the education and income levels of the ageing cohort. However, this association differed between the states and territories. This socioeconomic gap becomes more evident in the very remote areas of the country. Conclusions: The ageing population in Australia is increasing rapidly; this was associated with an evolving socioeconomic disparity among this ageing society. Our results demonstrated that socioeconomic inequalities were to be found among the older people based on their distribution over the remoteness areas in Australia. This information should be used to target healthcare and ageing policies that meet the specific needs of older people. [ABSTRACT FROM AUTHOR]

The study aimed to design a geographic theoretical model for school dental services (SDS) in Al-Madinah, Saudi Arabia (SA), using a geographic information system (GIS). The location of all primary public schools and the student population at each school were obtained from the General Administration of Education in Al-Madinah Al-Munawwarah Region website. The geographic modeling for SDS was analyzed using GIS according to two models. A scenario was developed to simulate the demand for dental care for the two models based on schoolchildren's estimated oral health profile. The areas with the higher number of schools; higher number of students; and dense child population as presented in the map suggest the future location of SDS. The total number of dentists required to work in SDS settings was 415 for the first model, and 277 for the second model. The suggested average number of dentists per district in the highest child population density districts is 18 dentists in the first model, compared to 14 in the second model. Establishing SDS is suggested as a solution to the persistently high prevalence of dental caries among schoolchildren in Al-Madinah and SA in general. A model was suggested for SDS with a guide of the proposed SDS locations and the number of dentists to hire for the services to meet the child population's oral health needs. [ABSTRACT FROM AUTHOR]

Background: This study focused on the Jazan region, Kingdom of Saudi Arabia. To date, there has not been any documented evidence about geographical distribution of dental health-care services in the region. The study aimed to assess the geographical accessibility of dental health-care services in Jazan. Materials and Methods: Most recent, openly accessible, nonidentifiable data and information were used in this study. The location of health facilities was obtained from the Ministry of Health (MOH) Statistical Yearbook 2020 and interactive map of the MOH, which was converted to longitude and latitude, using Google Maps with 90% of the level building. The study data to be analyzed were imported from the integrated database in Quantum Geographic Information Systems into Microsoft Excel software, where the ratios of health-care facilities to the study population were computed. Results: There were 145 primary health cares (PHCs) and 19 hospitals with a dental component in the Jazan region of 17 governorates with a total of 1,726,739 residents. The overall PHC-, hospital-, and dentist-to-population ratios were 1 PHC to 114,365 residents, 1 hospital to 90,881 residents, and 1 dentist to 9136 residents. Only 14.5% of PHCs and 5.6% of the hospitals served 70% of the population who are living within 20 km from the governorate's center. Conclusion: This study shows that irregular distribution of health services has led to decreased access to services in the region. Further research is needed focusing in mapping MOH, private and other health facilities, and the burden of oral disease in the region. [ABSTRACT FROM AUTHOR]

Background: Australian Aboriginal and Torres Strait Islander people continue to experience significant disparities in oral health and there remains an urgent need to improve services to rural and remote communities. Quantitative research has typically been used to highlight the disease burden and severity experienced by those living in remote communities, but this data does little to explore the lived reality and psychosocial nuances that impact on care. The Kimberley region of Western Australia is home to over 150 Aboriginal communities spread out across 400,000 square kilometres. The success and sustainability of oral health services to these remote communities relies on respect and reciprocity achieved through shared knowledge, decision making and involvement of Aboriginal people in discussions around oral health services and their delivery. This, study aimed to investigate the perceptions and attitudes toward dental services among Aboriginal Australian families living in remote Kimberley communities. Methods: Semi-structured interviews and yarning circles were carried out following purposive sampling of Aboriginal adults living in the East Kimberley region of Western Australia. Interviews were recorded, transcribed, and analysed guided by a constructivist grounded theory approach. Results: In total, 80 community members participated in the yarning process. Enablers to care included: promotion of existing services, integration with primary health services, using mobile dental services and volunteers to extend care. Barriers to care included transportation, cost of treatment, the complexity of appointment systems and shame associated with health-seeking behaviours. Conclusions: Reassessing the prevailing operative model of dental care to remote Aboriginal communities is warranted to better address the overwhelming structural barriers that impact on oral health. Integration with existing primary health services and schools, the use of mobile units to extend care and increasing community engagement through clinical yarning are recommended in improving the current state of dental services to communities in the Kimberley. [ABSTRACT FROM AUTHOR]

Objective: The Child Dental Benefit Scheme (CDBS), which provides dental services for targeted children in Australia, was implemented in 2014. Currently there is no information available on the cost and utilisation patterns of this publicly funded scheme. This study aimed to analyse the pattern of dental visits under the CDBS, as well as the cost of the CDBS over the first 2 years of operation. Methods: This study was a retrospective descriptive analysis, using data from Medicare Statistics (an Australian Government website) from two calendar years (2014 and 2015). Results: Nationally, the number of CDBS patients declined by 16.3% after the first year, and patients were predominantly aged 5–14 years. Preventive services were the most used service, and contributed to approximately 30% of total expenditure. Conclusion: The utilisation of CDBS is considered to be low. What is known about the topic?: Previous government dental schemes in Australia resulted in inequalities in utilisation of the scheme by targeted groups. The CDBS was implemented with an extension of eligibility criteria and services offered as a means to improve access to dental care. What does this paper add?: There is no information available on the utilisation and cost patterns of the CDBS; hence, this study analysed the pattern of utilisation and the cost of the CDBS over the first 2 years of operation. What are the implications for practitioners?: It is important that practitioners promote the scheme among those eligible to enable targeted populations access to the scheme and to ultimately improve child oral health. [ABSTRACT FROM AUTHOR]

Background: Despite great improvement in child oral health, some children subgroups still suffer from higher levels of dental caries. Geographic and socioeconomic barriers and the lack of access to dental care services are among common reasons for poor oral health in children. Historically in Australia, oral health therapists or dental therapists have been responsible for providing dental care for school children through the School Dental Services (SDS). The current SDS has been unable to provide sustainable dental care to all school children due to a reduction in workforce participation and limited resources. We propose a paradigm shift in the current service through the introduction of user-friendly technology to provide a foundation for sustainable dental care for school children. Methods/design: We describe an ongoing parallel, two-armed, non-inferiority randomised controlled trial that compares routine and teledental pathway of dental care in children aged 4–15 years (n = 250). Participating schools in Western Australia will be randomly assigned to the control or teledental group, approximately three schools in each group with a maximum of 45 children in each school. All participants will first receive a standard dental examination to identify those who require urgent referrals and then their teeth will be photographed using a smartphone camera. At the baseline, children in the control group will receive screening results and advice on the pathway of dental care based on the visual dental screening while children in the teledental group will receive screening results based on the assessment of dental images. At 9 months follow-up, all participants will undergo a final visual dental screening. The primary outcomes include decay experience and proportion of children become caries active. The secondary outcomes include the diagnostic performance of photographic dental assessment and costs comparison of two pathways of dental care. Discussion: The current project seeks to take advantage of mobile technology to acquire dental images from a child's mouth at school settings and forwarding images electronically to an offsite dental practitioner to assess and prepare dental recommendations remotely. Such an approach will help to prioritise high-risk children and provide them with a quick treatment pathway and avoid unnecessary referrals or travel. Trial registration: Australian New Zealand Clinical Trials Registry, ACTRN12619001233112. Registered 06 September 2019. [ABSTRACT FROM AUTHOR]

Abstract: Objective: The shortage of dentists in Outer Regional and Remote areas of Australia and long public dental waiting lists have been the subject of media attention over the last decade. A number of state and federal initiatives were introduced over the years to address these problems. This study aims to gauge whether the waiting lists and shortage of dentists in Outer Regional and Remote areas have seen a positive change over the last decade. Design: This evaluation study analysed and compared the number of dentists full‐time equivalent per 100 000 population, eligible population and waiting list size (New South Wales and Queensland) at various points in time over the last decade. Setting: National. Participants: Data were extracted from practitioner registry reports. Main outcome measures: Number of dentists practising in Outer Regional and Remote areas of Australia and number of people on the public dental waiting list (New South Wales and Queensland). Results: There was a significant improvement in the number of dentists practising in Outer Regional and Remote areas of Australia. The public dental waiting lists in New South Wales and Queensland (as of September 2016) were found to have surpassed their pre National Partnership Agreement levels in 2012. The growth of public dental waiting lists exceeded the growth of the eligible population by a significant margin. Conclusion: The dentist‐to‐population ratios in Outer Regional and Remote areas have seen a significant improvement. The reduction in the number of people on the public dental waiting list was significant, but brief. [ABSTRACT FROM AUTHOR]

Geographic Information Systems have become an invaluable tool in many industries as it can help to conceptualise available data and answer questions visually. The software allows for integration of key statistics and geographic data for a more detailed analysis. The objective of this study was to show how mathematically weighted, publicly available, relevant demographics data can be integrated with Geographic Information Systems to identify and rank potential locations for new primary healthcare facilities. Index of Relative Socio-economic Advantage and Disadvantage was mathematically weighted with respect to the usual resident population and the number of people not in the labour force data, at Statistical Area level 1 (SA1). Smoothing was applied by repeating the process at Statistical Area level 2,3 and 4 to produce a quasi-index of priority. A total of 229 SA1 areas were identified and preselected as potential primary healthcare facility infrastructure sites across Australia. The quasi-index was incorporated into a Geographic Information System to produce a map identifying and ranking areas of relative need. Combining a mathematical approach with Geographic Information Systems can yield significant qualitative and quantitative advantages over conventional methods of site selection. [ABSTRACT FROM AUTHOR]

Objective: The objectives of this study were to (i) compare a Capped Payment formula for adults, to the fee-for-service model and the New South Wales Government services payment model; (ii) identify the presenting oral health needs of a 65+ years of age cohort during the period January 2011 to March 2015.Background Data Discussing the Present Status Of the Field: Australia faces an ageing population with the vast majority accessing free market dental care, whilst the poor access Government services. This cohort retains most of their dentition increasing demand on Government services.Materials and Methods: The analysis of New South Wales Government adult de-identified patients' record unit data was from 2011 to 2015, for the three payment models and undertaken in three stages; (i) development of the Capped Payment Model; (ii) evaluation of twenty (20) case studies of adults 65+ years of age; (iii) analyse the cost efficiency of the three payment models.Results: This study found that the Government model was the most cost effective. The Capped-fee model performed less efficiently, particularly in the 75+ age group, with the fee-for-service model generally more costly. It was $2580 (85%) more costly for the 65-74 age cohort, and $4619 (66%) for the 75+ age cohort.Conclusion: Policy makers in partnership with Government and private service providers should seek to develop partnerships with Government, private services and universities, scope opportunities in applying a Capped-fee funding model, and one that helps address the oral needs of the elderly. [ABSTRACT FROM AUTHOR]

The aim of this study was to create an Urban Dental Index (UDI) for Perth, Western Australia, adapting a method utilised by the World Health Organisation. Dental health indicators were derived from the 2011 census, standardised on a (0,1) interval, amalgamated using a geometric mean, and mapped to identify dental health inequity. The validity of the UDI was tested by comparison with oral cellulitis data. Dental health disparities were examined using a ratio of the mean of the highest to lowest decile and slope of the eight middle deciles. The robustness of the UDI was tested using indicator correlation, weighting, and systematic indicator removal. There were a high proportion of low UDI census areas outside the inner city. Adult public dental clinics were unevenly distributed across these low UDI areas. The UDI was significantly correlated with oral cellulitis data and had a moderate disparity ratio (1.69) and slope (0.23). All dental indicators were highly correlated, and UDIs calculated with weighted indicators and indicators removed were significantly correlated with the original UDI. These results indicate that the UDI is a robust tool which can be used by policy makers to target dental health initiatives to high-risk areas. [ABSTRACT FROM AUTHOR]

Dental Health Services (DHS) is the largest public primary oral healthcare provider in WA. The objective of this study was to calculate probable distance patients are expected to travel to the nearest clinic, gauge utilisation rates and predict the direction of likely changes in future demand for subsidised dental care. Eligible population data was collected from the Department of Human Services and the Australian Bureau of Statistics websites and integrated with the waiting list and the recall list data provided by the DHS. In total, 65% of the eligible WA population are residing in the metropolitan area; however, only 19% of those are either on the waiting list or have already received subsidised care. In all, 35% of the total eligible WA population are residing in country areas. A total of 30% of the eligible country WA patients are located within a 100-km range of a Government Dental Clinic, with only 11% of those either on the waiting list or having already received subsidised dental care. Country WA residents are at a significant disadvantage by comparison to their metropolitan counterparts. Eligible WA country residents are up to 40% less likely to receive treatment when compared to the metropolitan residents. [ABSTRACT FROM AUTHOR]

Background: Australia has a significant mal-distribution of its limited dental workforce. Outside the major capital cities, the distribution of accessible dental care is at best patchy. Objective: This study applied geo-spatial analysis technology to locate gaps in dental service accessibility for rural and remote dwelling Australians, in order to test the hypothesis that there are a few key location points in Australia where further dental services could make a significant contribution to ameliorating the immediate shortage crisis. Method: A total of 2,086 dental practices were located in country areas, covering a combined catchment area of 1.84million square kilometers, based on 50 km catchment zones around each clinic. Geo-spatial analysis technology was used to identify gaps in the accessibility of dental services for rural and remote dwelling Australians. An extraction of data was obtained to analyse the integrated geographically-aligned database. Results: Resolution of the lack of dental practices for 74 townships (of greater than 500 residents) across Australia could potentially address access for 104,000 people. An examination of the socio-economic mix found that the majority of the dental practices (84%) are located in areas classified as less disadvantaged. Output from the study provided a cohesive national map that has identified locations that could have health improvement via the targeting of dental services to that location. Conclusion: The study identified potential location sites for dental clinics, to address the current inequity in accessing dental services in rural and remote Australia. [ABSTRACT FROM AUTHOR]

Oral disease continues to be a major problem in Australia impacting quality of life, the economy and broader health system. Although the understanding of caries and periodontal disease has improved along with increased government support, oral diseases continue to be the most prevalent among all health conditions. This is despite unprecedented levels of funding in the Chronic Disease Dental Scheme and the Teen Dental Plan. Access to primary care dentistry in the private sector, where the majority of dental services are provided, remains a critical issue. Under the current system of dentistry, it cannot be assumed that the practice of dentistry represents a prioritised approach to combat disease patterns based on scientific evidence in primary health and prevention. Drawing on data in relation to these two programs, the present study highlights issues impacting dental service provision. This includes issues such as access and affordability to dental care, sustainability of policy and its unintended consequences, private practice pressures and the impact of remuneration on treatment. This paper argues that without structural reform there will continue to be barriers in implementing policies capable of improving oral health. [ABSTRACT FROM AUTHOR]