Centre of Research Excellence in Primary Oral Health Care
The programs of research we plan to undertake will focus on oral health as an important aspect of primary health care.
These projects are funded by the Australian Primary Health Care Research Institute, as part of the Commonwealth Department of Health and Ageing’s Primary Health Care Research, Evaluation and Development Strategy.
We have identified four streams which represent marginalised groups as the focus of this research. Underpinning these research themes is a design built around consultation with stakeholders including consumers, as well as collaboration and partnership between research groups from across the country.
The specific projects listed below all have a strong translational component. Each will produce results that can support recommendations for policy and practice improvements that can be adopted at a national and international level.
|Successful Aging and Oral Health||
Rural Oral Health
Indigenous Oral Health
Physical and Intellectual Disability
Find further information about the research themes below.
Successful Aging and Oral Health
Project A: Community based trial: Medical GP assessment of need for dental care.
Background: A decline in oral health has been shown in older people prior to entry into residential care (Chalmers 2002). In 2003 a program was commenced in which the dental care needs of the community-dwelling elderly population aged 75+ years in nine statistical local areas (SLAs) within Adelaide’s Southern Division of General Practice were assessed using oral health items integrated within the Enhanced Primary Care Assessment. Questions about oral health care were added to the annual general health medical assessments for older people undertaken by General Practitioners and Registered Nurses. People identified through screening as requiring dental care and who were eligible for public dental care were offered an appointment by the South Australian Dental Service without the usual 2–3 waiting year period. The initial evaluation after six months found that the percentage of people rating their oral health as ‘good’ to ‘excellent’ increased from 53% to 83% and the number of adverse impacts from oral conditions on quality of life halved. Improvements were greatest for those who had the highest priority for care based on the screening tool (Slade, 2007). The longer term results of the program have not been assessed.
Aim: To evaluate prospectively the 2 year effectiveness of a medical general practice assessment of need for dental care and referral for priority dental care in maintaining general health (Aged Care Project).
Project B: Incorporating dental professionals into aged care facilities (Western Australia and Tasmania)
Overview: This is a qualitative project that investigates better options for primary oral health care in residential aged care with two components. The project will be strengthened by working across two states.
Background: Currently dental care for those in low and high level residential aged care is often conducted on an ad hoc basis with little structure to such services, dentists often working in isolation and without adequate or any links to the primary care team of the resident. Many aged care residents do not receive adequate oral hygiene care or any dental services. Ageing Australians with high dental treatment needs have been recognized as a concern (Chalmers 2001, Shay 2002). The limited number of geriatric-specialised dental services in Australia adds to poor oral health outcomes for older persons (Chalmers, 2001). The oral health status of older adults can decline with failing health, systemic diseases and medical treatment,(Moncrieff, 1996) with a profound effect on nutritional status (Ship, 1996) and quality of life (Sheiham, 2001).
Aims: An overall objective is the determination of primary care structures in residential aged care and barriers and enablers to this. Specific aims are:
- To systematically review the literature regarding models of care (particularly primary care models) for oral health care in residential aged care
- To determine how dental professionals perceive they could work in aged care, including potential models for this
- To determine how those working in aged care (other than dental professionals) see they could include a dental professional in their aged care team
More details can be obtained from Professor Linda Slack-Smith.
Rural Oral Health
A major focus of the APHCRI Centre of Research Excellence in Primary Oral Health Care will be on primary health care service research in rural and remote Australia. Three projects are planned.
Project A: Dental Practitioners: Rural Work Movements
A major focus of theAPHCRI Centre of Research Excellence in Primary Oral Health Care will be on primary health care service research in rural and remote Australia. Three projects are planned.
Aim: To investigate the attitudes, barriers and enablers of Australian dental practitioners towards living and working in rural areas.
Project outcomes: the project will provide policy relevant findings on recruitment and retention of rural dental practitioners that can inform the development of a discrete choice experiment approach to provide evidence for health care decision making.
Project B: Relationship of dental practitioners to rural primary care networks
Project aim and rationale: The broad aim of this study is to demonstrate that more collaborative, interprofessional systems of care can have a positive impact on the oral health of residents in rural areas of Australia. The specific objectives are to:
- map oral health services practices in mid-size and smaller rural communities across primary care providers,
- assess the extent to which oral health problems impact on service provision by primary health care providers
- assess the extent to which primary care networks can be more effectively utilised to improve the provision of oral health services to rural communities and what interventions/strategies are most likely to be effective.
Project outcomes: This project will result in broader benefits that have applicability to other rural communities and more generally, to improve the provision of oral health services to the Australian population.
Project C: Oral health policy: International policy implications for Australia
The project will have two mutually compatible aims:
- To map key state and national policy documents governing oral health (i.e. not research papers but rather relevant working policy instruments)
- To collect and analyse a selection of these in ways that identify gaps in Australian policy approaches to oral health,particularly as they relate to critical issues for disadvantaged and vulnerable groups and/or groups with unequal health access in rural and remote communities (Aboriginal people, farmers, older people, children, people with disabilities in rural and remote communities).
Outcome for future research: It is expected that this will be a foundation study offering broad insights into different oral health policy frameworks, models and policy solutions.
Indigenous Oral Health
Project A: Why Aboriginal adults who are referred for priority dental care do not take up or start but do not complete a course of dental care
Background: The general and oral health of the Aboriginal and Torres Strait Islander population of South Australia is significantly worse than the total population. As a consequence, Aboriginal and Torres Strait Islander oral health has been identified as priority in the South Australia’s Oral Health Plan 2010 – 2017 and an action area in Australia’s National Oral Health Plan 2004-2013.
Despite suffering poor oral health, prior to 2006 only a small percentage of Aboriginal people attended SA Dental Service clinics. Effective Health Promotion has the potential to play an important role in reducing oral health inequalities amongst Aboriginal people. Through the Aboriginal Liaison Program, partnerships have formed between SA Dental Service and Aboriginal Health/Case Workers. These partnerships have been pivotal in raising the profile of oral health and increasing acceptability of dental services among Aboriginal people, resulting in an increase in Aboriginal people accessing dental care.
The Aboriginal Liaison Program began in late 2005 in response to an identified need to improve oral health outcomes for Aboriginal people in the Central Northern Area Health Service (CNAHS) Region. Four demonstration sites were selected based on ABS population numbers– Salisbury, Noarlunga, Parks and Port Adelaide. Funding was initially provided by the CNAHS Health Improvement Pool. However since then SA Dental Service has covered the cost of expanding the program and the increased number of courses of dental care.
Initial planning for the program involved consultation with the Executive Director of Aboriginal and Torres Strait Islander Health and with a number of key Aboriginal staff who provided an insight into the oral health needs and expectations of the community and ways to assist people to access dental care.
One of the barriers identified initially was the 2 year plus waiting time for general dental care at SA Dental Service Community Dental Clinics (CDS). As a result, one of the main objectives of the Aboriginal Liaison Program has been to refer eligible Aboriginal adults to participating SA Dental Service Community Dental Clinics for priority dental care. Over the life of the project several policy changes have enabled the program to meet the needs of Aboriginal people. Currently the program is available to Aboriginal adults, 18 years of age and over with a current Centrelink card. Clients receive free general and emergency, priority care at all CDS clinics in SA.
Since the program began in 2005 over 5,000 patients have visited a dental clinic for dental treatment. However, many who are referred do not take up the care and many begin a course of care but do not complete it. It is unknown whether there are specific barriers or enablers which operate at a clinic or community level affecting take up of dental care which could be addressed.
Aim: To understand why many Aboriginal adults who are referred for dental care do not take up or start and do not complete a course of dental care.
Project B: Perceptions and beliefs regarding oral health of Aboriginal adults in Perth and key rural centres, Western Australia
Background: Oral health is a broad concept that includes dental caries (dental decay) but also gum disease, diet and exposures to potentially carcinogenic substances such as cigarette smoke and alcohol. Health interventions require a substantial understanding of the context of the problem if they are to be appropriately targeted and effective. In this project, it is recognised that oral health of Aboriginal people cannot be artificially separated from the contexts in which Aboriginal people live and the complex issues that impinge on their health and wellbeing (Brady 2002, Murphy 1999). Aboriginal people generally have poorer oral health measures and less access to relevant services (Slack-Smith 2011).
- Explore the issues, perceptions and attitudes regarding oral health among Aboriginal adults in the Perth Metropolitan Area and key rural centres (Bunbury, Geraldton)
- Explore the barriers and enablers to support oral health for Indigenous adults in the Perth Metropolitan Area
- Determine attitudes towards oral health among health professionals who work with Indigenous adults in the Perth Metropolitan Area
- Determine responses of Indigenous adults to options to improve oral health (dietary, dental care etc)
Project outcomes: the project findings will provide evidence on how Indigenous people perceive dental services, including identification of barriers and enabling factors that can provide recommendations that can be tested and applied to policy development.
More details can be obtained from Professor Linda Slack-Smith.
Physical and Intellectual Disability
Project: Community-based Trial - train carers of people with physical and intellectual disabilities (PID) then evaluate carers’ knowledge and practices & clinical outcomes for adults with disability.
Background: Recent work (Pradhan et al. 2009a) has found that decay rates among adults with physical and intellectual disabilities were associated with age and with assistance with oral hygiene. In addition, many of these adults received irregular dental care, particularly those being cared for in the family home (Pradhan et al. 2009b). In institutions and community care settings the frequent changes of staff means that oral health care may be compromised. It is estimated that around 1 million Australians would be in the “special need” category for oral health (National Oral Health Plan 2004-2013). These people now encounter many barriers when trying to access either private or public dental care (Chalmers 1999). A multidisciplinary team approach is needed, involving a range of primary health care providers (Chalmers 2003).
Aim: To consult with stakeholders and develop and test an intervention model for carers of adults with disabilities.
- To work with people from the disability sector to develop a model of intervention that will enable carers to provide adequate daily oral care for their care recipients at their residence.
- To trial the intervention in institutions, community and family settings to assess its efficacy in improving oral hygiene of adults with disability and use of dental services.
Method: This first stage of the project will consist of a literature review of models of intervention that have been tried and evaluated. From this basis a draft model and options for South Australia will be developed. The development of the draft model will be jointly undertaken by SA Dental Service and ARCPOH and include consultation with dental practitioners involved in dental care for adults with disabilities as part of a needs analysis. ARCPOH and SA Dental Service will then work collaboratively with the disability sector to finalise a model for implementation and evaluation.
The second stage of the project will be a community trial with intervention and control groups in institutional, community and family settings. Assessment of the efficacy of the intervention will include evaluation of knowledge and reported practices of carers in relation to oral hygiene and ability to use dental services using a questionnaire and an oral hygiene assessment of adults with a disability under their care.
Project outcomes: The project will produce a model for assisting carers of people with disabilities in oral health care that can be tested and developed in conjunction with the SA Dental Service.
Find further information about the research program's board members below.
Heather is an Aboriginal woman from the West Kimberley region of Western Australia. She trained as a registered nurse in Perth in the mid 1970s and as a midwife in Scotland in the mid 1980s. Heather has a Bachelor of Applied Science and Masters Health Economics (Aboriginal Health) from Curtin University.
Heather has over 20 years of clinical experience in rural, remote and urban areas, and five years of managing health services. She entered into health research with the Telethon Institute for Child Health Research in Perth and worked there for 8 years in the area of Aboriginal child health.
Heather moved to the Menzies School of Health Research just over three years ago to take up the position as Associate Director for Aboriginal Programs for the Menzies School of Health Research in Darwin.
Rosetta has more than 20 years experience in senior management and business management consultancy roles in the private, commercial and not for profit sector. She has worked in several industry sectors including – private hospitals, aged care, pharmaceutical, community and hospital pharmacy, manufacture and retail, industry associations such as Victorian Employers Chamber of Commerce and the Pharmacy Guild of Australia.
Rosetta’s areas of management specialty are – human resource management including industrial labour law management, work cover self-insurance, public health policy and legislation, corporate business and commercial development services and products. Rosetta is originally from Victoria but has spent the last 12 years in Adelaide. She came to Adelaide 12 years ago to oversee the merger and acquisition of 4 private hospitals in Adelaide known as ACHA Health, where she held the position of Director of Corporate and Human Resources.
Charles Maskell-Knight PSM
Charles joined the Australian Public Service in 1980, and worked in a number of Departments before being seconded to work on the National Health Strategy led by Jenny Macklin in 1990.
Charles subsequently joined the Department of Health in 1994, where he has worked on most of the Commonwealth’s major health programs including Medicare and pharmaceutical benefits, hospital financing and private health insurance regulation.
Charles also led a program of major legislative change at the Therapeutic Goods Administration. Since mid-2010 he has been involved in the development and implementation of national health reform.
Dr Mark Hutton
Mark has been in private practice in Mt Gambier and a member of the ADA since graduating in Adelaide in 1975. He has represented ADASA in the Limestone Coast as a Country Councillor since 1997 and served ADASA as President on two occasions in 2004 and 2007. Mark was closely involved in the formation of the Limestone Coast Partnership ten years ago and still continues this interest and service.
Mark has been active over a long period on matters such as media presentations; fluoridation of water supplies; workforce shortages, particularly in rural areas; improving access to oral health care for older people; strategies to achieve support for our dental schools and the development of fair processes to protect our members' interests.
A Federal Councillor since 2006, he is also the Vice-Chair of the ADA Inc. Policy Committee. He is an Australian Dental Council Councillor and also an ADC examiner. He is a Fellow of the International College of Dentists, a Fellow of the Academy of Dentistry International, a Fellow of the Pierre Fauchard Academy and a life member of ADASA.
Associate Professor Leigh Blizzard
Associate Professor Leigh Blizzard is the senior biostatistician at the Menzies Research Institute Tasmania, where he is a Principal Research Fellow and Senior Member. He has expertise and rich experience in the practice of biostatistics, and skills in designing and developing analytical strategies for health research projects. He has built statistical capacity at the Institute to 6 positions, when he was the only statistician at the time of completion of his PhD in 2000.
In statistical research, Leigh has contributed to developments in log-link modelling of binary, multinomial and ordinal outcomes to provide estimates of relative risk in follow-up and cross-sectional studies. Recently he has established a statistical research program in assessment of goodness-of-fit of log-link models in collaboration with Professor David Hosmer, a noted international authority.
Principally since completing his PhD in 2000, Leigh has produced more than 180 research publications.
Leigh has a sustained record of success in competitive grants as a CI with $14,780,195 gained after 2000, and with substantial contributions in respect of study design and analytical strategy to successful applications
Academically, Leigh was awarded the Australian Finance Conference Prize (based on results of ordinary examinations for degrees) for achievement in undergraduate study. Professionally, Leigh’s support role is to assist others to reach the podium and to achieve awards and high honours. That so many have done so (Dwyer, Ponsonby, Grimmer, Venn) suggests his role has been consequential.
Peter is the Training and Development Manager for Phoenix Society. Peter has worked in the disability field for the past 27 years in various areas such as: Bedford Industries, managing the production and product finishing area, Manager of Project Employment, where he placed people with Intellectual disabilities in to real work in the community, General Manager of Barkuma Industries, managing the manufacturing facilities including the quality and compliance requirements to meet government funding and Training and Development Manager for Phoenix Society, maintaining all training for 100 staff and 500 supported employees with varying disabilities.
In the past 27 years Peter has developed a good understanding of the disability sector in a range of different settings, he believes all people with disabilities have the right to have fulfilling lives and reach their full potential regardless of their level of disability. In his current role at Phoenix Society, he believes everyone has the right to quality training in what makes sense for them and not what government dictates. Phoenix Society, is currently running Certificate 1 courses and computer courses which a few years ago would have never happened as work was the main focus. Today, Phoenix Society is working with people to realise their full potential and reach their personal goals.
Qualifications: Certificate 3 in Disability, Certificate 4 in Training and Education, Diploma of Management