The National Oral Health Alliance (NOHA) last week welcomed news from Health Minister Greg Hunt that the two year cap for subsidised services under the Child Dental Benefits Scheme (CDBS) would remain at $1,000, and not be cut to $700 as the Federal Government had proposed after its decision to retain the CDBS after all.
NOHA had lobbied against the proposal, fearing a reduction in the cap would have led families in greatest need having to refuse treatment because they were unable to meet the additional costs. Spokesman Tony McBride had warned significant numbers of children from rural and remote and Aboriginal communities would have been affected.
Meanwhile, Professors Marc Tennant and Estie Kruger say recent research reports are showing how whole-of-country data systems in countries like Sweden and Denmark are improving the oral health of millions of people.
But they say, in this latest instalment of the ‘Talking Teeth‘ series, that Australia is lagging years behind, with a “motley patchwork of electronic systems and paper recording”, at great cost to systems and personal care.
Tennant and Kruger are based at the International Research Collaborative – Oral Health and Equity at The University of Western Australia.
Marc Tennant and Estie Kruger write:
Over the last 12-18 months a series of Scandinavian research papers has led big advances in dental public health knowledge. They include:
- a Swedish report published last month on the influence of social deprivation on dental caries in children and adolescents, as measured by an index for primary health care
- an investigation, also Swedish, of the survival of root-filled teeth in the adult population, and
- a register-based study in Denmark of variations of services received among dental care attenders.
What is the common link among these papers?
Their innovations and cost-savings are made possible by the use of massive, integrated data-stores from population-level systems of recording. These substantive, and in some cases whole-of-country data systems, are driving improvement in oral health of millions of people.
(As an aside to the principle focus of this story, the first Swedish study was of some 300,000 children and found that a primary health need index had a strong association with dental health, including giving stronger predictive tools for targeting services to those in need.)
Some 20 years ago our team, in the early development of the Oral Health Centre of Western Australia, identified the importance of this strategic direction for Australia. We began to advocate for and develop systems for large databases in dental public health. We designed and implemented some of the nation’s first dental hospital-wide electronic patient management systems. We may not have been the first to use the software but the essence of the back-end analysis was a first, and was a critical seed that was watered by some, but disregarded by many others.
The basis of this development was to move to near-real-time data analysis (and big data approaches) that at the time had some huge gains in effectiveness and efficiency and that grew exponentially with time. As dental public health experts know, technology (in particular patient management systems) has enabled, for over 20 years now, mass data collection directly from the dental clinicians at chair-side and this data can be utilised easily for ongoing analysis.
Stuck in the days of mass ‘random’ survey data collection
It is timely now, in the context of these recent international studies, to look back on those early efforts and reflect on why Australian dental health leadership was seemingly blind to the opportunity this offered. Why, in Australia, have State-funded oral health services been recording data on archaic paper-based systems (picture little index cards with pens and records stored in little cardboard boxes in caravans) until just a couple of years ago?
It helps to look at places like Denmark and Sweden where electronic data systems were taken up with alacrity, as they are now reaping the rewards that near real-time massive data have brought. They will be advancing the health of their populations for decades to come. These countries also suffer issues of distance and accessibility (for somewhat different reasons from Australia), so geography can offer no excuse.
So how is it that Australia’s dental public health has advanced so little since the mass “random” survey data collection days that were appropriate in the 1970s but continued for decades in Australia?
How has our leadership remained so narrowly focused on historical systems, and not advanced with the times? With data collection teams making robo-calls to fixed-line phones, other teams scanning coloured-in dots from bits of crumpled survey paper. Analytics limited to just a few.
These datasets include data from the Child Dental Health Surveys and the National Survey of Adult Oral Health as well as dental workforce data. As we noted:
Much of the substantial dental policy decisions made in Australia over the last two decades (eg dental workforce), as well as much discussion in the scientific literature and the wider professional press, has rested on these datasets, which have essentially only been open to a single analytical team.
And what is the result? We have a motley patchwork of electronic systems and paper recording, no discussion of integration of private practice data, no mention of any cohesive integrated data plan in our national oral health plan, and more specifically, at State levels (where there is the real imperative) no data plan either, other than…. yes, you guessed it – more surveys!
So while the genesis of innovative systems of data in dental public health started 20 years ago, its failure to take root has left Australia a dental public health global backwater while other nations can press their large integrated datasets into resolving grand health (and economic) problems of care delivery in dentistry with the click of a mouse, as the Swedish work on social deprivation demonstrates.
Risks of the status quo
Without such data sets, we end-up over-servicing some people and under-serving others. Remember, today, dental disease is not a condition evenly distributed through the population, there are some who suffer greatly while others are okay. Services need to target those in need.
Let’s also be clear: most of us reading this article are not the ones who are suffering. For the relatively wealthy, the risk is over-servicing, but that is a real risk too! No one wants extra fillings or crowns, or general anaesthetics that are not needed.
Secondly, if you think this problem of a lack of sensible, ethical, unified data is limited to dental then be clear it is not. Dental public health is a canary down the mine. If we compare our health data systems to places like the United Kingdom, Denmark, Sweden, and Norway, we look like something from the middle ages. Little seeds of greatness do exist – look no further than the linked data systems in Western Australia, which are world-class achievements but not nationally implemented.
We need now to play catch-up and fast! We need to integrate data systems and unite as a nation to get high quality extensive datasets to tease out the answers to the problems of the next two decades.
The authors would like to acknowledge the efforts of Professor Kate Dyson and a number of other experts who have contributed to this piece.
- Ostberg A, Kjellstrom AN, Petzold M. The influence of social deprivation on dental caries in Swedish children and adolescents, as measured by an index for primary health care: The Care Need Index. Community Dent Oral Epidemiol 2017;69: 1–9.
- Fransson H, Dawson VS, Frisk F3, Bjørndal L; EndoReCo, Kvist T. Survival of Root-filled Teeth in the Swedish Adult Population. J Endod. 2016; 42:216-20.
- Rosing K, Hede B, Christensen LB. A register-based study of variations in services received among dental care attenders. Acta Odontol Scand. 2016;7414-35.
Marc Tennant will be addressing the topic of data integration to advance health this week at the Plenty Valley Oral Health Conference 2017 where he is speaking on “The state of public health dentistry in Australia: What do the next two decades hold for us?”.