Adult Dental Health Survey 2009 Barriers to Care

Professor Gail DouglasUniversity of Leeds

Overview

• Access to care• Cost as a barrier to dental treatment• Relationship with the dentist at last visit

Access to care

• Attempts to make an NHS appointment*• Success in making an NHS appointment*

• not defined, no distinction between primary and secondary NHS dental services

Characteristics of those seeking an NHS dental appointment in the last 3 years

Characteristics of those seeking an NHS dental appointment in the last 3 years by sex

Characteristics of those seeking an NHS dental appointment in the last 3 years by socio-economic classification of household

Characteristics of those seeking an NHS dental appointment in the last 3 years by dental status

Percentage of adults by age who attempted to make an NHS dental appointment in the last 3 years

Characteristics of those seeking an NHS dental appointment in the last 3 years by self-reported dental health

Characteristics of those seeking an NHS dental appointment in the last 3 years by attendance pattern

Characteristics of those seeking an NHS dental appointment in the last 3 years by how often visits are made

6-12 12+

Characteristics of those seeking an NHS dental appointment in the last 3 years by time since last visit

Success (or not) in making an NHS appointment

Ease of having made an appointment

Percentage of adults by age who tried but failed to make an NHS dental appointment in the last 3 years by age

Those unable to make an appointment

Those unable to make an appointment by self-reported dental health and self-perceived need

Ease of making appointment by dental status

Ease of making appointment by dental status

Who had an NHS dentist? By self reported dental health

Who had an NHS dentist? By self perceived treatment need

Who had an NHS dentist? By dental attendance pattern

R O T

Who had an NHS dentist? By dental attendance frequency

Who had an NHS dentist? By time since last visit

Who found it less easy to make an NHS dental appointment?

• Those with poorer self-perceived dental health and those who attend dental check-ups less regularly. Majority however secured appointment at first attempt

• 9% attending less frequently than 12 monthly had to make 2 or more calls to get an NHS dentist compared to 2% who reported annual attendance

Cost as a barrier to dental treatment

• Had the cost of dental treatment influenced the type of treatment received?

• Had respondents ever delayed dental treatment because of its cost?

• 26% said treatment option had been affected by cost

• 19% said they had delayed dental treatment because of cost

• 15% said they had both delayed treatment and that their treatment option was affected by cost

Effect of treatment cost by age

Effect of treatment cost by age

Effect of cost by sex

Effect of cost by location

Effect of cost by socio-economic classification of household

Effect of cost by dental status

Effect of cost by dental status

Effect of cost by self-reported dental health

Effect of cost by self-reported dental health

Effect of cost by clinical and self-perceived treatment need

Effect of cost by clinical and self-perceived treatment need

Effect of cost by how often visits to the dentist are made (frequency)

Frequency

Effect of cost by attendance pattern

Attendance pattern

Effect of cost by time since last visit

Time since last visit

Relationship with dentist at last visit

• Questions asked respondent to consider:– dentist listened carefully to what they had

to say about their oral health– enough time to discuss their oral health– involved in decisions about their dental care– got answers they could understand– treated with dignity and respect– confidence and trust in dentist

0 5 10 15 20 25

At least one issue reported

Was NOT involved as much as wanted indecisions about dental care or treatment

Was NOT given enough time to discuss oralhealth with dentist

Dentist DID NOT listen carefully to what had tosay about oral health

Dentist DID NOT explain reasons for dentalcare or treatment in a way that could be

understood

DID NOT have confidence and trust in dentist

DID NOT get answers to questions that couldbe understood

Was NOT treated with respect and dignity

Issu

e re

port

ed

Percentage

Who was less satisfied?

• Younger adults less satisfied than older ones

• No difference by sex or location• Gradient by SE classification man/prof

less negative about dentist than rout/manual – 17% vs 23% negative in at least one aspect– e.g. 7% vs 11% with regard to ‘listened carefully’

People with worse oral health were less satisfied

• Those with self-reported poor oral health less satisfied than those with good oral health– e.g 21% vs 5% ‘less confidence in dentist’

• Those with clinically assessed decay more negative than those with no decay (28 and 18% respectively)

• Those with >12 v’s <12 restored teeth more negative (23 and 14% respectively)

Satisfaction by dental attendance

• Regular, routine and more frequent attenders were less negative about their relationship with the dentist:– 16% attended less than 1yr ago were negative vs

29% of those who had attended 1-5 yrs ago– 16% of those whose last visit was for a routine

check up were negative vs 28% who had last attended for an emergency treatment

– 15% of those attending 6-12m were negative vs 30% of those who attend less than yearly

Key Findings

• Access to NHS dentists– 58% of adults said they had tried to make an NHS

appointment in the previous three years• 92% successfully made and attended an appointment• 1% made but didn’t keep their appointment• 7% said they tried but were not able to make an

appointment with an NHS dentist

– Of those who successfully made an appointment • 87% already had an NHS dentist• 10% were able to get an appointment with the first

new NHS dentist they approached

Key Findings

• Cost of treatment– 26% said the type of treatment opted for had

been affected by the cost of this treatment– 19% said they had delayed dental treatment

because of cost

• Relationship with dentist at last visit– 80% gave no negative feedback about their last

visit to the dentist

Adult Dental Health Survey 2009

The NHS Information Centre commissioned the survey, with funding provided by the Department of Health in England, the Welsh Assembly Government and the Department for Social Services and Public Safety in Northern Ireland.

The Office for National Statistics (ONS) was the lead contractor working in partnership with the National Centre for Social Research, the Northern Ireland Statistic & Research Agency, and a team of academics from the Universities of Birmingham, Cardiff, Dundee, Newcastle and University College London