innovativeBehind this cover are bright ideas helping

to improve the oral health of Victorians

Thank you to the Victorian public dental agencies who shared their stories with us.

contents New models of patient care................................................ 2

Each Community Health Service - Mobile dental care .................................... 3Inner South Community Health - Preschool dental program ...................... 4Western Region Health Centre - Counting Smiles Initiative ....................... 5Maryborough District Health Service - Closing the Gap................................ 6Bairnsdale Regional Health Service - Sub-regional model ............................ 7Lower Hume PCP - Partnering with MCHN in the region ............................ 8Monash Health - Teaming up with private practitioners ................................ 9Monash Health - Early childhood oral health program ................................. 10Royal Flying Doctors/ADA/DHSV - Mobile Dental Care ........................... 11

Service improvement .......................................................... 12Ballarat Health Service - Thinking outside the chair ...................................... 13The Royal Dental Hospital of Melbourne - eRecords ...................................... 14Merri Community Health Service - Reorienting service delivery ........... 15Nillumbik Health - A new way of thinking ............................................................ 16Barwon Health - Kinder Wide Smiles ....................................................................... 17The Royal Dental Hospital of Melbourne - Care of refugee groups ...... 18Monash Health - Improving the client experience ........................................... 19

Workforce and partnerships ........................................... 20Monash Health - Tackling high rates of absenteeism .................................... 21

Peninsula Health - Strengthening referral pathways ...................................... 22

Monash Health - Evidence based health promotion ....................................... 23

Plenty Valley Community Health - Teamwork in the research space.... 24

Dental Health Services Victoria - Rural access to specialist care ........... 25

Albury Wodonga Health - Value the DA role ...................................................... 26

Dental Health Services Victoria - Disability day services ........................... 27

cohealth - Changing to meet community need .................................................. 281

Behind these smiles are new models of

patient centred care

2

EACH community dental service sees many more eligible clients thanks to their mobile dental units.

In 2009, EACH commissioned a fully equipped dental van from Dental Health Services Victoria and Lisa Arton, Clinic Coordinator said it has become a much needed fourth chair for its East Ringwood clinic.

“Without this service, eligible adults, children and vulnerable members of our local community would not receive the dental care they need.

“The dental van provides dental access to students from local pre-natal, preschool, primary and secondary schools and has helped students access dental services with minimal disruption to their schooling,” she said. “Having the van on site makes treatment much

more accessible and eliminates transport to and from appointments which can interrupt the flow of continuous and completed care,” Ms Arton said.

In 2013, EACH extended its dental van service to Worawa Aboriginal College in Healesville, a boarding school for girls (Years 7 to 10) who come from Aboriginal and Torres Strait Islander communities in urban, regional and remote Australia.

“We took the van to Worawa to provide much needed dental care for the girls and continue to do so today,” she said.

“We want to ensure that oral health care is delivered to as many young Victorians as possible, as well as the general eligible clients in the population,” Ms Arton said.

f lexibleBehind this story is an agency committed to providing dental care to as many eligible clients as they can

3

Tooth decay is Victoria’s most prevalent health problem, with more than half of all children affected. Despite a reduction in rates of tooth decay in children over the last 30 years, it remains five times more prevalent than asthma and continues to be a significant health problem.

That is why Inner South Community Health (ISCH) launched its pre-school dental program in efforts to improve the oral health of all pre-school children in the City of Port Philip and the City of Stonnington.

Sue White, General Manager of ISCH said the program has conducted dental screenings for around 2500 children across pre-schools, childcare centres, family day care and playgroups annually.

“Dental staff who have experience working with pre-school aged children conduct the screening sessions and we then offer treatment at ISCH dental clinics,” Ms White said.

“About 20% of children require additional follow-up and 50% of these experienced tooth decay.”

Results found that the remainder were more likely to require preventative interventions such as fissure sealants or orthodontic investigation.

“Data indicated that while the program is highly effective for the majority of families, we need to do more work to make sure that children from lower income families secure health promoting habits at an early age. The program also provides oral health education to these pre-school settings,” she said.

“We try to educate children on the importance of oral health through a variety of play based vehicles, such as puppets and storytelling,” Ms White said.

“We also offer health education to staff and parents to support a wider change in health behaviours,and provide preschools with resources and expertise to develop healthy eating and drinking policies.”

promisingBehind this story is a successful dental program that gives our young ones a great start with their oral health

4

Dental caries is the cause of the most preventable hospital admissions in children in Australia and oral health has been identified by the Office for Children and Early Childhood Development as one of the key aspects of child health and wellbeing vital to the future of Victorian children.

At cohealth during 2011-12, 52% of 0-5 year olds experienced dental caries and most had not visited health services elsewhere meaning a majority of decay was untreated.

With this data in mind, the Counting Smiles Initiative (CSI) was implemented in mid-2013. CSI is an early intervention dental screen and oral health education initiative in which registered dental clinicians visit playgroups or pre-schools by invitation, and with permission of both parent/guardian and the child, perform visual examinations, provide oral health care products, and oral health education.

The screening is designed to take place in a non-confrontational manner and intended to be fun as well as educational. This service is provided free and there is no cost to the parent or the playgroup.

The oral health education component of the program closely links with key messages — Eat well, Drink well and Clean well — from the DHSV Smiles 4 Miles program.

From June 2013 to end Dec 2013, cohealth saw: • 27 preschools/playgroups screened• all parents/children receive oral health

education and oral health care products• 76% of those screened requiring no work • 3% of children screened 2 appeared to need

urgent care• a cost-effective method to improve access• an effective method to link Smiles 4 Miles

messages with service delivery • an increase in staff exposure to young clients • clear identification of populations at risk.

smileBehind this story is a team at cohealth counting a growing number of smiles

5

Maryborough District Health Service (MDHS) is working to close the gap between Indigenous and non-Indigenous health outcomes through their Closing the Gap funding and strategic partnerships with The Meeting Place — a community-run initiative providing a safe, healthy and supportive environment for Indigenous children to learn about their culture and heritage.

MDHS are supporting The Meeting Place to implement an adapted version of DHSV’s Smiles 4 Miles program throughout 2014. The Meeting Place children will visit the dental clinic during the school term to help them become familiar with the environment and any oral disease identified at screening will be treated at block treatment sessions over the school holidays with transport provided by the Castlemaine District Community Health service. Appointments are made for family groups as

required and children will undertake surveys about their oral health knowledge prior to and post-implementation of the program to measure the program’s impact.

To ensure the sustainability of the program, a more formalised model of care is being developed to embed the relationship between The Meeting Place and MDHS dental service into standard practice.

The Loddon Mallee Oral Health Network project officer was recruited in 2014 to assist with this and other Indigenous programs.

A working group was also established in the central goldfields region which included representatives of Castlemaine District Community Health, Maryborough public dental service, Dental Health Services Victoria (DHSV), Medicare Locals and The Meeting Place.

engagingBehind this story is a team at Maryborough closing the gap for Aboriginal families in the Loddon Mallee region

6

Regional dental clinics can face some significant problems recruiting and retaining staff. Peer engagement can be hard to facilitate in regional areas and significant integration pressures are placed on clinicians living and working in rural locations. If not addressed, these issues can negatively affect patient care and satisfaction.

In light of these challenges, Bairnsdale Regional Health Service (BRHS) considered developing a sub-regional model of service to encourage consistency in the oral healthcare provided among local clinics, and to provide a wider population catchment for clinicians.

BRHS approached Orbost Regional Health and Omeo District Health and began to develop a collaborative means to offer dental care in their local communities. In February 2014, the three agencies signed a Memorandum of Understanding, and the new model commenced.

The new model emphasises collaboration, sharing resources and developing staff integration and engagement.

Joyleene Abrey of BRHS said a key aspect of moving to a sub-regional model was planning.

“Ensuring all needs are established for each clinic prior to implementation meant we spent a lot of the project time in the development phase. But this has enabled a quick and cost-effective roll-out of services through the implementation phase.”

“There have been some challenges but the overall impact of the new model has been positive. It has allowed BRHS to build a larger team and sub-contract services to other clinics and has also helped implement a much-needed peer support program which in turn has had a positive impact on staff recruitment and retention”.

communityBehind this story is a team at Bairnsdale developing an innovative model of care to service the local community

7

The oral health of children in the Lower Hume region is in good hands with the Lower Hume Primary Care Partnership (LHPCP) now implementing the Smiles 4 Miles health promotion program.

Many families in the area with young children were unaware of the Smiles 4 Miles program and messages, the importance of oral health and the existence of local dental services.

LHPCP took this opportunity to use extension program funding to build partnerships with local dentists and maternal and child health nurses (MCHN) to inform the community about good oral health practices and the services available at Seymour Health Dental Service.

Ten dental services were invited to meet to discuss potential health promotion activities using the three key oral health messages: Drink well, Eat well and Clean well.

Six services agreed to participate and display the key messages and three have worked in partnership with early childhood services to deliver dental visits or dental screenings since the initial discussion.

Mitchell and Murrindindi Shire Council MCHN Coordinators were also provided with oral health training, information packs, dental brochures and toothbrushes. First mothers groups were also offered nutrition and oral health workshops.

LHPCP’s work with MCHNs and private clinics has led to increased awareness of the Seymour Health Dental Service and the importance of oral health for families living in Lower Hume.

The training has helped build the knowledge and skills of MCHNs to recognise dental caries and give accurate information to families. MCHNs now have various referral pathways to previously unavailable family dental care.

awareBehind this story is a team at Lower Hume PCP creating community links to promote child oral health

Lower Hume Primary Care Partnership

LH8

Over 25,000 people over three local government areas (LGA) and seven sites benefit from Monash Health dental services annually. The catchment area for Monash Health encompasses some of the most culturally and linguistically diverse populations in Victoria, in addition to being one of the fastest growing municipalities in the country.

To address the growing pressure on service delivery, the dental team conceptualised and implemented a novel initiative. The new program aimed to improve access to public oral health services for patients sitting on typically long wait lists.

A forum was held in July 2013 to engage local private dental practitioners and inform them of how the National Partnership Agreement (NPA) funding could be used to the best advantage of eligible patients. Over 60 private dentists attended the information session.

Through its engagement of these external stakeholders and an increase in in-house activity (namely by extending opening hours), Monash Health waiting lists were slashed.

In fact:• 11,291 patients were successfully removed from

the general waiting list and offered care• as of 12 December 2013, there were zero

patients on general and denture waiting lists.

Through this initiative Monash Health learned:• a collaborative approach involving private

dentists in the region was the key driver to reduce waiting lists and improve patient outcomes

• the reduction in waiting times improved staff morale as it helped reduce the number of patients frustrated with long wait times

• patients received more timely care meaning they were less likely to present again with an ongoing dental health condition.

Behind this story is a team building partnerships between Monash Health Dental Services and private dental clinics

together

9

The poor oral health status of preschool aged children in the Southern Metropolitan Region (SMR) of Victoria is of growing concern, particularly around the City of Greater Dandenong. In order to address the issue, Monash Dental Health Services and the City of Greater Dandenong have developed an early childhood oral health program.

The project aligns with the Department of Health and Dental Health Services Victoria’s (DHSV) mandate of improving access to public dental care for priority groups and includes on-site mouth-checks, screenings of children, referrals to local oral health services and family oral health education sessions.

The preliminary evaluation findings were presented at the Australian Research Alliance for Children and Youth conference: Linking Up For Kids.

The findings were also well received when presented to the Mayor and council staff of the City of Greater Dandenong.

The Shire of Cardinia has now commenced implementation of this program and Greater Dandenong City Council has agreed to a trial with primary school children in that region.

This project represents a large and positive step towards expanding the program’s population focus from preschool and kindergarten age groups to children of all ages.

This successful outreach model combines simple health and education streams and encourages a holistic approach to health promotion within schools and health services. Its strong focus on prevention also helps ensure its sustainability moving forward.

initiativeBehind this story is a team at Monash helping to prevent oral health problems developing in preschool aged kids

10

The Victorian arm of the Royal Flying Doctors Service, along with Dental Health Services Victoria and The Australian Dental Association Victorian Branch have developed an exciting program to deliver oral health care to rural Victorian communities who might otherwise miss out.

The Mobile Dental Care (MDC) Program was launched in August 2012 in the North Mallee and has recently expanded into the West Wimmera. The program focuses on three key components of service delivery:• Education – deliver key oral health messages• Examination – schools, aged care facilities etc.• Fixed-site treatment – using existing clinics.

The MDC program targets rural and isolated Victorian communities with typically poor access to oral health care services. It operates for one week per month and involves teams of volunteer dentists, dental assistants, dental students and oral health therapy students.

The teams use a custom fitted 4WD to deliver promotion and education as well as free dental examinations. Since March 2013, over 1,100 examinations have been conducted.

The MDC volunteer clinicians collaborate with local health professionals, educators and community groups to determine how best they can assist in addressing their oral health issues.

The program helps support and promote oral and general health promotion activities and visits are often co-ordinated to coincide with local events.

Evaluation of the program will include collection of patient data, completion of patient surveys, volunteer feedback and interviews with local health professionals and service providers.

An expansion strategy is currently being developed to assist the roll out of the program to more rural communities throughout the state.

Behind this story is a team creating a sustainable oral health care program for rural communities in need

linking

11

Service improvementBehind these smiles

are great improvements in service delivery

12

Ballarat Health Services (BHS) has found a solution for elderly patients who need to see the dentist but have trouble making their way to the clinic.

BHS Dental Manager, Jacqui Nolan, said the idea of bringing the chair to the patient came about because aged care facilities would often ring BHS to seek advice on oral health problems their patients were facing.

“Sometimes the aged care facility would call about a patient who had stopped eating, talking or seemed distressed, and required an oral health care provider to help assess if there was a dental problem,” she said.

BHS decided to implement a dental program that not only provided treatments to patients at aged care centres using a portable chair, but also

assisted these centres to handle common oral health care complaints from their elderly patients.

“This has been particularly useful for patients who have difficulty coming to the hospital,” Ms Nolan said.

“We’ve been to two aged care centres and have seen and treated over 170 patients so far.”

Ms Nolan said the program aimed to educate aged care providers on how to manage oral health and common oral health related complaints.

“Staff and management over the years were finding that at least 50% of their patients still had teeth but no clear ideas on how to take care of their dental needs. They also found it hard to determine what an appropriate course of care was,” she said.

Behind this story is a dental team with a great idea on how to treat Ballarat patients outside the chair

clever

13

Patients at The Royal Dental Hospital of Melbourne (RDHM) can smile wide thanks to service improvements that have dramatically reduced their surgery wait times over the past 12 months and improved efficiencies for all surgery services.

In the wake of a departmental redesign, the hospital’s surgery departments have seen significant reductions in wait list times. In July 2013, wait times sat at close to 18 months for surgical dental procedures. Since then, RDHM has reduced that number to approx. 5 months and can attribute much of the reduction to system improvements.

The Surgery departments have better planned and used their clinic operating hours, boosting chair utilisation from 56% to 94% in just over 12 months.

Over the last year, the hospital surgery units have kept the patient in front of mind, always conscious of opportunities to enhance the patient experience.

In fact, the Patient Experience Satisfaction rating has jumped from 67% (July 2013) to 86% (present).

The team continues to improve their clinics with: 1. The Mini Residency Program (MRP) which aims

to upskill dentists in community clinics and give patients living in remote areas better access to care. The program will reduce high referral ‘hot spots’ and through new technologies, will give dentists better access to Oral Maxiofacial Specialists.

2. The Rapid Response Referral program which will provide key inner city community agencies with emergency access to the Oral and Maxillofacial Surgery Unit at RDHM, enhancing service delivery and decreasing wait times for emergency and priority patients.

The surgery team is also developing a new model for external chair examination and post-operative procedure to better use resources available.

connectingBehind this story is a dedicated hospital team creating new ideas to improve patient access and quality of care

14

Scores of patients in the Brunswick area are living healthier lives thanks to Merri Community Health Services’ (MCHS) delivery of over 260,000 occasions of service in the 2012/13 financial year.

MCHS’ dental service operates at maximum capacity thanks to an efficient and innovative operational model and inclusive workforce mix. Its client management processes, screening and practice management have also helped ensure it continues to provide safe, quality care, responsive to community needs.

By re-orienting its service model, MCHS has exceeded service targets, exceeded the target for individuals treated, consistently achieved high chair utilisation and exceeded triage compliance. The service also sees significantly lower waiting times than average and its engagement with community and key stakeholders have helped improve client outcomes.

Specifically, activities at MCHS have included:• compliance with accreditation requirements • relationship building with key stakeholders• planning to address long term infrastructure

needs to meet increasing community demand• staff engagement and support initiatives• engagement with diverse community groups• robust reviews to maximise efficiency and

effectiveness while fostering innovation• catchment based population health planning.

MCHS focused on three core principles:

1. Continuous Quality Improvement (CQI)2. Philosophy and Integration 3. Prevention, Early Intervention, Partnerships.

The health service continuously monitors and reviews its performance, ensuring a flexible and holistic approach is taken to service delivery. Care provided at MCHS is grounded in the core principles of the social model of health and the service espouses a ‘no wrong door’ approach.

improvementBehind this story is a team at Merri Community Health improving efficiencies to suit growing community needs

15

Nillumbik Health is undertaking wide-reaching new initiatives to tackle key objectives for growth in the delivery and quality of dental services.

These initiatives have included targeted marketing, advertising, and community outreach through educational and screening programs in kindergartens aimed at increasing awareness and growth of its dental service and imprcving the oral health status of preschool aged children and families.

In October 2013, the service saw a 312% jump in new dental patients aged 2-12 years. Results of the initiatives included:• 814 children aged 2-12 years registered over six

months on the recall system• 235% average increase over the six months

compared to the previous year• 428 children screened within preschools and

of the 428 preschool children seen, only 67 had been seen previously at Nillumbik Health

• 59 children booked for full exam and treatment• Almost 40% increase in awareness amongst the

preschool target group. Nillumbik Health saw innovative learning and growth opportunities for the Graduate Oral Health Therapist as part of the Oral Health Therapist Graduate Year Program, Nicoletta Karagiannidis, Oral Health Graduate said, “this experience has improved my confidence, clinical skills and opportunity to grow as an Oral Health Therapist. It’s been awesome; I’m loving it”.

Nillumbik Health will focus its efforts on the Child Dental Benefits Schedule and introduction of its private dental practice over the coming year. Staff will also continue with preschool visits throughout 2014.

growingBehind this story is a team delivering dental services to more people in the Nillumbik local community

16

A large number of children under 5 years of age require emergency dental appointments in the Geelong and Colac Otway regions. This unfortunate trend has only been encouraged by parents presenting at dental clinics when children are experiencing pain, not for regular check-ups before issues surface.

The Kinder Wide Smiles project was initiated to complement Dental Health Services Victoria’s ongoing Smiles 4 Miles health promotion messages in the area, drawing particularly on a Northern Territory report entitled Healthy Smiles. The NT report specifically encourages integration of oral health awareness activities into general community health assessments for Indigenous and non-Indigenous children.

Kinder Wide Smiles was implemented namely to: • provide oral health promotion information to

children and parents

• measure the effect of topical fluoride application in the Colac and Otway region

• remineralise initial carious lesions in kindergartens rather than dental clinics

• achieve cost benefits by assessing, examining and treating children in non-clinical settings

• improve access to dental services for children identified as having caries.

In 2013, dental staff visited kindergartens throughout the Geelong (44) and Colac/Otway (16) regions willing to participate in the ‘Kinder Wide Smiles’ program. During this time:• 2361 children were given consent to have

dental examinations at kindergartens • 247 referrals were made following the first

visit and topical fluoride was applied to the teeth of 787 children during visit two.

• Two virtual chairs were created reducing the usual 30 minute chair time in the clinic to 3-6 minutes in the kindergarten setting.

healthyBehind this story is a team working to improve the oral health of Barwon’s youngest community members

KIN

DER WIDE SMILES

Ph: 4215 6990

17

The number of asylum seeker and refugee patients presenting without appointments at The Royal Dental Hospital of Melbourne’s (RDHM) Emergency Department spiked in 2013.

Upon further investigation, RDHM staff found that when asylum seekers and refugees are released from detention they are required to have a general health check within four to five days. Health checks are arranged by referring agencies and performed by a triage nurse. When patients report a problem with their teeth, they are advised to attend RDHM as a walk in patient.

Although some patients were sent from the triage to community dental agencies, most were referred to RDHM, particularly those in temporary accommodation or living in central Melbourne. This process posed some issues for RDHM in that: • patients arrived unannounced, meaning no

interpreters could be organised in time• phone interpreters can create delays and

challenges

• patients presented with non-specific issues and did not have an actual dental emergency

• groups of patients (4-5) often arrived together• patients had unrealistic expectations about the

level of treatment they would receive.

These issues meant that an initial visit was usually unproductive for the patient and meant other patients with more advanced clinical needs could wait longer, or not be seen on the day.

To remedy this, RDHM staff met with referring agencies (Red Cross, AMES, Foundation House, Western Region Health Service and Asylum Seeker Resource Centre) to develop a better process.

It was agreed that a RDHM Cert IV DA would attend general health triage sessions, undertake specific dental triage and refer patients to RDHM emergency or agencies according to their clinical need. These patients are now able to book with a dentist fluent in their language (or interpreter) at their first visit and the flow of patients without an appointment has improved.

Behind this story is a team at The Royal Dental Hospital taking better care of refugee and asylum seeker patients

caring

18

The City of Greater Dandenong is the most culturally diverse locality in Australia, with residents from over 150 different birthplaces. More than 60% of clients accessing public dental services in the area are from culturally and linguistically diverse communities.

To ensure its services are appropriate for such a diverse population, Monash Health Dental Services worked in partnership with the Victorian Refugee Health Network and Dental Health Services Victoria to develop the Refugee Oral Health Sector Capacity Building Project.

Facilitated by Foundation House, the first component of the program — the Targeted Education Program — combined experiential learning and a whole-of-service approach to build staff capacity to deliver culturally appropriate care.

The second component — the Client Experience Survey — was led by volunteers who, with interpreter support, would conduct a survey using electronic patient experience trackers.

Upon evaluation, results showed: • 98% of patients surveyed thought staff

communication ranged from good to excellent• 94% patients thought that treatment

explanation ranged from good to excellent• all staff members who were a part of this

program indicated that they had a better understanding of experiences of refugees and asylum seekers, cross-cultural communication and health promotion.

Since the training participants are more confident in identifying refugee and asylum seeker community needs, delivering health information and explaining procedures.

Participants now work with management to block-book interpreters, improve the cultural appropriateness of waiting areas and define referral pathways in and out of the oral health service.

These changes have made services more comfortable for refugee and asylum seeker patients.

Behind this story is a team at Monash Health Dental Services who are improving client experiences every day

adaptive

1019

Behind this smile is an integrated and connected

public dental workforce

20

Despite all efforts to improve it, nursing staff absenteeism at Monash Health has been higher in comparison to the health service’s other programs over the past two years (range between 5.5 — 7%).

The higher than average absenteeism among nursing staff impacted staff morale, productivity, and the quality of service provided to Monash Health patients.

To rectify this, a leadership workshop was run and the health service used the opportunity to workshop the nursing absenteeism issue.

The problem solving process involved identifying the PROBLEM, CAUSE and SOLUTION. A Root Cause (Canal) Analysis was used to identify specific and actionable causes of these problems.

The service sought expressions of interest from

the nursing team to participate in the brainstorming activity and the group generated a list of robust solutions and 58 improvement ideas.

The solutions were grouped into themes and prioritised based on potential impact and the ease with which the solution could be implemented.

Four key areas were identified as ‘easy’ to implement and were initially addressed:• Recognising and rewarding staff performance• Improving patient hygiene • Reviewing rostering arrangements• Improving work environment.

After solution implementation, absenteeism decreased from 5.47% to 4.41%. The reward and recognition program has improved staff morale, the service is seeing better employee engagement and patient outcomes have improved.

Behind this story is a team at Monash Health tackling nurse absenteeism through better staff engagement

happy

21

Midwives in high needs areas are being provided with comprehensive online training as part of the Healthy Families, Healthy Smiles health promotion initiative.

The Midwifery Initiated Oral Health (MIOH) education program equips midwives with the skills and knowledge to include oral health in the first antenatal care appointment, in line with the new National Clinical Practice Guidelines for antenatal care in the first trimester.

The training builds knowledge and confidence to provide advice, undertake mouth checks and refer women to dental services where appropriate. The Frankston and Mornington Peninsula area was identified as a target community to focus on midwife recruitment and training.

All 11 midwives involved in the first antenatal booking visit at Peninsula Health Women’s

Services are enrolled in the training and to-date, five have completed the training.

The referral pathway to dental services is critical to support the transfer of knowledge into practice so a partnership between DHSV’s Health Promotion Team and Peninsula Health’s Women’s Services, Dental Services and Health Promotion teams was established to strengthen referral pathways for pregnant women into dental services.

The project has since broadened in scope and an e-referral system established to target partnerships with not only midwives but other health and early childhood professionals including Aboriginal services, GPs, schools and early childhood services.

Seeking input from both sides of the referral process has resulted in a more robust e-referral product being developed, supporting midwives to include oral health in antenatal care.

Behind this story is a team strengthening referral pathways at Peninsula Health

partnership

22

In an initial survey in 2010, the speech pathology department at Peninsula Health looked at the oral hygiene of their patients while in the acute setting of the hospital.

The survey found that:• a patient may have more plaque present when

they were dependent on nursing staff• people who do not own a toothbrush may

have more plaque present than those who do have a toothbrush.

The Peninsula Health dental team then looked at the oral hygiene of both acute and subacute inpatients to determine what factors contributed to the oral hygiene of inpatients, in particular if length of stay effected oral hygiene or those who were dependent upon hospital assistance for their dental care, and those independent of it.

The study allocated patients with a ‘plaque score’ as an indicator of oral hygiene. Plaque scores were measured against in-patient demographics including hospital setting, age, gender, length of stay, dependency rated by nursing staff, dependency rated by research staff and if a toothbrush was present.

The health service saw that:• allied health played a large role in both

measuring and regaining independence• if dependency is recorded accurately within

the hospital environment, correct patient management can be applied

• good oral hygiene is obtainable for everyone• simple brushing and interproximal cleaning

twice daily maintains a clean mouth.

Results from the study showed people were more likely to have poor oral hygiene if they were male, in the acute setting, had no toothbrush and/or were dependant on nursing assistance.

Higher plaque scores were recorded if:

There was poor agreement between documentation and measured independence

Kappa=0.33

The patient was male p=0.023

The patient required assistance to perform oral hygiene

p=0.028

The patient was in an acute environment

p=0.025

The patient did not have a toothbrush p=0.001

Results were presented at the Victorian Allied Health Conference in April 2014 and the team is currently finalising the complete research paper.

Behind this story is a dental team working closely with other departments to conduct ground-breaking research

results

Plaque scores: 3 2 1 0

23

Plenty Valley Community Health (PVCH) is committed to improving dental access for children in the local community.

In a joint study with the eviDent Foundation, The University of Melbourne, Melbourne Dental School and PVCH, it found that school dental check-ups could increase access to care for children from lower socioeconomic areas.

In early 2013, the research team (Prof Mike Morgan, Dr Sajeev Koshy, Tan Nguyen, Dr Shibu Mathew and Dr Samantha Lew) organised free dental check-ups at Jacaranda Preschool and Thomastown West Primary School and compared data collected with dental check-ups completed at PVCH (where about half of the children held a healthcare card).

One study coordinator, Tan Nguyen said the team identified a low participation rate for children receiving school dental check-ups.

“Our data analysis compared differences in healthcare card eligibility, the failed to attend rate for dental check-up appointments and current level of dental access to care,” he said.

Dr Shibu Mathew, Clinical Manager at PVCH was pleased to note children were attending their follow-up appointments.

“Preliminary findings suggest children were referred for follow-up dental care and had dental appointments booked at PVCH in Epping and Whittlesea,” Dr Mathew said.

Dr Sajeev Koshy, Clinical Director at PVCH said that this study was supported by a research grant from Dental Health Services Victoria.

“The study is important in helping us understand how children in our community access dental care and it will help us find ways to improve access and oral health outcomes,” Dr Koshy said.

Behind this story are teams working together to find effective ways to improve access to child dental care

driven

24

Rural communities will enjoy better access to specialist dental services through a new project bringing care to rural and remote locations.

The DHSV-led project will help combat the increasingly high demand for speciality services at The Royal Dental Hospital of Melbourne.

Project Manager, Shay Keating says rural patients experience many barriers to specialist dental services and location is at the top of that list.

“The most common barrier for people in remote areas to reach the care they need is distance, particularly when it comes to specialist care”.

“With RDHM providing the majority of specialist services in the state, we see many clients opt out of care altogether simply because they cannot travel to their appoinrments”.

DHSV saw that there were opportunities available to expand the capacity of clinicians in regional agencies to provide more complex general dental care locally. At the same time, there was an opportunity to improve access to care provided by registered specialist dentists or specialists-in-training.

The working group selected Oral Surgery, Special Needs and Paediatric Dentistry as the three initial priority areas and, should the sector’s funding environment permit, actions will include: 1. Increasing professional development on

specialist topics and maximising access2. Developing a framework for supporting

RDHM education and training programs and dentists with special interests

3. Scoping and costing models for using registered specialists in rural communities and establishing pilot programs.

Behind this story is a team exploring opportunities to increase access to specialist services in rural areas

expand

25

Albury Wodonga understands the importance of their dental assistants and their valuable contribution to clinical care and patient satisfaction.

Over the past few months, Albury Wodonga has developed the Dental Assistants team by introducing new positions including the daily in-charge role, health promotion role and senior dental nurse educator role.

Helen Mitchell, Acting Program Manager at Albury Wodonga Health Dental Services said the roles were added to improve the quality of care for patients.

“We are pleased that our Daily In-Charge Nurse started in December last year. They’ve provided great support to students and clinicians,” Ms Mitchell said.

“Our senior dental nurse educator is a newly created role focussing on education of our dental assistants and promoting the best practice and quality of care for our patients.”

There has also been a new role created to promote oral health in the community, especially in Corryong which is located 120km east of Albury-Wodonga.

“Our oral health promotion position will help us to promote good oral health to our isolated client groups such as the Corryong clinic and special schools in our region,” Ms Mitchell said.

“DAs play such an important role in the dental team and we want to make sure that their needs are nurtured and skills further developed”.

Behind this story is a dental team in Albury Wodonga that values every member of their dental team

nurture

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Evidence shows that people with an intellectual disability often experience poorer oral health than the general population.

Dental Health Services Victoria (DHSV) is working hard to address this fact and improve oral health for people with an intellectual disability.

Recently, DHSV supported a disability Day Service in Maffra, the George Gray Centre (GGC), to launch ‘Wise choices are for everyone’, a project to highlight the importance of good oral health. The centre offers a Day Service in Maffra for adults with intellectual and/or physical disabilities, mental health issues, acquired brain damage or any combination of disabilities.

Kerrie-Anne Miller, GGC Project Manager, worked with GGC participants to create a set of four posters to illustrate key oral health messages relevant to this population group.

“One in four people in Australia have a disability, but they are generally underrepresented in posters and other materials in the health community. This project was a wonderful opportunity to rectify this disparity by showcasing people with a disability taking control of their own health,” Kerrie-Anne said.

“At the same time, it demonstrated to the wider community that people with a disability are able to manage health issues such as oral health in the same way as anyone else.”

DHSV Health Promotion Program Manager Bonnie Morrison said DHSV was pleased to be part of this project.

“We were thrilled to work in partnership with GGC to produce these resources. They are genuine, relevant and accurate,” Ms Morrison said.

“With the help of a small grant, GGC was able to offer a set of these wonderful posters to all day services and community dental services across Victoria.”

“We hope other services use this resource to promote oral health and inclusion of people with disabilities in the wider community.”

Behind this story is a Disability Day Service breaking the mould to promote good oral health

empowered

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When it comes to providing patients with the best quality dental care, cohealth believes that it’s not just the dentists, but a range of oral health professionals who have a part to play.

In its new model of care, cohealth has pioneered effective ways of sharing responsibilities and tasks across the oral health team to explore how every oral health practitioner can contribute to prevention and intervention strategies.

Bree Jones, Holmesglen Institute Oral Health Program Leader said the provision of dental services in Australia has traditionally been dentist-based, but this is evolving.

“Dentists have often been the sole provider of dental care and the gatekeeper to treatment by

oral health therapists, dental therapists, dental hygienists and DAs,” Ms Jones said.

“However certain oral health practitioners may be more suitable for preventative planning and services,” Ms Jones said.

Anne Lennard, Oral Health Manager at cohealth said using the range of oral health practitioners would allow her dental team to work smarter and to its full potential.

“We are exploring ways to match the skill set of the provider to the needs of the patients so that our dental workforce can respond in the most appropriate and cost-effective way. This also helps us to meet the changing needs of our patients,” Mrs Lennard said.

Behind this story is an evolving organisation that strives to meet the changing needs of their patients

dynamic

Chronic Disease and Complex Care Team referred patients Priority access patients

Oral Health Therapist (Comprehensive history & examination, Periodontal Analysis, Radiographs)

Oral Health Risk Assessment Tool

Treatment Coordination Matrix matching complexity of medical history

and treatment needs to service specific providersGeneral Health Risk

Assessment Tool

18 years and over general care dentistry patients coming off waitlist

IntakeDirect or Indirect

Oral Health Educator (Den-tal Assistant)

Oral hygiene instruction, sali-va testing, dietary counselling

Oral Health Therapist Preventative care planning

and treatment, hygiene therapy, restorative treatment

within scope

Dentist Preventative care planning

and treatment, hygiene therapy

Referral (public/private specialist) or prosthetistReturn to general care waitlist

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