Abdul Murat, N; (2012) Estimating oral health needs and workforce requirements using sociodental and skill mix approaches. Doctoral thesis , UCL (University College London).

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Abstract

Background: Traditional measures for planning in dentistry estimate dental workforce requirements based solely on normative approach. In contrast, the sociodental approach combines normative and subjective needs assessments and also incorporates behavioural propensity. The sociodental model has been recommended as a more rational approach to assessing dental needs. Much lower and more realistic levels of dental treatment needs have been reported using the sociodental approach compared to normative measures. This study compares the two approaches and applied the sociodental approach to different skill mix scenarios. Objectives: 1) To estimate and compare dental treatment needs and dental workforce requirements for a sample of Malaysian adults using the traditional normative and the sociodental approaches. 2) To estimate workforce requirements using different skill mix scenarios. Methods: This cross-sectional study was carried out on a selected sample of 732 adults aged 30-54 years who were employees of a public university in Kuala Lumpur, Malaysia. The participants’ sociodental need was assessed at three different levels; i) Normative Need, where their treatment needs were assessed based on professional judgements; this is equivalent to the traditional normative need estimates, ii) Impact-Related Need, where those who had normative need were assessed on their level of oral impacts using the Oral Impacts on Daily Performances (OIDP) index, and iii) Propensity-Related Need, where those who had both normative need and oral impacts associated with their treatment needs were assessed on their level of behavioural propensity to determine the type dental interventions most appropriate for them. The estimates of sociodental approach based on the integration of Normative, Impact-related and Propensity-related needs were compared to normative approach. Then, the requirements for dental workforce per 100,000 adults were assessed and compared between the different methods of assessing needs. Next, five different skill mix scenarios were developed where different ranges of dental tasks were delegated from dentists to professionals complementary to dentistry (PCDs). Results: The sociodental approach which comprises the assessments of Normative, Impact-Related and Propensity-Related needs resulted in significantly lower estimates than the conventional approach which uses normative assessment alone. The percentage differences in needs estimates between the sociodental and normative approaches were 91% for periodontal treatment and 89%-91% for prosthodontic treatment. Consequently, there were also differences in the number of dentists needed to treat 100,000 people. For restorative treatment, the number of dentists needed were 12.54 (normative approach) and 12.12 (sociodental approach), for periodontal treatment the respective figures were 14.43 (normative approach) and 2.32 (sociodental approach) and for prosthodontic treatment the need for dentists was 10.26 (normative approach) and 0.98 (sociodental approach). There was considerable potential for delegation of care to the PCDs, whereby the required number of dentists decreased and the required number of PCDs increased for varying levels of delegation. Conclusions: The sociodental approach to assessing dental treatment needs resulted in much lower estimates of oral health and workforce requirements than the normative needs approach. The numbers of dentists needed to deal with the dental needs of Malaysian adults can be markedly reduced by using PCDs.

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