An evaluation of the discriminant and predictive validity of relative social disadvantage as screening criteria for priority access to public general dental care, in Australia

Abstract

Background: Most public dental care services provide preventive, general dental care on a chronological, first come-first served basis. There is concern about lack of transparency, equity and timeliness in access to public dental services across Australia. Using social determinants as screening criteria is a novel approach to triage in dental care and is relatively untested in the literature. The research evaluated the discriminant and predictive validity of relative social disadvantage in prioritising access to public general dental care.

Methods: A consecutive sample of 615 adults seeking general dental care was selected. The validation measure used was clinical assessment of priority. Nine indicators of relative social disadvantage (RSD) were collected: Indigenous status; intellectual disability; physical disability; wheelchair usage; dwelling conditions; serious medical condition; serious medical condition and taking regular medication; hospitalised within 12 months; and, regular medical visits. At the first dental visit, dentists rated care as a priority if treatment was required ≤6 months (PriorityTx) and otherwise non-priority (non-PriorityTx). A standardised dental examination was conducted. Sensitivity, specificity, positive and negative predictive value and area under the ROC curve analyses of 1+ of RSD in predicting clinical priority were calculated.

Results: In bivariate analyses, one or more indicators of relative social disadvantage status were significantly associated with PriorityTx (P < 0.001; χ2). In multivariate analyses, one or more indicators of relative social disadvantage persisted as an independent predictor of PriorityTx (OR 3.8, 95% CI = 2.6-5.6). Compared with clinicians' classification of PriorityTx, one or more indicators of relative social disadvantage had a sensitivity of 77.1%, and specificity of 53.3%, together with a positive predictive value of 81.9% and negative predictive value of 46.0%. ROC curve analysis supported one or more indicators of relative social disadvantage as a predictor of greater priority for access to general dental care (0.66).

Conclusions: Considerable heterogeneity exists among persons seeking public general dental care in New South Wales. RSD performs as a valid predictor of priority for access to treatment and acts as valid screening criteria for triaging priority access to treatment. Such indicators may address issues of inequality in access to general public oral health services.

Figure 1

Analysis of Model 1.

Figure 2

Comparison of AUR between Model 1 and Model 2.