CDA Essentials 2017 • Volume 4 • Issue 6

I ssues and P eople Dr. Rosamund Harrison Dr. Karen Campbell ❘  On improving publicly funded dental benefits: “Since this first study, we’ve done additional studies in BC on the access to care issue that have investigated both children and young adults with special health care needs, older persons with disabilities, and the dental providers that take care of them. Financial barriers to receiving care were consistently identified throughout these studies. Many families with special needs children or adults are supported by government- sponsored benefits. Therefore, improving publicly funded benefits seems a logical next step to improve access to care. Dental providers in BC also shared that they felt reimbursement for services needed to increase to reflect the extra time and responsibility needed to provide care for persons with special health care needs.” ❘  On early referral to tertiary-level care: “In our paper, which reflects the situation in BC, we recommend early referral to tertiary-level care if appropriate. Our study showed that many families felt their experience with the general or specialty dentist in community practice only delayed needed care. They were ultimately referred to the BC Children’s Hospital after the dentist determined referral to be the best option.” ❘  On increasing availability of care: “Given the broad definition of ‘special health care needs,’ some patients falling under this definition—the medically complex and fragile—do need to be managed in tertiary-care hospital settings, where there is access to specialty and sub-specialty services in anesthesia, nursing, post-anesthetic care and support from other specialty medical services. But a significant proportion of patients who fall under the definition of ‘special health care needs’ are medically healthy, but have a profound intellectual disability that makes it challenging to treat them in a private practice or community clinic without sedation adjuncts or general anesthesia. This is one area we need to invest in for the future and we need to involve more general dentists in managing this population.” ❘  On investing in training for general dentists: “Not unlike other specialties in dentistry, the training required to treat all patients that fall under the broad definition of ‘special health care needs’ is best left to the post-graduate level, suited for those graduate dentists with the interest, desire and disposition to care for these special patients. Rather than expanding existing undergraduate dental training, investments should be focused on developing accredited ‘special care dentistry’ residencies or enhancing existing general practice residency programs. These programs are largely based in hospital facilities and could be augmented by service- learning community opportunities to provide advanced training in sedation dentistry, medical management and behavioural management.” ❘  On improving access to general anesthesia: “Because access to general anesthesia is also a barrier for patients with special health care needs, there is also a need to augment fees for community-based anesthesia services. Currently, faced with low reimbursement levels, many outpatient surgical centres are gravitating to more profitable, less logistically complex dental or other surgical cases.” a From the Authors ACourse of Action for Improving Access to Care CDA Essentials followed up with two of the study authors: Dr. Karen Campbell, chief of dentistry at BC Children’s Hospital, and Dr. Rosamund Harrison, professor emerita in pediatric dentistry at the University of British Columbia, to ask what they believe needs to be done to improve access to care for children with special health care needs. Here is what they said: Theviewsexpressedarethose oftheauthorsanddonot necessarilyreflecttheopinions orofficialpoliciesofCDA.