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Deprivation, demography and missed scheduled appointments at an NHS primary dental care and training service

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Background - Patients often do not attend planned routine dental appointments. This leads to unmet dental needs, under-utilisation of dental services, lost revenue for dental practice owners and lost educational opportunities when this occurs in centres of training. The aim of this project was to use Electronic Dental Health Records to investigate the factors associated with failing to attend dental appointments in an NHS primary dental care service provided free at the point of delivery.

Method
- Electronic patient data over a one-year period were extracted. Data included; patients’ age, sex, deprivation status and whether they missed at least one appointment. Deprivation status was derived from patients’ postcodes converted to the indices of multiple deprivation quintiles (IMD). Data was analysed descriptively and analytically. Chi square tests were used to identify statistically significant associations (p<0.05) between patient characteristics and a record of a missed dental appointment. Logistic regression was used to model the patient related factors which predict failure to attend scheduled appointments while controlling for confounding.

Results - A total of 3,678 patients aged between 2 and 98 years had at least one appointment offered within the twelve-month period studied. Of these, 627 (17%) had at least one instance of ‘Did Not Attend’ (‘DNA’) on record. The age group with the highest proportion of patients with a ‘DNA’ were the 6-12 year olds (23.6%), and the lowest proportion were the >75 years olds (10.4%). A higher proportion patients had a ‘DNA’ in the two most deprived quintiles (Quintile 1 - 32.4% and Quintile 2 – 33.3%), when compared with the least deprived quintile (Quintile 5 – 6.5%). Logistic regression showed that males were 20% more likely to have a ‘DNA’ than females, the most deprived were twice more likely to have a ‘DNA’ than least deprived (p<0.05) and younger patients were more likely to not have a ‘DNA’ on record.

Conclusion
- Electronic primary dental care records when analysed at the individual level revealed a predictive pattern of missed appointments, which were independently associated with patients’ age, deprivation and sex. Understanding these patterns can positively influence comprehensiveness of care, child safeguarding, patient outcomes and primary dental care practice financing.
Original languageEnglish
JournalBritish Dental Journal
Publication statusAccepted for publication - 14 Oct 2019

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