Clinical need and economic factors: influencing orthodontic care in a sample of patients in Ireland
| dc.contributor.advisor | Woods, Noel | |
| dc.contributor.author | McDermott, Patricia Ann | en |
| dc.contributor.funder | Higher Education Authority | en |
| dc.date.accessioned | 2024-05-28T14:21:45Z | |
| dc.date.available | 2024-05-28T14:21:45Z | |
| dc.date.issued | 2023 | en |
| dc.date.submitted | 2023 | |
| dc.description.abstract | AIM: The primary aim of the thesis is to investigate factors impacting on the child, adolescent, or parent in their decision to seek orthodontic care. The study has three objectives: 1) To investigate clinical and non-clinical factors influencing pre-treatment perceived need for orthodontic care by both parent and child/adolescent 2) To determine the amount a parent is willing to pay (WTP) pre and post treatment in order to obtain the benefit of straight teeth for their child, and 3) To investigate factors that influence patient compliance (in terms of hygiene) during fixed appliance treatment. The investigation is important in the current economic environment as orthodontic services tend to be an extremely expensive intervention and can be publicly funded. The research is influenced by studies highlighting that perceptions of need for care are multi-factorial and often influenced by non-clinical elements. Recent studies have highlighted the necessity for essential behavioural propensity assessment. RATIONALE: As orthodontic services are an expensive healthcare intervention, it is important to continue to examine the factors that may affect demand and outcomes in publicly funded and privately funded healthcare systems. There are very few studies on WTP in mainstream orthodontics. METHOD: It is a prospective longitudinal study using convenience sampling. The sample was stratified by age and gender, and consists of 177 subjects from the Republic of Ireland (RoI) and 177 from Northern Ireland (NI). The treatment modality was fixed appliance orthodontic treatment. The patients, aged 12 to 18 years (mean = 13.5), were studied in three different healthcare funding systems, from recruitment in 2004 until the completion of follow-up questionnaires in 2008. Instruments used to collect data included a patient administered interview at both pre- and post-treatment, two parent self-administered instruments, and a compliance instrument administered by the orthodontist. The pre- and post-treatment models were scored using Peer Assessment Rating (PAR), and the Index of Orthodontic Need (IOTN). The Dental Health Component (DHC) and the Aesthetic Component (AC) were scored by orthodontists. The orthodontists administering the treatment judged compliance and questionnaires were completed three months from the start of treatment and at the time the braces were removed. The data was analysed descriptively and empirically. The empirical analysis was undertaken using bivariate and multivariate regression analysis. RESULTS: The results indicate a misalignment between professionally assessed IOTNAC, and the child’s perceived need. Perceived need for orthodontic treatments was more pronounced in children treated in privately funded healthcare systems and was influenced by peer groups in both public and private funding systems. Parental factors influencing perceived need were the appearance of their children’s teeth and gender differences. Parents from both NI and RoI had high perception of need levels with no significant difference between parents who are publicly funded or those who pay fees privately. Willingness to pay at the pre-treatment was associated with higher parental income and WTP did not change pre- and post-treatment. Parents from the RoI were willing to pay more than their NI counterparts, and this was true, whether or not, they were paying full societal or subsidized fees. Parental WTP pre-treatment and at completion is closely related to the societal market values for the jurisdiction and was related to ability to pay in both funding systems. There was no difference in the level oral hygiene compliance by those treated in either funding system. Compliance during treatment was better in females and children/adolescents from higher income households. More highly compliant children/adolescents had better treatment outcomes and lower PAR scores. CONCLUSIONS: The misalignment between perceived need and normative need may be due to lack of education in terms of what is a socially acceptable level of dento-facial appearance. The expectations of publicly funded patients/parents and their misalignment between perceived need and the value they place on treatment may not always be grounded, in practical realities but rather in external influences. Means testing would help public systems identify those who cannot afford treatment, but have a definite need for treatment. Practitioners and policy makers should consider whether the criteria for qualification for orthodontic treatment in healthcare systems should include an assessment of oral hygiene levels and cooperation. This thesis contributes by highlighting the importance of patient and parental perception and societal expectations on the demand for orthodontic care. In terms of behavioural propensity, the study provides an insight into the qualification for treatment based on potential behavior during treatment. The study has developed a practical tool for use by practitioners to gain an insight into the possible compliance of a child, depending on what is motivating them to seek treatment. | |
| dc.description.status | Not peer reviewed | en |
| dc.description.version | Accepted Version | en |
| dc.format.mimetype | application/pdf | en |
| dc.identifier.citation | McDermott, P. A. 2023. Clinical need and economic factors: influencing orthodontic care in a sample of patients in Ireland. PhD Thesis, University College Cork. | |
| dc.identifier.endpage | 318 | |
| dc.identifier.uri | https://hdl.handle.net/10468/15932 | |
| dc.language.iso | en | en |
| dc.publisher | University College Cork | en |
| dc.rights | © 2023, Patricia Ann McDermott. | en |
| dc.rights.uri | https://creativecommons.org/licenses/by-nc-nd/4.0/ | |
| dc.subject | Economic | en |
| dc.subject | Orthodontic | en |
| dc.subject | Clinical need | en |
| dc.title | Clinical need and economic factors: influencing orthodontic care in a sample of patients in Ireland | |
| dc.type | Doctoral thesis | en |
| dc.type.qualificationlevel | Doctoral | en |
| dc.type.qualificationname | PhD - Doctor of Philosophy | en |
