The Poche Centre for Indigenous Health and the Faculty of Dentistry Centre for Oral Health Strategy Meeting 3 and 4 May 2013 Steve Naoum, Lecturer, Faculty of Dentistry Kylie Gwynne, Director, Poche Centre for Indigenous Health

The Poche Centre for Indigenous Health Faculty of Dentistry -The Poche Centre for Indigenous Health was established in 2008 from a generous donation by Mr Greg Poche. -Harnessing the commitment of the University of Sydneys Medical School and donating 10 million dollars, Greg Poche had made real his goal of improving the health status of Indigenous Australians. -The Poche Centre has 3 areas of core business: Clinical Service, Research and Education and over the next 3 years we will be focusing on 3 key themes: Health kids, Healthy Teeth & Healthy Hearts -The Poche Centre for Indigenous Health works across all of the health related faculties at the University of Sydney and has funded a post doctoral research position in each of the faculties to build our research program. -This year we expect to provide clinical education for 250 students and provide free, local, specialist services for more than 4000 people. 2 The Poche Centre – Who are we?

The Poche Centre for Indigenous Health Faculty of Dentistry -The University of Sydneys Faculty of Dentistry is Australias first and has been involved in the training of dental practitioners for 100 years. -The faculty currently has 349 dental students, 68 oral health students and 82 postgraduate students. -Dean of the faculty is Professor Chris Peck, who also is a member of the Poche board of directors. -Professor Andy Blinkhorn, Senior academic within the faculty and member of the Poche Centres Executive Academic Working Group. -Dr Steve Naoum, lecturer in the faculty and Poche Centre clinician for dental outreach clinics. -Dr Peter Salameh, part time lecturer in the faculty and Poche Centre clinician -Dr Andrea Lenard, dentist at Westmead Dental Hospital and Poche Centre clinician -Dr Rajah Selvarajah, part time lecturer in the faculty and Poche Centre clinician 3 Sydney Faculty of Dentistry

The Poche Centre for Indigenous Health Faculty of Dentistry The Poche Centre of Indigenous Health has recently launched a new 3 year strategic plan. One of the primary focuses is Healthy Teeth This includes provision of clinical dentistry services to Bourke and Dubbo (although this service is currently on hold) and expansion to other areas as funds become available In 2013 the Poche dentistry clinic expects to provide services to 925 people in rural and remote areas 4 Healthy Teeth

The Poche Centre for Indigenous Health Faculty of Dentistry Limited Access, Limited Continuity -Prior to 2010 Bourke was serviced by a private dentist and access to this service was limited by cost. In addition, the service being delivered was of low quality -Services provided through the AMS werent frequent and when they were provided they were not coordinated to ensure continuity of patient care -It was difficult to recruit and sustain health professionals in the area – even as locums 5 Bourke – Background: A limited Service

The Poche Centre for Indigenous Health Faculty of Dentistry Limited treatment - Services addressed acute issues only, treatment being confined to temporary fillings; extractions; short term pain relief. Thus despite the need there was no provision of: -Dento-alveolar surgery -Prosthetic services to provide the prosthetic rehabilitation needed by most patients. -Root therapy for restorable teeth (even anterior teeth) -Preventive education programs or preventive services eg mouthguards -Treatment under General Anaesthetic Consequently management of chronic and complex oral conditions and a focus on prevention was absent in services to the population of Bourke prior to Bourke – Background : A limited Service

The Poche Centre for Indigenous Health Faculty of Dentistry Limited sustainability -There was no teaching/student involvement in the clinics. Without exposing the next generation of practitioners to dentistry in remote Indigenous communities the ability to ensure adequate workforce participation in towns such as Bourke is very limited. - A need for infrastructure investment 7 Bourke – Background : A limited Service

The Poche Centre for Indigenous Health Faculty of Dentistry A new model of service delivery was developed in partnership between the Poche Centre, Faculty of Dentistry, Bourke Aboriginal Health Service and NSW Health to address the need for a high quality, free dental service for Aboriginal people in Bourke and surrounds. The model is defined by five key pillars 1.Quality 2.Continuity 3.Care 4.Sustainability 5.Prevention 8 The Bourke Model

The Poche Centre for Indigenous Health Faculty of Dentistry The service provided is to be of the same quality as a highly reputable Sydney Private Practice. All clinicians are senior clinical educators and mentors at The University of Sydney and have a minimum of 10 years clinical experience. All clinicians ensure treatment is completed according to the University of Sydney Teaching protocols- protocols which are evidenced based and identified as best practice. Investment in infrastructure within the AMS clinic has been by the Poche Centre Investment in infrastructure at Bourke hospital theatres has been by the Area Health Service 9 The Bourke Model - Quality

The Poche Centre for Indigenous Health Faculty of Dentistry Treatment continuity is an important pillar of the Bourke model due to the prevalence of : - Chronic oral conditions - Complex oral conditions - Preventable oral conditions Treatment continuity is achieved by: - Visit regularity (at least one 2 day visit/month) enables multiple visits for the management of a single patient to be coordinated - Restricting clinician number - A compatible and communicative clinical team 10 The Bourke Model - Continuity

The Poche Centre for Indigenous Health Faculty of Dentistry Genuine care is to meet the presenting needs of the community through the service provided. Consequently to demonstrate genuine care to the Bourke community we concluded that the scope of treatment provided needed to be expanded to include: -Dento-alveolar surgery -Prosthetic services to provide prosthetic rehabilitation. -Root therapy for restorable teeth -Preventive education programs and preventive services eg mouthguards -Treatment under General Anaesthetic Developing genuine rapport and trust through genuine, regular community engagement. Genuine Relationships with key community institutions. 11 The Bourke Model - Care

The Poche Centre for Indigenous Health Faculty of Dentistry Without genuine sustainability any service has limited value in solving the highly prevalent chronic and complex oral heath problems of Indigenous communities. Sustainability of our Bourke service is being achieved through a four pronged approach: 1.Student involvement – work force sustainability 2.Key partnerships between stakeholders with long term outlook – facilitating complex clinical service delivery, infrastructure investment 3.The central role of AMS staff in the program – record keeping, clinic bookings/ordering 4.Genuine relationship with key community groups developing trust and an ongoing connection; distinctive compared to other fly in-fly out models. 12 The Bourke Model - Sustainability

The Poche Centre for Indigenous Health Faculty of Dentistry A dental health promotion program is provided within the Bourke High School. At present action is being taken to ensure this is an annual event: -formalising a connection between the dental students association and The Poche Centre -grant applications for funding sources are being written Evaluations from last years program revealed improved understanding of oral hygiene practices and diet significance in oral health. Emphasis on prevention in the clinical setting is paramount within the Bourke model. Presence of students ensures additional time is able to be spent with patients as part of routine care to provide Oral hygiene instruction and dietary advice. 13 The Bourke Model - Prevention

The Poche Centre for Indigenous Health Faculty of Dentistry Community oral health outcomes have improved dramatically Prosthetic provision to numerous patients whom previously were unable to have adequate nutritional intake due to edentulism Complex restorative/root therapy provided to patients whom had extractions scheduled- facilitating function and well being; physical and psychological. Children requiring treatment under General Anesthesia no longer required to go to Dubbo/Sydney Children of the community have developed an awareness for oral hygiene and are making better choices for the health of their teeth Andrea, Pete and I are now recognised in the community, which demonstrates the connection made between the team and the people of Bourke. Lost trust with the dental profession has somewhat been regained. Dentistry students are gaining valuable experience in the clinic 14 Notable Outcomes to date

The Poche Centre for Indigenous Health Faculty of Dentistry The Faculty of Dentistry and the Poche Centre intend to expand our dental/oral health program-research, community partnerships, clinics. We are working with the Centre for Oral Health Strategy to achieve this We will appoint a Poche Research Fellow in the Faculty of Dentistry this year who will develop our research program under the leadership of Professor Anthony Blinkhorn The research team will formally evaluate the Bourke model, assist the development of a maternal oral health program, roll out and evaluate a dental triage tool, and work with COHS to scope a fluoride varnish program We are working on a partnership with Souths Cares so we can develop a local presence – our first project will be providing mouth guards for local kids playing league We are interested in: -establishing a mobile service to complement our other health services -providing our comprehensive fly in fly out service to other communities 15 Whats Next?

The Poche Centre for Indigenous Health Faculty of Dentistry Boe Rambaldini, John Skinner, Shanti Sivaneswaren, Jenni Floyd and the AMS teams The patients and communities that work with us Professor Anthony Blinkhorn The students and staff that deliver the services 16 Acknowledgements and thanks

The Poche Centre for Indigenous Health Faculty of Dentistry 17 A brighter future….