REGIONAL DIFFERENCES IN ACCESS TO DENTAL HYGIENE

1
TUPE0241
REGIONAL DIFFERENCES IN ACCESS TO DENTAL HYGIENE
SERVICES FOR THOSE WITH HIV/AIDS IN CANADA

McCarthy G. M., Mara T. W., Driessen C, Stitt L.
W. Schulich School of Medicine Dentistry, The
University of Western Ontario London, Canada
DISCUSSION Refusal to treat HIV patients can
result in charges of discrimination from
professional or human rights organizations in
Canada (Bergin, 2004) or elsewhere. Despite this,
some health care workers are reluctant to treat.
Across Canada, rates of refusal reported by
dental hygienists ranged from 3 in BC and the
NWT to 12 in Ontario. Fear of occupational
exposure to HIV is an issue for many dental
professional although the risk of HIV infection
is lt1. Further investigation
of Ontario hygienists indicated that 91 and 86
were willing to treat HIV and AIDS patients
respectively - even though 50 believed that they
would be placed at increased risk. In addition,
40 reported concern that they may lose other
patients if they treated patients with HIV.
Reports of an ethical responsibility to treat
knowledge of HIV and use of standard precautions
were important predictors of non-refusal to treat
patients with HIV/AIDS amongst hygienists in
Canada. This confirmed previous findings from
national studies of dentists (McCarthy et al,
1999), surgeons (McCarthy et al, 2005) and nurses
in Ontario (McCarthy et al, 2006). Hygienists
perception - that the dentist with whom they
worked was willing to treat HIV patients- was
also a major influence on acceptance of HIV
patients for dental hygiene services.
RESULTS Characteristics of Respondents
Age 20-39 69 40-49 23
50 8 Region BC/NWT
12 AB/SK/MB/YU 12 ON 45 QC
24 NB/NS/PEI/NL 6 Training 2 yrs
dental hygiene 38 1 yr assisting 1 yr
hygiene 31 Other 31 Year of
graduation Pre 1980 12 1980-1989 16
1990-2003 72
BACKGROUND Dental hygienists have an important
role in the provision of oral care for patients.
People living with HIV/AIDS can be very
vulnerable to oral infections and severe
periodontal disease. Prevention, early detection
and treatment of oral disease can reduce
morbidity, improve prognosis and enhance quality
of life. A national survey of dental hygienists
in Canada was conducted to investigate attitudes
regarding the treatment of patients with HIV, HCV
or HBV infection control practices and
occupational exposures to blood. This poster
focuses on access to dental hygiene services for
patients with HIV / AIDS. OBJECTIVES To
estimate the proportion of dental hygienists in
different regions of Canada who report refusal to
treat HIV patients. To investigate dental
hygienists attitudes related to the treatment of
HIV.
METHODS INSTRUMENT The questionnaire was
developed and tested using focus groups,
test-retest procedures and a pilot study (n500)
of hygienists in Ontario. Items in the
questionnaire included sociodemographic
variables, attitudes related to the treatment of
HIV/AIDS patients, infection control procedures
and continuing education. The final
questionnaire was mailed to a stratified, random
sample of 5,900 dental hygienists, licensed by
their provincial or territorial colleges in
Canada. The stratification was based on region.
Follow up included two additional
mailings. SAMPLE SIZE 5,900 REGIONS Britis
h Columbia and the North West Territories
(BC/NWT). Alberta, Saskatchewan, Manitoba and
the Yukon (AB/SK/MB/YU). Ontario (ON). Quebec
(Q). Prince Edward Island, Nova Scotia, New
Brunswick and Newfoundland (PEI/NS/NB/NL).
DATA ANALYSIS Weighted data were analyzed
using Pearsons chi square tests. Significant
variables were entered into a multiple logistic
regression using SPSS/PC. Weighting allowed
for differences in probability of selection and
non-response between the strata. (McCarthy et al,
1997) RESPONSE RATE WAS 56
Predictors of Refusal to Treat
refusal Age (p.009)
20-39 9 40-49 13 50
7 Training (p .002) 2 yrs dental hygiene
7 1 yr as. 1 yr hygiene 13
Other 9 Year of graduation (plt
.001) 1980-1989 15 pre1980/1990-2003
8 Continuing education infection
control (p.019) no hours 11 some
hours 8 Dentist is reluctant to treat
HIV patients (p lt.001) yes
23 no 7 As a hygienist I
have an ethical responsibility to treat patients
with HIV (p.001) disagree 20
agree 9 Use extra infection control
procedures for patients with HIV
(plt.001) sometimes/never
6 always 12 MULTIPLE LOGISTIC
REGRESSION ANALYSIS Hygienists in Ontario were
more likely to refuse to treat HIV patients than
hygienists in other regions. Odds Ratio 4.2
(ref BC/NWT) p0.005 Other significant
variables in the model included year of
graduation, continuing education on infection
control in the last two years, dentists
reluctance to treat patients with HIV, ethical
responsibility to treat patients with BBPs and
compliance with standard (universal) precautions.
CONCLUSIONS Dental hygienists rates of refusal
to treat patients with HIV differed significantly
across Canada and were lowest in BC and the NWT
and highest in Ontario. RECOMMENDATIONS Improve
ments in education on infection control (standard
precautions), HIV/AIDS and ethics. Selection of
more compassionate students for training in
dental hygiene and dentistry Expansion of two
year training program in dental hygiene. More
research is required. References McCarthy GM,
Koval JJ. MacDonald JK. Factors associated with
refusal to treat patients with HIV The results
of a national survey of dentists in Canada.
American Journal of Public Health 1999
89541-5. McCarthy GM, MacDonald JK.
Non-response bias in a national study of
dentists infection control practices and
attitudes related to HIV. Community Dentistry and
Oral Epidemiology 1997 25119-25. McCarthy GM,
Bednarsh H, Ssali CS et al. Transmission of HIV
in the dental clinic and elsewhere. Proceedings
of 4th International Workshop on Oral
Manifestations of HIV Infection. Oral Diseases
2002 8(suppl 2) 126-135. McCarthy GM, Harris
K, Stitt L. Access to elective surgery for
patients with HIV or other bloodborne pathogens
in Canada. Ontario HIV Treatment Network Research
Conference, November 24-25, 2005. Aragon C,
McCarthy GM, Stitt L. Access to dental hygiene
services for patients with HIV in Canada Ontario
HIV Treatment Network Research Conference,
2005. Gillian McCarthy, Larry Stitt, Ken Harris,
Michael John, Cornel Driessen. Attitudes of
Ontario nurses related to the care of patients
with HIV/AIDS. XVI International AIDS Conference
2006. Abstract TUPE0247. Fiona Bergin. Duty to
treat. Royal College of Dental Surgeons of
Ontario Dispatch Oct/Nov 2004.
Acknowledgements This study was supported by a
grant from the Canadian Institutes of Health
Research.
XVI INTERNATIONAL AIDS CONFERENCE, AUGUST 13
- 18 2006, TORONTO, CANADA