title: Geographic location and indirect costs as a barrier to dental treatment: a patient perspective.
abstract: BACKGROUND
  The recently published National Survey of Adult Oral Health 2004-06 indicated that tooth loss, mean decayed and number of DMF teeth were all higher outside capital city locations. In addition, dental attendance patterns were worse in terms of frequency, reason for visit, and continuity in rural and remote locations, but there was no difference by geographical location in terms of financial barriers to dental care. The objective of this research was to identify, quantify and analyse some of the non-treatment costs associated with dental treatment from the perspective of the patient and to determine whether the perceived impact of those costs may limit access to dental care.
  
  
  METHODS
  This cohort study was nested within a clinical trial. Patients had been allocated to treatment arms within clusters dependent on the randomization status of the dental practice they usually attended, classified as major city, regional or remote. A questionnaire was developed from a series of focus groups in which patients were asked to identify the domains of non-treatment costs associated with a dental visit that were important to them and to quantify those costs. Factor analysis was used to reduce these items to four core scales. These scales were assessed for reliability and validity. Regression and ANCOVA was used to explore differences in DMFS scores between the three groups and a predictive model developed to adjust for potential confounders.
  
  
  RESULTS
  Two core scales were identified as key drivers on the perceived impact of indirect costs associated with dental visits; travel impact and family impact. Patients living in remote locations incurred significantly higher indirect costs associated with dental treatment and higher mean DMFS scores.
  
  
  CONCLUSIONS
  Patient perception of the impact of travel costs and impact on family life are major drivers restricting access to dental services for people living in remote locations in New South Wales. Further research using outcomes directly related to access is required to validate the claim that patients living in regional and remote locations suffer both perceived and real financial barriers to dental care.
authors.affiliation: Community Oral Health and Epidemiology, Faculty of Dentistry, The University of Sydney. bradcurtis13@msn.com
authors.forename: B
authors.initials: B
authors.lastname: Curtis
authors.forename: R W
authors.initials: RW
authors.lastname: Evans
authors.forename: A
authors.initials: A
authors.lastname: Sbaraini
authors.forename: E
authors.initials: E
authors.lastname: Schwarz
mesh_terms: D000328:Adult; D003729:Dental Care / Q000191:economics* / Q000706:statistics & numerical data; D003731:Dental Caries / Q000191:economics / Q000517:prevention & control / Q000628:therapy; D004812:Epidemiologic Methods; D005260:Female; D006297:Health Services Accessibility / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009517:New South Wales; D009910:Oral Hygiene / Q000706:statistics & numerical data; D012424:Rural Population / Q000706:statistics & numerical data