title: Dental therapists/hygienists working in remote-rural primary care: a structured review of effectiveness, efficiency, sustainability, acceptability and affordability.
abstract: OBJECTIVE
  To examine the use of dental therapist/hygienists to provide primary dental treatment in remote-rural areas with regard to their effectiveness, efficiency, sustainability, acceptability and costs (affordability).
  
  
  METHODS
  The structured literature review of studies indexed in Medline, Embase and CinAHL was conducted using search terms relevant to 'dental therapists' and 'remote-rural'. Remote-rural was defined as 'those (individuals) with a greater than 30-minute drive time to the nearest settlement with a population of greater than 10,000'.
  
  
  RESULTS
  From 1,175 publications screened, 21 studies from 19 publications were initially included. Only seven studies were included that explicitly focused on remote-rural areas. Four were surveys and three were qualitative studies. All of the included studies were reported within the last 7 years. The methodological quality of the surveys varied, particularly with regard to their response rates. All three of the qualitative studies were assessed as potentially weak methodologies. Regarding the research question, none of the studies included provided data relevant to understanding efficiency, cost issues or the acceptability of dental therapists. The available empirical evidence contained only indirect indicators about the sustainability of dental therapy in rural areas.
  
  
  CONCLUSIONS
  The available data indicates that dental therapist/hygienists have suitable skills and could constitute a valuable asset to meet the dental demands in remote-rural areas. However, the evidence base is limited and of a poor quality. There is a need to put in place 'well-designed interventions with robust evaluation to examine cost-effectiveness and benefits to patients and the health workforce'.
authors.affiliation: University of Dundee, Dundee, UK. r.e.freeman@dundee.ac.uk
authors.forename: Ruth
authors.initials: R
authors.lastname: Freeman
authors.forename: Cathy
authors.initials: C
authors.lastname: Lush
authors.forename: Steve
authors.initials: S
authors.lastname: MacGillveray
authors.forename: Markus
authors.initials: M
authors.lastname: Themessl-Huber
authors.forename: Derek
authors.initials: D
authors.lastname: Richards
mesh_terms: D001294:Attitude to Health; D003365:Costs and Cost Analysis; D003727:Dental Auxiliaries / Q000706:statistics & numerical data*; D003729:Dental Care / Q000191:economics / Q000706:statistics & numerical data*; D003756:Dental Hygienists / Q000706:statistics & numerical data*; D004526:Efficiency; D006801:Humans; D011320:Primary Health Care / Q000191:economics / Q000706:statistics & numerical data*; D019035:Rural Health Services / Q000191:economics / Q000706:statistics & numerical data*
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