Assessing patient complexity in Special Needs Dentistry in the Australian and New Zealand context: a qualitative study

Background and objectives: Special Needs Dentistry (SND) has colloquially been referred to as the speciality that manages the oral health of complex patients. However despite various case mix models aiming to capture the factors that contribute to patient complexity, there continues to be a range of views on the topic. This study aims to explore the perspectives of specialists in SND in Australia and New Zealand on factors that contribute to complexity in patient care. Methods: Semi-structured interviews were conducted with SND specialists using video conferencing software. Interview transcripts underwent initial open coding to facilitate subsequent analysis using a thematic framework approach. Results: Twelve specialists across Australia (n=10) and New Zealand (n=2) were interviewed from January – April 2024. Participants included those primarily employed in Private Practice (n=1), Hospitals (n=9) and Universities (n=2). The average specialist experience of participants were 11 years (range 1-23). Five major themes of factors contributing to complexity emerged: (i) medical complexity, (ii) communication, (iii) behaviour, (iv) socio-cultural, and (v) rational treatment planning. All participants commented that complexity was a product of many factors. In addition, participants remarked that existing case mix models did not record ethnicity, and as a consequence did not capture the complexity associated with managing the oral health needs of indigenous peoples in Australia and New Zealand. Conclusions: Findings revealed that patient complexity in SND was multi-factorial and included both patient and external factors. Certain aspects of complexity may not be captured in existing case mix tools such as sociocultural factors.