status. Healthcare disparities stemming from implicit bias can manifest in several ways. For example, a healthcare provider might unconsciously give less attention to a patient or make assumptions about their medical needs based on race, gender, or age. The unconscious assumptions can lead to delayed or inadequate care, misdiagnoses, or inappropriate treatments, all of which can adversely impact health outcomes. Addressing implicit bias in healthcare is crucial for achieving equity in medical treatment. Strategies to combat these biases involve education and awareness programs for healthcare professionals.
These programs help individuals recognize and acknowledge their biases, fostering a more empathetic and unbiased approach to patient care. Additionally, implementing policies and procedures prioritizing equitable treatment for all patients can play a pivotal role in reducing healthcare disparities. Ultimately, confronting implicit bias in healthcare is essential to creating a more just and equitable healthcare system where everyone receives fair and equal treatment regardless of their background or characteristics.
DEFINING THE SPECIAL NEEDS POPULATION
The term patient with special needs describes a broad range of people who have difficulty achieving good oral health or accessing oral health services as a result of their disabilities. The Special Care Dentistry Association (SCDA) defines “special care dentistry” as “that branch of dentistry that provides oral care services for people with physical, medical, developmental, or cognitive conditions which limit their ability to receive routine dental care” (SCDA, 2022). Similarly, the Commission on Dental Accreditation, in its 2016 standards for dental and dental hygiene education programs, defines “patients with special needs” as those “whose medical, physical, psychological, or social situations make it necessary to modify normal dental routines,” including “people with developmental disabilities, complex medical problems, and significant physical limitations” (Commission on Dental Accreditation, 2022, p.18). The American Academy of Pediatric Dentistry (AAPD) has recently revised its definition of “special healthcare needs” to include any “physical, developmental, mental, sensory, behavioral, cognitive, or emotional impairment or limiting condition that requires medical management, healthcare intervention, and/or use of specialized services or programs” (AAPD, 2021). The AAPD definition further states that the condition “may be congenital, developmental, or acquired through disease, trauma, or environmental cause and may impose limitations in performing daily self-maintenance activities or substantial limitations in a major life activity.” Traditional and emerging special needs groups The number of people with special healthcare needs is expected to grow substantially due to demographic and other trends. In 2019, approximately 19% of those 65 years of age or older had difficulty with at least one of the six functioning domains which include vision, hearing, mobility, communication, cognition and self-care (Administration for Community Living, 2021). The nation’s elderly population is at high risk for oral health problems, particularly those individuals with general health problems or other disabilities (American Dental Association, 2021). As of 2020, 55 million persons age 65 and older lived in the United States (Kilduff, 2021). In the year 2060, the number of individuals age 65 and older is expected to increase to 94.7 million with 19.0 million people 85 years of age and older among this group (Mather & Kilduff, 2020). It is important to distinguish the elderly population as a unique group because of the large disease burden this group tends to have. The elderly population includes those aged 65 and older. As many as 30% of the elderly population may be considered frail due to mobility problems, chronic conditions, and dependence on others for assistance in activities of daily living. Frail elderly persons may be found living in skilled nursing Inadequate oral health in special needs populations Over the past several decades, the oral health of Americans in general has improved, but this improvement has not occurred in adults with disabilities (Milano, 2017). Considerable evidence indicates that individuals with disabilities suffer from more dental disease and missing teeth, and they face greater challenges in obtaining oral health care than the general population (Moore,
Data from the Centers for Disease Control and Prevention (CDC) indicated that the number of people with a disability was approximately 61 million, which represented about 26% of adults in the United States with about 2 in 5 adults 65 years of age and older having a disability (CDC, 2019). The types of functional and activity limitations described by the U.S. Census Bureau based on the 2014 U.S. Census data were grouped into three domains of disability: communicative, mental, and physical. The breakdown according to the Social Security Administration of disability is as follows: 38.6 million had a disability or disabilities in only one domain; while 33.7 million had disabilities in two or more domains; (Taylor, 2018). In addition to an increasing prevalence of disability with age, several demographic groups have comparatively higher rates. Women are slightly more likely than men to have a disability, although this may also be explained by the fact that in 2019 there was 30 million women and 24.1 million men aged 65 and older (Administration for Community Living, 2021). Racial and ethnic differences also emerge, with African Americans more likely to have disabilities than Asians, Hispanics, and whites. Socioeconomic factors also play a role in the prevalence of disability. Most individuals with disabilities are of low socioeconomic status, lack private insurance and rely on government programs such as Medicare and Medicaid to cover the costs of their medical and dental care (Moore, 2017). They are more likely to be unemployed or employed only part-time and have low levels of education. facilities or in typical community settings. Because of their reliance on others, it can be difficult for this group to readily access oral healthcare services which can compromise their oral health. (Tirth, 2017; Centers for Disease Control and Prevention, 2021). Children with special health care needs can face several obstacles in obtaining appropriate dental care and have higher rates of oral diseases and carious lesions compared to that of the general population (Obeidat, et al., 2022). Although there is expected to be only slight growth in the number of young children in the next decade, immigrants and ethnic minorities, which are at higher risk of poor oral health, will make up a larger share of this segment of the population. Young children with physical, mental, and emotional disabilities represent a second distinct group of children vulnerable to poor oral health. Overall, the population with special healthcare needs is expanding. This demographic group includes those with socioeconomic access barriers and people living longer with medical conditions. The population with special needs also includes those across the age spectrum with developmental conditions that prevent ready access to oral healthcare services. 2017; SCDA, 2017). Adults with intellectual and developmental disabilities (IDD) have a higher prevalence of untreated caries; edentulism; decayed teeth; missing teeth; and decayed, missing, filled teeth compared to the general population. The study found that the IDD population demonstrated a higher disease burden in each category (NCD, 2017; Milano, 2017).
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