This research explores final year dental students’ knowledge and attitudes towards the treatment and management of patients with Intellectual and Developmental Disabilities (I/DD) as related to variations in the dental practices in Special Health Care Needs (SHCN) training they received. A quantitative, non-experimental study was conducted, employing survey data collection methods, to address descriptive, comparative, and correlational questions. One cohort, Class 2020, attended extramural rotations in specialized clinics for patients with I/DD and in-person lecture concerning this topic. However, due to the COVID-19 pandemic and its health-related restrictions, another cohort, Class 2021, did not have the same opportunity as rotations were cancelled and the lecture was prerecorded and viewed online. Responses from a 35-item survey, distributed through an online platform, were obtained from both cohorts (n= 14 for Class 2020; n= 19 for Class 2021), addressing descriptive, comparative, and correlational research questions. Results revealed higher levels of knowledge and more positive perceptions of the program from Class 2020, the group that received clinical guidance, than Class of 2021. Analysis revealed positive relationships between students’ confidence levels and whether they had examined, assisted, or treated patients with I/DD. Associations were also found between students’ confidence and willingness to treat patients with I/DD. Although only correlational, this study’s findings suggest ways to foster students’ confidence and induce positive attitudes in dental school graduates that are likely to improve equitable access to healthcare for those with I/DD.

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Abstract The aim of the study was to describe and analyse access to care and factors relating to access to care theoretically and empirically. Access to care is a theoretical concept, analysed through waiting list lengths categorised by field of special health care. Public health services and related factors, access to care and the disparity between demand and supply are analysed within a theoretical framework. The study is divided into a theoretical and an empirical section. Access to care was studied through a mixed methods approach, based on a two-phase empiric material. The first phase is composed of focus group interviews (N=4). Interviewees were hospital district administrators and medical directors as well as chairpersons of the board and council or their representatives. The interviews were analysed by phenomenographic methods. The second phase is composed of waiting list data collected by THL (N=79) as well as population and prevalence data acquired from SOTKAnet (N=12) for 2008–2010. For 2009–2010, hospital district documents include financial statements (N=16), annual reports (N=23), annual statistics (N=6), personnel reports (N=21) and balance sheet books (N=6). The second phase were statistically analyzed. Results of the study on factors affecting access to care are divided into two themes: 1. challenges related to access to care from the hospital district’s perspective and 2. component factors of the realisation of access to care. Macro-level challenges related to access to care are legislation, politics, regulatory bodies, uniform grounds for non-urgent treatment, Current Care Guidelines recommendations and the connection between access to care, Current Care Guidelines recommendations, uniform grounds for non-urgent treatment, prioritisation and regulations. Meso-level challenges are operative decision-making and organisational operations models, resources, supply-based demand and the chain of treatment. Component factors of the realisation of access to care are the variance in waiting list lengths between different fields; the connection between waiting lists, the population and the hospital district; population size and its prevalence as well as resources and financial factors. / Tiivistelmä Tutkimuksen tarkoituksena oli kuvata ja analysoida hoitoon pääsyä ja siihen vaikuttavia tekijöitä teoreettisesti ja empiirisesti. Hoitoon pääsy on teoreettinen käsite, jota analysoidaan erikoisaloittaisten jonojen pituutena. Teoreettisessa viitekehyksessä tarkastellaan julkisen terveydenhuollon palveluja ja niihin vaikuttavia tekijöitä, hoitoon pääsyä sekä kysynnän ja tarjonnan epäsuhtaa. Tutkimus jakautuu teoreettiseen ja empiiriseen osaan. Hoitoon pääsyä tutkittiin mixed methods -menetelmällä kaksivaiheisen empiirisen aineiston pohjalta. Ensimmäinen vaihe koostui fokusryhmähaastatteluista (N=4). Haastateltavina olivat SHP:n johtajat ja johtajaylilääkärit sekä SHP:n ky:n valtuuston ja hallituksen puheenjohtajat tai heidän edustajansa. Haastattelut analysoitiin fenomenografisen menetelmän mukaisesti. Toinen vaihe koostui THL:n erikoisaloittaisista jonotiedoista (N=79) ja SOTKAnetistä saaduista väestö- ja sairastavuustiedoista (N=12) vuosilta 2008–2010. Aineistona vuosilta 2009–2010 käytettiin myös SHP:n dokumentteja, joita olivat tilinpäätökset (N=16), vuosi-/toimintakertomukset (N=23), vuositilastot (N=6), henkilöstökertomukset (N=21) ja tasekirjat (N=6). Toinen vaihe analysoitiin tilastollisesti. Tutkimustulokset hoitoon pääsyyn vaikuttavista tekijöistä jakaantuivat kahteen teemaan: 1. hoitoon pääsyn haasteisiin SHP:n näkökulmasta sekä 2. hoitoon pääsyn toteutumisen osatekijöihin. Hoitoon pääsyn haasteita makrotasolla olivat lainsäädäntö, politiikka, STM, THL ja EOA merkityksellisinä tahoina, yhtenäiset kiireettömän hoidon perusteet, Käypä hoito -suositukset sekä hoitoon pääsyn, Käypä hoito -suositusten, yhtenäisten kiireettömän hoidon perusteiden sekä priorisoinnin ja sääntelyn yhteys. Mesotason haasteita olivat operatiivinen päätöksenteko ja organisatoriset toimintamallit, resurssit, tarjontalähtöinen kysyntä ja hoitoketju. Hoitoon pääsyn toteutumisen osatekijöitä ovat erikoisaloittaisten jonojen pituuden vaihtelu, jonojen yhteys väestöön ja SHP:iin, väestön määrä ja sen sairastavuus sekä resurssit ja taloudelliset tekijät.

There is a growing population worldwide who are not able to receive dental care. The numbers and trend are increasing and the availability of providers and resources are dwindling in comparison. The dissertation starts off with an example of how the current dental healthcare system has allowed some tragic outcomes. This paper will discuss the barriers of obtaining dental care for this growing population, challenges in dental education and offer some future solutions. Using the example of a dental tragedy, we hope to be inspired as a call to action to avert further fatalities and improve the dental healthcare system. The paper reviews the issue from: 1. A Long term perspective with the current and projected statistics for special needs population nationwide and California. 2. An Expanding population perspective that focuses on patients with autism spectrum disorder. 3. A Complex needs perspective of an example of the increasing necessity of hospital dentistry care.

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