Economic evaluation of the Midwifery Initiated Oral Health-Dental Service programme in Australia

Journal article

Tannous, Kathy W, George, Ajesh, Ahmed, Moin Uddin, Blinkhorn, Anthony, Dahlen, Hannah, Skinner, John, Ajwani, Shilpi, Bhole, Sameer, Yaacoub, Albert, Srinivas, Ravi and Johnson, Maree. (2021). Economic evaluation of the Midwifery Initiated Oral Health-Dental Service programme in Australia. BMJ Open. 11(8), p. Article e047072. https://doi.org/10.1136/bmjopen-2020-047072

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Authors	Tannous, Kathy W, George, Ajesh, Ahmed, Moin Uddin, Blinkhorn, Anthony, Dahlen, Hannah, Skinner, John, Ajwani, Shilpi, Bhole, Sameer, Yaacoub, Albert, Srinivas, Ravi and Johnson, Maree
Abstract	Objectives To critically evaluate the cost-effectiveness of the Midwifery Initiated Oral Health-Dental Service (MIOH-DS) designed to improve oral health of pregnant Australian women. Previous efficacy and process evaluations of MIOH-DS showed positive outcomes and improvements across various measures. Design and setting The evaluation used a cost-utility model based on the initial study design of the MIOH-DS trial in Sydney, Australia from the perspective of public healthcare provider for a duration of 3 months to 4 years. Participants Data were sourced from pregnant women (n=638), midwives (n=17) and dentists (n=3) involved in the MIOH trial and long-term follow-up. Cost measures Data included in analysis were the cost of the time required by midwives and dentists to deliver the intervention and the cost of dental treatment provided. Costs were measured using data on utilisation and unit price of intervention components and obtained from a micro-costing approach. Outcome measures Utility was measured as the number of Disability Adjusted Life Years (DALYs) from health-benefit components of the intervention. Three cost-effectiveness analyses were undertaken using different comparators, thresholds and time scenarios. Results Compared with current practice, midwives only intervention meets the Australian threshold (A$50 000) of being cost-effective. The midwives and accessible/affordable dentists joint intervention was only ‘cost-effective’ in 6 months or beyond scenarios. When the midwife only intervention is the comparator, the midwife/dentist programme was ‘cost-effective’ in all scenarios except at 3 months scenario. Conclusions The midwives’ only intervention providing oral health education, assessment and referral to existing dental services was cost-effective, and represents a low cost intervention. Midwives’ and dentists’ combined interventions were cost-effective when the benefits were considered over longer periods. The findings highlight short and long term economic benefits of the programme and support the need for policymakers to consider adding an oral health component into antenatal care Australia wide. Trial registration number ACTRN12612001271897; Post-results.
Year	2021
Journal	BMJ Open
Journal citation	11 (8), p. Article e047072
Publisher	BMJ Publishing Group
ISSN	2044-6055
Digital Object Identifier (DOI)	https://doi.org/10.1136/bmjopen-2020-047072
PubMed ID	34341045
Scopus EID	2-s2.0-85112047608
PubMed Central ID	PMC8330572
Open access	Published as ‘gold’ (paid) open access
Research or scholarly	Research
Page range	1-12
Funder	National Health and Medical Research Council (NHMRC)
Publisher's version	OA_Tannous_2021_Economic_evaluation_of_the_Midwifery_Initiated.pdf License CC BY-NC 4.0 File Access Level Open
Output status	Published
Online	02 Aug 2021
Publication process dates
Accepted	19 Jul 2021
Deposited	22 Dec 2021
Grant ID	NHMRC/1022007

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Specialist perinatal mental health services: Characteristics of women and services provided

Johnson, Karen Anne, Schmied, Virginia, Johnson, Maree and Cleary, Michelle. (2013). Specialist perinatal mental health services: Characteristics of women and services provided. The Marcé International Society International Biennial General Scientific Meeting. Germany: Springer-Verlag. pp. S36 - 146 https://doi.org/10.1007/s00737-013-0355-x

Outcome of routine psychosocial assessment: A pilot study of the relationship between risk factors, service utilisation and outcomes in women at 6 weeks and 12 months after birth

Schmied, Virginia, Johnson, Maree, Langdon, Rachel, Austin, Marie-Paule, Matthey, Stephen and Kemp, Lynn. (2013). Outcome of routine psychosocial assessment: A pilot study of the relationship between risk factors, service utilisation and outcomes in women at 6 weeks and 12 months after birth. Women and Birth. 26(Supplement 1), pp. 37 - 37. https://doi.org/10.1016/j.wombi.2013.08.209

Maternal Mental Health in Australia and New Zealand : A review of longitudinal studies

Schmied, Virginia, Johnson, Maree, Naidoo, Norell, Austin, Marie-Paule, Matthey, Stephen, Kemp, L, Mills, Annie, Meade, Tanya and Yeo, A. (2013). Maternal Mental Health in Australia and New Zealand : A review of longitudinal studies. Women and Birth. https://doi.org/10.1016/j.wombi.2013.02.006

Views of pregnant women in South Western Sydney towards dental care and an oral-health program initiated by midwives

George, Ajesh, Johnson, Maree, Blinkhorn, Anthony, Ajwani, Shilpi, Ellis, Sharon and Bhole, Sameer. (2013). Views of pregnant women in South Western Sydney towards dental care and an oral-health program initiated by midwives. Health Promotion Journal of Australia. https://doi.org/10.1071/HE13040

Measuring the qualities of nurses : Development and testing of the Qualities of Nurses Scale

Johnson, Maree and Cowin, Leanne. (2013). Measuring the qualities of nurses : Development and testing of the Qualities of Nurses Scale. Nursing Education Perspectives. 34(2), pp. 111 - 117. https://doi.org/10.5480/1536-5026-34.2.111

Oral health care during pregnancy

George, Ajesh, Johnson, Maree, Reath, Jennifer, Dahlen, Hannah, Bhole, Sameer, Ajwani, Shilpi and Korda, Andrew. (2013). Oral health care during pregnancy. Australian Nursing and Midwifery Journal. 21(3), pp. 42 - 42.

The role of anxiety and other factors in predicting post-natal fatigue : From birth to 6 months

Taylor, Jan and Johnson, Maree. (2013). The role of anxiety and other factors in predicting post-natal fatigue : From birth to 6 months. Midwifery. https://doi.org/10.1016/j.midw.2012.04.011

Assessment of the elderly : It's worth covering the risks

Langdon, R, Johnson, Maree, Carroll, Vince and Antonio, Geraldine. (2013). Assessment of the elderly : It's worth covering the risks. Journal of Nursing Management. https://doi.org/10.1111/j.1365-2834.2012.01421.x

How Do Dental and Prenatal Care Practitioners Perceive Dental Care During Pregnancy? : Current Evidence and Implications

George, Ajesh, Shamin, Simin, Johnson, Maree, Dahlen, Hannah, Ajwani, Shilpi, Bhole, Sameer and Yeo, Anthony. (2012). How Do Dental and Prenatal Care Practitioners Perceive Dental Care During Pregnancy? : Current Evidence and Implications. Birth : Issues in perinatal care. 39(3), pp. 238 - 247. https://doi.org/10.1111/j.1523-536X.2012.00553.x

Models of care in nursing : A systematic review

Fernandez, Ritin, Johnson, Maree, Tran, Duong and Miranda, Charmaine. (2012). Models of care in nursing : A systematic review. International Journal of Evidence-Based Healthcare. 10(4), pp. 324 - 337. https://doi.org/10.1111/j.1744-1609.2012.00287.x

Building research capacity in South West Sydney through a Primary Community Health Research Unit

Friesen, Emma, Comino, Elizabeth, Reath, Jennifer, Derrett, Alison, Johnson, Maree, Powell Davies, Gawaine, Teng-Liaw, Siaw and Kemp, L. (2012). Building research capacity in South West Sydney through a Primary Community Health Research Unit. Australian Journal of Primary Health: the issues influencing community health services and primary health care. 20(1), pp. 4 - 8. https://doi.org/10.1071/PY12081

A ward-based writing coach program to improve the quality of nursing documentation

Jefferies, Diana, Johnson, Maree, Nicholls, Daniel and Lad, Shushila. (2012). A ward-based writing coach program to improve the quality of nursing documentation. Nurse Education Today. 32(6), pp. 647 - 651. https://doi.org/10.1016/j.nedt.2011.08.017

Developing a minimum data set for electronic nursing handover

Johnson, Maree, Jefferies, Diana and Nicholls, Daniel. (2012). Developing a minimum data set for electronic nursing handover. Journal of Clinical Nursing. 21(2016-04-03), pp. 331 - 343. https://doi.org/10.1111/j.1365-2702.2011.03891.x

Midwives and oral health care during pregnancy : Perceptions of pregnant women in South-Western Sydney, Australia

George, Ajesh, Johnson, Maree, Duff, Margaret, Ajwani, Shilpi, Bhole, Sameer, Blinkhorn, Anthony and Ellis, Sharon. (2012). Midwives and oral health care during pregnancy : Perceptions of pregnant women in South-Western Sydney, Australia. Journal of Clinical Nursing. 21(2016-08-07), pp. 1087 - 1096. https://doi.org/10.1111/j.1365-2702.2011.03870.x

Country of birth recording in Australian hospital morbidity data : Accuracy and predictors

Tran, Duong, Jorm, Louisa, Lujic, Sanja, Bambrick, Hilary and Johnson, Maree. (2012). Country of birth recording in Australian hospital morbidity data : Accuracy and predictors. Australian and New Zealand Journal of Public Health. 36(4), pp. 310 - 316. https://doi.org/10.1111/j.1753-6405.2012.00893.x

Developing standard data for handover

Nicholls, Daniel, Johnson, Maree and Jefferies, Diana. (2012). Developing standard data for handover. Nursing Times. 108(12), pp. 20 - 20.

Falls e-learning program

Johnson, Maree, Kelly, Linda, Siric, Katica and Overs, Bronwyn. (2012). Falls e-learning program. Australian Nursing Journal. 19(7), pp. 37 - 37.

Comparing written and oral approaches to clinical reporting in nursing

Jefferies, Diana, Johnson, Maree and Nicholls, Daniel. (2012). Comparing written and oral approaches to clinical reporting in nursing. Contemporary Nurse: Health care across the lifespan. 42(1), pp. 158 - 167. https://doi.org/10.5172/conu.2012.42.1.129

Exploring the structure and organization of information within nursing clinical handovers

Johnson, Maree, Jefferies, Diana and Nicholls, Daniel. (2012). Exploring the structure and organization of information within nursing clinical handovers. International Journal of Nursing Practice. 18(5), pp. 462 - 470. https://doi.org/10.1111/j.1440-172X.2012.02059.x

The psychometric properties of five Professional Identity measures in a sample of nursing students

Cowin, Leanne, Johnson, Maree, Wilson, Ian and Borgese, Kaye. (2012). The psychometric properties of five Professional Identity measures in a sample of nursing students. Nurse Education Today. 33(6), pp. 608 - 613. https://doi.org/10.1016/j.nedt.2012.07.008

Evaluating an intensive ward-based writing coach programme to improve nursing documentation : Lessons learned

Jefferies, Diana, Johnson, Maree, Nicholls, Daniel, Langdon, Rachel and Lad, Shushila. (2012). Evaluating an intensive ward-based writing coach programme to improve nursing documentation : Lessons learned. International Nursing Review. 59(3), pp. 394 - 401. https://doi.org/10.1111/j.1466-7657.2012.00994.x

Measuring perinatal mental health

Johnson, Maree, Schmeid, V, Lupton, S, Austin, Marie-Paule, Matthey, Stephen, Kemp, L, Meade, Tanya and Yeo, A. (2012). Measuring perinatal mental health. Archives of Women's Mental Health. 15(5), pp. 375 - 386. https://doi.org/10.1007/s00737-012-0297-8

Barriers to clinical leadership development :Findings from a national survey

Fealy, Gerard, McNamara, Martin, Casey, Mary, Geraghty, Ruth, Butler, Michelle, Halligan, Phil, Treacy, Margaret and Johnson, Maree. (2011). Barriers to clinical leadership development :Findings from a national survey. Journal of Clinical Nursing. 20(13-14), pp. 2023 - 2032. https://doi.org/10.1111/j.1365-2702.2010.03599.x

Nurturing and Nourishing :The nurses' role in nutritional care

Jefferies, Diana, Johnson, Maree and Ravens, Jennifer. (2011). Nurturing and Nourishing :The nurses' role in nutritional care. Journal of Clinical Nursing. 20(3/4), pp. 317 - 330. https://doi.org/10.1111/j.1365-2702.2010.03502.x

Analysis of falls incidents :Nurse and patient preventative behaviours

Johnson, Maree, George, Ajesh and Tran, Duong. (2011). Analysis of falls incidents :Nurse and patient preventative behaviours. International Journal of Nursing Practice. 17(1), pp. 60 - 66. https://doi.org/10.1111/j.1440-172X.2010.01907.x

Nursing documentation :How meaning is obscured by fragmentary

Jefferies, Diana, Johnson, Maree and Nicholls, Daniel. (2011). Nursing documentation :How meaning is obscured by fragmentary. Nursing Outlook. 59(6), pp. e6 - e12. https://doi.org/10.1016/j.outlook.2011.04.002

Many paths lead to nursing :Factors influencing students' perceptions of nursing

Cowin, Leanne and Johnson, Maree. (2011). Many paths lead to nursing :Factors influencing students' perceptions of nursing. International Nursing Review. 58(4), pp. 413 - 419. https://doi.org/10.1111/j.1466-7657.2011.00905.x

Many paths lead to nursing: Factors influencing students' perceptions of nursing

Cowin, Leanne S. and Johnson, Maree. (2011). Many paths lead to nursing: Factors influencing students' perceptions of nursing. International Nursing Review. 58(4), pp. 413 - 419. https://doi.org/10.1111/j.1466-7657.2011.00905.x

Maintaining oral health during pregnancy :Perceptions of midwives in Southwest Sydney

George, Ajesh, Johnson, Maree, Duff, Margaret, Blinkhorn, Anthony, Ajwani, Shilpi, Bhole, Sameer and Ellis, Sharon. (2011). Maintaining oral health during pregnancy :Perceptions of midwives in Southwest Sydney. Collegian. 18(2), pp. 71 - 79. https://doi.org/10.1016/j.colegn.2010.10.003

Developing risk management behaviours for nurses through medication incident analysis

Johnson, Maree, Tran, Duong and Young, Helen. (2011). Developing risk management behaviours for nurses through medication incident analysis. International Journal of Nursing Practice. 17(6), pp. 548 - 555. https://doi.org/10.1111/j.1440-172X.2011.01977.x

Periodontal treatment during pregnancy and birth outcomes :A meta-analysis of randomised trials

George, Ajesh, Shamin, Simin, Johnson, Maree, Ajwani, Shilpi, Bhole, Sameer, Blinkhorn, Anthony, Ellis, Sharon and Andrews, Karen. (2011). Periodontal treatment during pregnancy and birth outcomes :A meta-analysis of randomised trials. International Journal of Evidence-Based Healthcare. 9(2), pp. 122 - 147. https://doi.org/10.1111/j.1744-1609.2011.00210.x

The Application of ARonson's Taxonony to Medication Errors in Nursing

Johnson, Maree and Young, Helen. (2011). The Application of ARonson's Taxonony to Medication Errors in Nursing. Journal of Nursing Care Quality. 26(2), pp. 128 - 135. https://doi.org/10.1097/NCQ.0b013e3181f54b14

Boundary matters: Clinical leadership and the distinctive disciplinary contribution of nursing to multidisciplinary care

McNamara, Martin, Fealy, Gerard, Casey, Mary, Geraghty, Ruth, Johnson, Maree, Halligan, Phil, Treacy, Pearl and Butler, Michelle. (2011). Boundary matters: Clinical leadership and the distinctive disciplinary contribution of nursing to multidisciplinary care. Journal of Clinical Nursing. 20(23-24), pp. 3502 - 3512. https://doi.org/10.1111/j.1365-2702.2011.03719.x

A new role for midwives in promoting dental health

George, Ajesh, Johnson, Maree, Ellis, Sharon, Dahlen, Hannah, Blinkhorn, Anthony, Bhole, Sameer and Ajwani, Shilpi. (2010). A new role for midwives in promoting dental health. Australian Nursing and Midwifery Journal. 18(1), pp. 37-37.

A shared care model vs. a patient allocation model of nursing care delivery : Comparing nursing staff satisfaction and stress outcomes

Tran, Duong, Johnson, Maree, Fernandez, Ritin and Jones, Sonya. (2010). A shared care model vs. a patient allocation model of nursing care delivery : Comparing nursing staff satisfaction and stress outcomes. International Journal of Nursing Practice. 16(2), pp. 148 - 158. https://doi.org/10.1111/j.1440-172X.2010.01823.x;10.1111/j.1440-172X.2010.01823.x

Interdisciplinary communication in general medical and surgical wards using two different models of nursing care delivery

Fernandez, Ritin, Tran, Duong, Johnson, Maree and Jones, Sonya. (2010). Interdisciplinary communication in general medical and surgical wards using two different models of nursing care delivery. Journal of Nursing Management. 18(3), pp. 265 - 274. https://doi.org/10.1111/j.1365-2834.2010.01058.x;10.1111/j.1365-2834.2010.01058.x

A meta-study of the essentials of quality nursing documentation

Jefferies, Diana, Johnson, Maree and Griffiths, Rhonda. (2010). A meta-study of the essentials of quality nursing documentation. International Journal of Nursing Practice. 16(2), pp. 112 - 124. https://doi.org/10.1111/j.1440-172X.2009.01815.x;10.1111/j.1440-172X.2009.01815.x

Promoting oral health during pregnancy : Current evidence and implications for Australian midwives

George, Ajesh, Johnson, Maree, Blinkhorn, Anthony, Ellis, Sharon, Bhole, Sameer and Ajwani, Shilpi. (2010). Promoting oral health during pregnancy : Current evidence and implications for Australian midwives. Journal of Clinical Nursing. 19(23-24), pp. 3324 - 3333. https://doi.org/10.1111/j.1365-2702.2010.03426.x;10.1111/j.1365-2702.2010.03426.x

Engaging clinicians in evidence based policy development: The case of nursing documentation

Jefferies, Diana, Johnson, Maree, Griffiths, R., Arthurs, Kathy, Beard, David, Chen, Tanghua, Edgetton-Winn, Maureen, Hecimovic, Tony, Hughes, Margaret, Linten, Karen, Maddox, Julie, McCaul, Damien, Robson, Kim, Scott, Shelley and Zarkos, Tina. (2010). Engaging clinicians in evidence based policy development: The case of nursing documentation. Contemporary Nurse. 35(2), pp. 254 - 264. https://doi.org/10.5172/conu.2010.35.2.254

How women manage fatigue after childbirth

Taylor, Jan and Johnson, Maree. (2010). How women manage fatigue after childbirth. Midwifery. 26(3), pp. 367 - 375. https://doi.org/10.1016/j.midw.2008.07.004

The Nursing and Midwifery Content Audit Tool (NMCAT) : A short nursing dcumentation audit tool

Johnson, Maree, Jefferies, Diana and Langdon, Rachel. (2010). The Nursing and Midwifery Content Audit Tool (NMCAT) : A short nursing dcumentation audit tool. Journal of Nursing Management. 18(7), pp. 832 - 845. https://doi.org/10.1111/j.1365-2834.2010.01156.x;10.1111/j.1365-2834.2010.01156.x

Classifying nursing errors in clinical management within an Australian hospital

Tran, Duong and Johnson, Maree. (2010). Classifying nursing errors in clinical management within an Australian hospital. International Nursing Review. 57(4), pp. 454 - 462. https://doi.org/10.1111/j.1466-7657.2010.00846.x;10.1111/j.1466-7657.2010.00846.x

Identifying research priorities for midwifery in Ireland

Butler, Michelle M., Meehan, Therese C., Kemple, Mary, Drennan, Jonathan, Treacy, Margaret and Johnson, Maree. (2009). Identifying research priorities for midwifery in Ireland. Midwifery. 25(5), pp. 576 - 587. https://doi.org/10.1016/j.midw.2007.08.004

Personality, Gender and Medico-Legal Matters in Medical Practice

Nash, Louise, Daly, Michele, Johnson, Maree, Coulston, Carissa, Tennant, Chris, van Ekert, Elizabeth, Walter, Garry, Willcock, Simon and Walton, Merrilyn. (2009). Personality, Gender and Medico-Legal Matters in Medical Practice. Australasian Psychiatry. 17(1), pp. 19 - 24. https://doi.org/10.1080/10398560802085359

Does the implementation of a clinical guideline change nursing practice in screening for alcohol and other substance use?

Johnson, Maree. (2009). Does the implementation of a clinical guideline change nursing practice in screening for alcohol and other substance use? Contemporary Nurse. 33, pp. 13 - 19.

GPs' concerns about medicolegal issues: How it affects their practice

Nash, Louise, Walton, Merrilyn, Daly, Michele, Johnson, Maree, Walter, Garry, van Ekert, Elizabeth, Willcock, Simon and Tennant, Chris. (2009). GPs' concerns about medicolegal issues: How it affects their practice. Australian Family Physician. 38(1/2), pp. 66 - 70.

Changes in general nurses knowledge of alcohol and substance use and misuse after education

Tran, Duong Thuy, Stone, Andrea M., Fernandez, Ritin S., Griffiths, Rhonda D. and Johnson, Maree. (2009). Changes in general nurses knowledge of alcohol and substance use and misuse after education. Perspectives in Psychiatric Care. 45(2), pp. 128 - 139. https://doi.org/10.1111/j.1744-6163.2009.00213.x

Perinatal oral health care: Implications for midwives

Johnson, Maree. (2009). Perinatal oral health care: Implications for midwives. Midwifery Matters. 27(4), pp. 22 - 23.

GP's concerns about medicolegal issues: How it affects their practice

Johnson, Maree. (2009). GP's concerns about medicolegal issues: How it affects their practice. Australian Family Physician. 38, pp. 66 - 70.

Does implementation of clinical practice guidelines change nurses' screening for alcohol and other substance abuse?

Tran, Duong Thuy, Stone, Andrea M., Fernandez, Ritin, Griffiths, Rhonda and Johnson, Maree. (2009). Does implementation of clinical practice guidelines change nurses' screening for alcohol and other substance abuse? Contemporary Nurse: Health care across the lifespan. 33(1), pp. 13 - 19. https://doi.org/10.5172/conu.33.1.13

Causal modeling of self-concept, job satisfaction, and retention of nurses

Cowin, Leanne S., Johnson, Maree, Craven, Rhonda Gai and Marsh, Herbert Warren. (2008). Causal modeling of self-concept, job satisfaction, and retention of nurses. International Journal of Nursing Studies. 45(10), pp. 1449 - 1459. https://doi.org/10.1016/j.ijnurstu.2007.10.009