Using Operational Research to Model Preventive-led Paediatric Care Pathways

Objectives: To explore the use of Operational Research (OR) techniques to model preventive-led paediatric care pathways as part of the NHS General Dental Services (GDS) Reform Programme in Wales, UK

Methods: A secondary analysis of routinely collected NHS GDS activity data was conducted to describe existing paediatric (0-17y) pathways. Published clinical guidelines were then synthesised to develop preventive-led care pathways (stratified for age and oral health risk and need status). These were brought together in a Microsoft Excel-based optimisation tool, which was tested using real-world data collected as part of the Welsh NHS GDS Reform Programme.

Results: The model was tested using a dataset of 5,076 paediatric patients, collected from 17 Welsh general dental practices. The preventive-led clinical pathways utilised a similar resource compared to existing care in terms of dental professionals’ time (+0.3% difference, 5001.9 hours vs. 5016.2 hours). However, there were 38.5% more preventive interventions (preventive advice and brushing demonstrations, fluoride varnish and fissure sealant applications) delivered under the preventive-led pathways compared to existing care. Under the new pathways, dental professionals spent proportionately more time providing care to patients considered to be at a greater risk of developing dental caries, and comparatively less time with lower-need patients than in current care models. However, preventive-led pathways generated 23.9% fewer Units of Dental Activity than existing pathways, predominantly due to increasing recall intervals for lower-risk patients.

Conclusions: The findings of this work suggest that preventive-led paediatric dental care could be delivered by altering the utilisation of existing NHS GDS resources in Wales. However, this is largely contingent on patients being recalled according to their oral health risk and need status. This work demonstrates the potential of OR techniques to model alternative clinical care pathways. Similar methods could be used to simulate task delegation as part of dental skill-mix use.