IADR Abstract Archives
Optimising Value-Based Preventive Dental Care.
Objectives: In many dental care systems current clinical pathways reflect a “drill and fill” ethos, rather than a preventive approach. This study utilised operational research techniques to model skill-mix use in a preventive-led dental care system and compared this to current care delivery.
Methods: Current clinical pathways were described though analysis of routinely-collected consultation data. Twenty-one preventive pathways were developed following an evidence-based clinical guideline synthesis and clinician and patient consensus events. Three models of skill-mix use were developed using UK General Dental Council (GDC) guidelines. Timings of 55 common clinical procedures were obtained via a cross-sectional study of Welsh dental professionals.
A demand and optimisation model with a web-based user interface was developed. The population used to demonstrate the model was based on 236,490 individuals (65,513 children, 179,977 adults) who visited NHS General Dental Service (GDS) practices in Wales between July 2018 and September 2019. The outputs of preventive pathway scenarios follow an intention-to-treat approach and assume 90% attendance rates.
Results: Under preventive-led scenarios, the number of treatment items delivered increased 47.7% compared to current practice, principally driven by a 372% increase in preventive interventions, primarily for the highest-need patients. Using existing patterns of skill-mix use, preventive-led scenarios incurred 24.5% more staff hours than current care and 27.1% greater staff costs. However, whilst incorporating maximal skill-mix into preventive-led scenarios incurred 11.0% more staff hours than existing skill-mix patterns, total staff costs were 23.9% lower. Under this final scenario, dental therapists and hygienists delivered a fifth of all care.
Conclusions: This work suggest that it may be possible to deliver a preventive-led model of care within existing resources but only if skill-mix use is optimised. This challenges previous policy which has suggested that reducing the frequency of attendance of low-risk patients may alone free-up sufficient resource to reorientate care.
Methods: Current clinical pathways were described though analysis of routinely-collected consultation data. Twenty-one preventive pathways were developed following an evidence-based clinical guideline synthesis and clinician and patient consensus events. Three models of skill-mix use were developed using UK General Dental Council (GDC) guidelines. Timings of 55 common clinical procedures were obtained via a cross-sectional study of Welsh dental professionals.
A demand and optimisation model with a web-based user interface was developed. The population used to demonstrate the model was based on 236,490 individuals (65,513 children, 179,977 adults) who visited NHS General Dental Service (GDS) practices in Wales between July 2018 and September 2019. The outputs of preventive pathway scenarios follow an intention-to-treat approach and assume 90% attendance rates.
Results: Under preventive-led scenarios, the number of treatment items delivered increased 47.7% compared to current practice, principally driven by a 372% increase in preventive interventions, primarily for the highest-need patients. Using existing patterns of skill-mix use, preventive-led scenarios incurred 24.5% more staff hours than current care and 27.1% greater staff costs. However, whilst incorporating maximal skill-mix into preventive-led scenarios incurred 11.0% more staff hours than existing skill-mix patterns, total staff costs were 23.9% lower. Under this final scenario, dental therapists and hygienists delivered a fifth of all care.
Conclusions: This work suggest that it may be possible to deliver a preventive-led model of care within existing resources but only if skill-mix use is optimised. This challenges previous policy which has suggested that reducing the frequency of attendance of low-risk patients may alone free-up sufficient resource to reorientate care.