Periodic Reporting for period 3 - ADVOCATE (Added Value for Oral Care)
Berichtszeitraum: 2018-05-01 bis 2019-04-30
The current restoration and conservation paradigm in oral health care originated in an era when the caries level in the population was of epidemic proportion. However, while still the most common chronic disease, in developed countries the incidence of caries has been greatly reduced and rather than being epidemic it is now endemic and preventable. In contrast, health payment systems such as provider payment do not mirror the prevention paradigm, for example, with fee-for-service remaining the predominant reimbursement mechanism. Such characteristics encourage under-utilisation of oral care in high risk groups and over-utilisation in low risk groups. The multidisciplinary ADVOCATE consortium came together with the shared vision of achieving a step change in oral health care systems design and performance. Its intention was to shift the focus away from the predominant surgery and treatment model towards one which is patient centred, prevention-orientated and sustainable, and delivers safe and effective care.
ADVOCATE recognised the value of data and proposed a data driven learning oral health care system which relied on patient centred extrinsic and intrinsic motivational approaches to develop a prevention-orientated oral health care system.
The power to shape practitioner behaviour through extrinsic motivation delivered through the remuneration system has been demonstrated.
The potential to change dentists’ behaviour via intrinsic motivational and peer learning approaches was confirmed through patient feedback and subsequent reflection and discussion of comparative performance in an academic detailing system.
Through an extensive series of focus groups, interviews and questionnaires, ADVOCATE identified the barriers and facilitators to prevention from the perspective of the patient, the practitioner and the policy maker. This new knowledge is available to inform oral health care system design that addresses the objectives of a patient centred prevention-orientated oral health care system.
The multifaceted system described as Health Care Model 2020 is a learning health care system informed by evidence from the outcome of system redesign and patient feedback and driven by quality improvement groups.
ADVOCATE also demonstrated the usefulness of an operational paradigm in the relatively straightforward context of oral disease, which has the potential to translate into more complex areas of health care.
The identification of best practice in system design will be offered to policy makers and insurers as evidence based recommendations for system planning and development to promote prevention
The design and application of the patient focused App and the dashboard for dentists and insurers which are designed to motivate prevention of dental disease will be offered as a new tried and tested approach.
The overall aim of ADVOCATE is to reorientate dental services from a primarily restorative focus to primarily disease prevention. A successful outcome will lead to a gradual decrease in the need for invasive treatments and result in less pain and distress for patients of all ages, and possibly less expense in the long term.
Crucially, ADVOCATE has the potential to demonstrate the usefulness of this approach not only for oral healthcare but for general health, with healthcare providers adapting the model for their own areas of practice.