Unlocking the potential of NHS primary care dental datasets

Moore, Deborah; Allen, Thomas; Boyers, Dwayne; Mckenzie, Kate; Thompson, Wendy; Nyakutsikwa, Blessing; Pretty, Iain A.; Tickle, Martin

doi:10.1038/s41415-022-3987-2

Cited by 5 publications

(7 citation statements)

References 39 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…One aspect we explored was the feasibility of using routinely held NHSBSA data for a primary outcome, and the reliability of linking personal identifiers collected in the urgent dental care setting. Relatively few trials have made use of these data in England [ 22 ], and although we experienced a relatively high matching rate, we identified that by adding postcode as an additional identifier, this could be further improved.…”

Section: Discussionmentioning

confidence: 99%

Behavioural intervention to promote the uptake of planned care in urgent dental care attenders: a feasibility randomised controlled trial

Harris,

Lowers,

Best

et al. 2024

BMC Oral Health

View full text Add to dashboard Cite

Background Urgent dental care may be the only place where many people, especially vulnerable groups, access care. This presents an opportunity for delivery of a behavioural intervention promoting planned dental visiting, which may help address one of the factors contributing to a socio-economic gradient in oral health. Although we know that cueing events such as having a cancer diagnosis may create a ‘teachable moment’ stimulating positive changes in health behaviour, we do not know whether delivering an opportunistic intervention in urgent dental care is feasible and acceptable to patients. Methods The feasibility study aimed to recruit 60 patients in a Dental Hospital and dental practices delivering urgent care within and outside working hours. Follow-up was by telephone, e mail and post over 4 months. Results Although the recruitment window was shortened because of COVID-19, of 47 patients assessed for eligibility, 28 were enrolled (70.1% of screened patients provided consent). A relatively high proportion were from disadvantaged backgrounds (46.4%, 13/28 receiving State benefits). Retention was 82.1% (23/28), which was also the rate of completion of the Oral Health Impact Profile co-primary outcome. The other primary outcome involved linking participant details at recruitment, with centrally-held data on services provided, with 84.6% (22/26) records partly or fully successfully matched. All intervention participants received at least some of the intervention, although we identified aspects of dental nurse training which would improve intervention fidelity. Conclusions Despite recruitment being impacted by the pandemic, when the majority of clinical trials experienced reduced rates of recruitment, we found a high recruitment and consenting rate, even though patients were approached opportunistically to be enrolled in the trial and potentially receive an intervention. Retention rates were also high even though a relatively high proportion had a low socio-economic background. Therefore, even though patients may be in pain, and had not anticipated involvement before their urgent care visit, the study indicated that this was a feasible and acceptable setting in which to position an opportunistic intervention. This has the potential to harness the potential of the ‘teachable moment’ in people’s lives, and provide support to help address health inequalities. Trial registration ISRCTN 10,853,330 07/10/2019.

show abstract

Section: Discussionmentioning

confidence: 99%

Behavioural intervention to promote the uptake of planned care in urgent dental care attenders: a feasibility randomised controlled trial

Harris,

Lowers,

Best

et al. 2024

BMC Oral Health

View full text Add to dashboard Cite

show abstract

“…One aspect we explored was the feasibility of using routinely held NHSBSA data for a primary outcome, and the reliability of linking personal identi ers collected in the urgent dental care setting. Relatively few trials have made use of these data in England, 21 and although we experienced a relatively high matching rate, we identi ed that by adding postcode as an additional identi er, this could be further improved.…”

Section: Discussionmentioning

confidence: 99%

Behavioural intervention to promote the uptake of planned care in urgent dental care attenders: a feasibility randomised controlled trial

Harris

Lowers

Best

et al. 2023

Preprint

View full text Add to dashboard Cite

Background Urgent dental care may be the only place where many people, especially vulnerable groups, access care. This presents an opportunity for delivery of a behavioural intervention promoting planned dental visiting, which may help address one of the factors contributing to a socio-economic gradient in oral health. Although we know that cueing events such as having a cancer diagnosis may create a ‘teachable moment’ stimulating positive changes in health behaviour, we do not know whether delivering an opportunistic intervention in urgent dental care is feasible and acceptable to patients. Methods The feasibility study aimed to recruit 60 patients in a Dental Hospital and dental practices delivering urgent care within and outside working hours. Follow-up was by telephone, e mail and post over 4 months. Results Although the recruitment window was shortened because of COVID-19, of 47 patients assessed for eligibility, 28 were enrolled (70.1% of screened patients provided consent). A relatively high proportion were from disadvantaged backgrounds (46.4%, 13/28 receiving State benefits). Retention was 82.1% (23/28), which was also the rate of completion of the Oral Health Impact Profile co-primary outcome. The other primary outcome involved linking participant details at recruitment, with centrally-held data on services provided, with 84.6% (22/26) records partly or fully successfully matched. All intervention participants received at least some of the intervention, although we identified aspects of dental nurse training which would improve intervention fidelity. Conclusions Despite recruitment being impacted by the pandemic, when the majority of clinical trials experienced reduced rates of recruitment, we found a high recruitment and consenting rate, even though patients were approached opportunistically to be enrolled in the trial and potentially receive an intervention. Retention rates were also high even though a relatively high proportion had a low socio-economic background. Therefore, even though patients may be in pain, and have not anticipated involvement before their urgent care visit, the study indicated that this was a feasible and acceptable setting in which to position an opportunistic intervention. This has the potential to harness the potential of the ‘teachable moment’ in people’s lives, and provide support to help address health inequalities. Trial registration: ISRCTN 10853330 07/10/2019

show abstract

“…Routinely collected NHS dental claims data offered an innovative solution but have been a relatively underused resource for research, particularly in comparison to other NHS activity data sets, for example, Hospital Episode Statistics (HES), or the general medical practice-based Clinical Practice Research Datalink database. 165 In working with NHS BSA we have increased our knowledge and understanding of the potential for these data sets to be used for research. These reflections inform our recommendations for the further development of these data sets, and the utility of NHS dental data sets across the four UK home countries has been explored in more detail in a separate paper.…”

Section: Strengthsmentioning

confidence: 99%

“…These reflections inform our recommendations for the further development of these data sets, and the utility of NHS dental data sets across the four UK home countries has been explored in more detail in a separate paper. 165 The benefits of using these routinely collected data are that very large samples are available and the data provide an ability to follow patients over long time periods. Once the necessary permissions are secured, the data are available at minimal costs and within a relatively short time frame.…”

Section: Strengthsmentioning

confidence: 99%

“…Important demographic variables are routinely collected, including age, sex, ethnicity and postcode. 165 Postcode is crucial as it enables the LSOA in which each patient lives and its level of deprivation to be assigned via the IMD index. This feature, and the large sample size, allowed us to address the MRC recommendation to investigate how the effect of water fluoridation deprivation varied with social class (patient deprivation decile and NHS exemption status used as proxy measures for social class).…”

Section: Strengthsmentioning

confidence: 99%

See 1 more Smart Citation

Effect of fluoridated water on invasive NHS dental treatments for adults: the LOTUS retrospective cohort study and economic evaluation

Moore,

Nyakutsikwa,

Allen

et al. 2024

Public Health Research

Self Cite

View full text Add to dashboard Cite

Background Most water fluoridation studies were conducted on children before the widespread introduction of fluoride toothpastes. There is a lack of evidence that can be applied to contemporary populations, particularly adolescents and adults. Objective To pragmatically assess the clinical and cost effectiveness of water fluoridation for preventing dental treatment and improving oral health in a contemporary population of adults, using a natural experiment design. Design Retrospective cohort study using routinely collected National Health Service dental claims (FP17) data. Setting National Health Service primary dental care: general dental practices, prisons, community dental services, domiciliary settings, urgent/out-of-hours and specialised referral-only services. Participants Dental patients aged 12 years and over living in England (n = 6,370,280). Intervention and comparison Individuals exposed to drinking water with a fluoride concentration ≥ 0.7 mg F/l between 2010 and 2020 were matched to non-exposed individuals on key characteristics using propensity scores. Outcome measures Primary: number of National Health Service invasive dental treatments (restorations/‘fillings’ and extractions) received per person between 2010 and 2020. Secondary: decayed, missing and filled teeth, missing teeth, inequalities, cost effectiveness and return on investment. Data sources National Health Service Business Services Authority dental claims data. Water quality monitoring data. Primary outcome Predicted mean number of invasive dental treatments was 3% lower in the optimally fluoridated group than in the sub/non-optimally fluoridated group (incidence rate ratio 0.969, 95% CI 0.967 to 0.971), a difference of −0.173 invasive dental treatments (95% CI −0.185 to −0.161). This magnitude of effect is smaller than what most stakeholders we engaged with (n = 50/54) considered meaningful. Secondary outcomes Mean decayed, missing and filled teeth were 2% lower in the optimally fluoridated group, with a difference of −0.212 decayed, missing and filled teeth (95% CI −0.229 to −0.194). There was no statistically significant difference in the mean number of missing teeth per person (0.006, 95% CI −0.008 to 0.021). There was no compelling evidence that water fluoridation reduced social inequalities in treatments received or missing teeth; however, decayed, missing and filled teeth data did not demonstrate a typical inequalities gradient. Optimal water fluoridation in England in 2010–20 was estimated to cost £10.30 per person (excluding original setup costs). Mean National Health Service treatment costs for fluoridated patients 2010–20 were 5.5% lower per person, by £22.26 (95% CI −£23.09 to −£21.43), and patients paid £7.64 less in National Health Service dental charges per person (2020 prices). Limitations Pragmatic, observational study with potential for non-differential errors of misclassification in fluoridation assignment and outcome measurement and residual and/or unmeasured confounding. Decayed, missing and filled teeth data have not been validated. Water fluoridation cost estimates are based on existing programmes between 2010 and 2020, and therefore do not include the potentially significant capital investment required for new programmes. Conclusions Receipt of optimal water fluoridation between 2010 and 2020 resulted in very small health effects, which may not be meaningful for individuals, and we could find no evidence of a reduction in social inequalities. Existing water fluoridation programmes in England produced a positive return on investment between 2010 and 2020 due to slightly lower National Health Service treatment costs. These relatively small savings should be evaluated against the projected costs and lifespan of any proposed capital investment in water fluoridation, including new programmes. Future work National Health Service dental data are a valuable resource for research. Further validation and measures to improve quality and completeness are warranted. Trial registrations This trial is registered as ISRCTN96479279, CAG: 20/CAG/0072, IRAS: 20/NE/0144. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme (NIHR award ref: NIHR128533) and is published in full in Public Health Research; Vol. 12, No. 5. See the NIHR Funding and Awards website for further award information.

show abstract

Unlocking the potential of NHS primary care dental datasets

Cited by 5 publications

References 39 publications

Behavioural intervention to promote the uptake of planned care in urgent dental care attenders: a feasibility randomised controlled trial

Behavioural intervention to promote the uptake of planned care in urgent dental care attenders: a feasibility randomised controlled trial

Behavioural intervention to promote the uptake of planned care in urgent dental care attenders: a feasibility randomised controlled trial

Effect of fluoridated water on invasive NHS dental treatments for adults: the LOTUS retrospective cohort study and economic evaluation

Contact Info

Product

Resources

About