ABSTRACT
Periodontitis is a chronic inflammatory disease resulting in the destruction of tooth-supporting tissues. It affects billions of people around the globe and substantiates an enormous economic burden to society. Digital tools such as mobile Health (mHealth) applications have the potential to increase patient engagement, knowledge about the disease, and adherence to treatment recommendations. Digital health companions represent a new kind of digital tool aiming to support patients throughout their course of periodontal care. This paper presents the study protocol of the Paro-ComPas project which aims to co-develop and evaluate a digital patient companion application ("app") to empower patients along their journey with periodontitis. As a first step, a qualitative study design encompassing semi-structured interviews with patients and experts as well as focus group discussions (FGD) will be used. Patients in different stages of periodontal care will be recruited from dental practices across Germany and are invited to share their experiences and opinions about their care and potential areas for support. Experts from relevant areas (e.g., mHealth, behavior change psychology, oral health, and dental hygiene) will be interviewed to map a holistic view on the current delivery of care and best practices of mHealth development. After setting up a minimal viable product (MVP) based on a requirements analysis, FGDs with patients will take place to incorporate user feedback and finalize the development of the prototypic app. The prototypic app will then be evaluated in a randomized, multi-center clinical trial in comparison with the current standard of care. Finally, a comprehensive implementation roadmap will be developed together with all relevant stakeholders. This comprehensive approach will allow us to map the patient journey and develop a digital health companion tailored to the needs of patients with periodontitis using an already existing indication independent medical companion toolbox. Novel insights into patients' knowledge and perception of periodontal disease as well as barriers in adherence to periodontal care pathways will be provided. This knowledge will be converted in a systematically tailored companion app to serve the needs and preferences of people to better address periodontitis. The results from the clinical trial will provide unique insights into the extent to which the patient companion app contributes to adherence to periodontal care. Although mHealth applications have become popular in recent years, only few apps focusing on promotion of oral health have been released so far. Our study presents a novel and comprehensive approach to both co-developing and evaluating a proof of concept for a digital health companion for patients with periodontitis.
ABSTRACT
Equipping health systems with suitable incentives for efficient resource allocation remains a major health policy challenge. This study examines the impacts of 2015 regulatory changes in Danish dental care which aimed at effectuating a transition from six-to-twelve-monthly dental recall intervals, for every patient, towards a model where patients with higher need receive dental recalls systematically more frequently than patients with lower need. Exploiting administrative data from the years 2012-2016 from the Danish National Health Insurance database containing 72,155,539 treatment claims for 3,759,721 unique patients, we estimated a series of interrupted time-series regression models with patient-level fixed-effects. In comparison to the pre-reform period, the proportion of patients with recall intervals of up to 6 months was by 1.2%-points larger post-implementation; that of patients with 6-12-monthly recalls increased by 0.7%-points; that of patients with more than 12-monthly dental recalls decreased by 1.9%-points. The composition of care shifted more substantially: the proportion of treatment sessions including preventive care increased by 31.5%-points (95%-CI: 31.4;31.6); that of sessions including scaling increased by 24.1%-points (24.0;24.2); that of sessions including diagnostics decreased by 34.5%-points (34.4;34.6). These findings suggest that dental care providers may have responded differently to regulatory changes than intended by the health policy.
Subject(s)
Medical Assistance , Motivation , Denmark , Health Policy , Humans , National Health ProgramsABSTRACT
OBJECTIVE: This second article of a series of four is aimed to inform dental practitioners about the relevance to provide more formal analysis of economic resources when helping patients make clinical decisions. METHODS: The following methods of health economic evaluation are described: Cost-effectiveness-analysis (CEA), cost-utility-analysis (CUA) and cost-benefit-analysis (CBA). CEA compares the effectiveness of different interventions usually based on specific clinical outcome measures, for example pocket depth reduction. CUA evaluates the effectiveness of therapies by taking into account more generic health outcome measures such as quality adjusted life years (QALYs). Cost-benefit-analysis (CBA) is based on measuring patients' actual willingness to pay. Cost-benefit-analysis (CBA) is based on measuring patients' actual willingness to pay, and it offers a method of economic evaluation that values all benefits against all costs. In other words, the total costs of a specific intervention are subtracted from the value of benefits related to that intervention. RESULTS: This article reported common methods of health economic evaluation that could be taken into account throughout clinical decision-making. Decision makers (patients, practitioners, health policy) should be adequately informed about costs and health outcomes associated with the various therapeutic alternatives in order to act responsibly within scenarios of resource scarcity. Economic evaluations can be informative with respect to whether or not the health outcomes outweigh the costs of an intervention, and hence provide a decision-making tool for decision makers considering treatment alternatives. CONCLUSIONS: The information provided here may help decision makers (patients, practitioners, health policy) to understand economic considerations as an essential component of the decision-making process. Carefulness is advised with regard to interpreting the results from economic evaluation studies.