Taking a big bite of healthcare data The cost of caring for oral diseases in the EU is around 80 billion Euros a year, yet these conditions can be prevented through relatively simple measures. We spoke to Professor Kenneth Eaton about the work of the Added Value for Oral Care (ADVOCATE) project which is investigating how healthcare systems can be modernised in line with today’s demands. “With ever more sophisticated and expensive therapies, arising from medical-technical innovations and an ageing population, costs and complexity of care are expected to increase further in future, prompting researchers to look again at how healthcare is provided. The design of healthcare delivery systems has evolved over time and varies between countries. However, only a few countries have adopted a preventive approach to healthcare provision, and where they have it’s been only partial. Nevertheless, the pressure of economics is now such that we need to strengthen this, to prevent the occurrence of ever greater numbers of diseases and conditions,” outlines Professor Kenneth Eaton, leader of work package 6 within the Horizon 2020 programme ADVOCATE project, which is exploring how routinely collected data can be used in modernising oral health system planning in line with contemporary demands. This should in future mean a greater focus on prevention rather than treatment. “It’s generally accepted in healthcare today that you have to explain to patients – and the public in general – how to prevent disease conditions from occurring. Then it’s largely in their hands,” says Professor Eaton. This editorial will now explain the challenge preventing oral diseases and gives details of the ADVOCATE project.
Oral diseases There are essentially three groups of oral diseases, namely tooth decay, gum diseases and diseases of the cheeks, tongue, palate and lips including oral cancers, all of which can be prevented through relatively simple measures. “Tooth decay – or dental caries – is the most common disease in the world and is entirely preventable. If you restrict your sugar intake to mealtimes, use fluoride toothpaste, and don’t have sweet, sugary drinks between meals, then you can prevent it,” stresses Professor Eaton. Gum diseases are one of the most common groups of
10
disease and are also preventable with meticulous cleaning at the point where the tooth and the gum meet and between the teeth. Professor Eaton says diseases like oral cancer can in some cases be prevented by adopting a healthy lifestyle (not smoking and not drinking excess alcohol) which, alongside dietary changes are central elements of efforts to improve oral health. The rationale behind placing greater emphasis on prevention seems to be clear, enhancing quality of life and reducing the overall burden of care. Yet in many countries across Europe oral healthcare systems are structured rather differently. Many systems reward treatment with payment on a fee per item of treatment basis. Prevention is less easy to monitor and is often inadequately remunerated explains Professor Eaton. “If you look at Denmark, where there is a
The ADVOCATE project ADVOCATE is a collaboration between universities, public and private funders of healthcare, industry and patients from Denmark, Germany, Hungary, Ireland, the Netherlands and the United Kingdom, which seeks to develop an innovative evidenceinformed oral health care model which is patient-oriented, delivers safe and efficient care, is sustainable and resilient to crises. It has three main objectives which are to: • Design an innovative healthcare system which promotes chronic disease prevention. • Establish a set of harmonised indicators which acknowledge success in the prevention of disease and avoidance of unnecessary treatment. • Provide evidence-informed guidance to policy and decision makers for improved health systems planning.
We should establish more initiatives to improve disease prevention. There have been changes in this direction, with the UK and Irish governments recently introducing a tax on sugary soft drinks. very large public sector, about half of oral healthcare is provided within public sector clinics, and around half by private dentists. In the public clinics there is no incentive to carry out large amounts of treatment, because their staff are paid salaries. The result is that there’s more time for advice and preventive treatments to be given to patients.” Funding organisations, such as state and private insurance companies, have often been reluctant to pay for preventive work. While there will always be accidents and traumas, ideally only relatively minimal amounts of invasive dental treatment would be required. A large part of the ADVOCATE’s work centres around seeking ways to achieve this ambition, drawing on existing examples of good practice from across Europe.
The project is funded by the Horizon 2020 programme and is coordinated from University College Cork by Professor Helen Whelton. One part of the project’s work centres around analysing large volumes of data (big data) from oral healthcare insurers in European countries. “By looking at the generality of information across a region, you can spot trends and look at why some practitioners might be performing better than others,” explains Professor Eaton. This can then be used to inform the debate around the development of healthcare models, with researchers aiming to identify which approaches have proved effective. “Denmark and Scotland have done particularly well as a result of better prevention aimed at children and stand as positive examples of the benefits of
EU Research