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Applying New Ideas and Program Design to Ontario Government Sponsored Dental programs —— —— Dr. Ian McConnachie Ontario Dental Association. Ontario Statistics 55% with employer sponsored plans 4% with private dental plans 5% on government plans Balance self-paying

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slide1

Applying New Ideas and Program Design to Ontario Government Sponsored Dental programs

—— ——

Dr. Ian McConnachie

Ontario Dental Association

slide2

Ontario Statistics

    • 55% with employer sponsored plans
    • 4% with private dental plans
    • 5% on government plans
    • Balance self-paying
    • 14.4% defined as “low income” (Statistics Canada)
    • 70% of Ontarians visit a dentist annually
      • Highest percentage in Canada
slide3
Ontario government perspective on government plan coverage

Gap coverage

High needs, not high risk

Low socioeconomic levels

Disabled and their families

slide4
36 Public Health Departments in the province
    • All provide dental services required by mandatory provincial programs
    • Some have dental clinics
    • Services vary with local mandates and funding
  • Over 4000 private dental practices
slide5
Ontario Public Health Programs for At-Risk Children
    • Healthy Babies, Healthy Children
    • Best Start
    • Early Years Centers
    • 18-month Well Baby Visit
    • Nipissing District Developmental Screen
    • Healthy Schools Initiative

Oral Health Care is not currently a part of these programs

slide6
Mandatory government dental programs for public health
    • Dental Indices Survey (DIS)
    • Oral health screening
    • Monitor fluoridation of water supply
    • Provide Children In Need of Treatment Program (CINOT)
    • Provide dental education to high risk schools,…
slide7
Dental Indices Survey (DIS)
    • Limited value
    • Non-calibrated
    • Less than ideal examination
    • No radiographs
    • Inconsistent data collection methods

Beynon et al 2004

slide8
Provincial government children’s dental plans
    • Children in Need of Treatment (CINOT)
    • Ontario Works (OW)
    • Ontario Disability Support Program (ODSP)
    • Assistance for Children with Severe Disabilities (ACSD)
slide10
Decreasing Welfare Rolls does not decrease your risk

Persons covered on social assistance 1995

1,344,600

Persons covered 2003

673,900

Children under 19 living in poverty

594,428Quinonez et al 2005

Persons on social assistance accessing care

Between 20% and 40%

slide11
Patient profile

Self-identified and other barriers to dental care

      • Lack of info re program funding
      • Language
      • Inflexible work situation
      • Mistrust of bureaucracy Harrison et al 2003
      • Foreign born
      • Lower education level of caregiver
      • Lower income level Kenney et al 2000
slide13
Delivery Models - Problems
    • Unique high-needs populations
      • Dental care is only one of their needs
        • Low socioeconomic levels
        • Homeless
        • Recent immigrants with cultural differences
        • Out of work with lost benefits
        • First Nations
        • Working poor
        • Language barriers
slide14
Delivery Models – Problems
    • Lack of a “dental home”
slide15
Delivery Models – Problems
    • Lack of a “dental home”
    • Dental care a low priority until pain/infection
slide16
Delivery Models – Problems
    • Lack of a “dental home”
    • Dental care a low priority until pain/infection
    • Many of population lack awareness of oral health priorities
slide17

Successful Delivery Models

  • - School-based prevention
      • School-based dental care (Albert et al 2005)
        • Screening
        • Preventive
        • Office-centered
        • Collaborative
        • Preventive/primary restorative
        • Comprehensive community dentistry
slide18
Successful Delivery Models
    • School-based prevention
      • PEI
      • ChildSmile Pitts
      • Forsythkids Niederman 2005
      • Scandinavia Axelsson 2006
      • Quebec – CLSC’s Verronneau 2008
slide19
PEI School Program

deft/DMFT = 0 grown 6-12 % 1998-2007

deft/DMFT scores lower 0.30-0.55

Exception 9 year olds – no change

80% participation

Dental community generally positive

slide20
Successful Delivery Models
    • Pre-school prevention is important
        • U.S. Surgeon General 2000
        • Vargas et al 1998
        • Beltran-Aguilar et al 2005
      • AAPD and Head Start Schneider et al 2007
        • Underlying philosophy of prevention, early intervention and parental involvement
      • Role of medical community
        • “Into the Mouths of Babes”Savage et al 2004
        • Wawrzyniak et al 2006
      • First exam by first birthday
slide21
Successful Delivery Models
    • Integrate with community resources

Hartsock et al 2006 Burry unpublished

    • Sensitivity to unique community needs
      • Lay ethnic counselor Harrison, Wong 2003
      • Community dental facilitator Harrison et al 2003
      • Motivational interviewing Harrison
slide23
Ontario Government
    • Recognition the programs are not meeting needs
    • Co-ordination of oral health with public health initiatives
    • Increased resources
    • Willingness to collaborate
slide24
Ontario Government
    • Promotion of water fluoridation
        • CDC 2001, Health Canada 2007
    • Development of educational resources for providers and public
    • Funding of further epidemiological research
    • Process of accurate reporting of outcomes with sharing of data
slide25
Dental Public Health

Evaluate the needs of the community

Data collection – ICDAS

Design local programs with the dental community

Measures to assess performance

E.g. RE-AIM Glasgow et al 1999

Case management model

ADA, Ottawa

Increased resources

slide26
Dental Public Health
    • Development of community-specific programs
    • Collaboration
      • Individual communities
      • School boards
      • CHC’s
      • Medical and dental community
slide27
Organized Dentistry
    • Collaborate in program design, setting up outcomes and measurement
    • Education of dental team re early intervention
    • Work with members to increase participation
slide28
Program Specifics
    • Adequate funding
    • Involvement of the dental community in plan design and delivery
    • Strong preventive emphasis including antimicrobials with appropriate periodicity
    • Strong data-collection standardized and calibrated
    • Ongoing review and revision incorporating new techniques
    • Education and involvement of parents/caregivers
slide29
Program Specifics
    • Pre-school
      • Select communities
      • Data collection (ICDAS) and review
    • Referral system to dental community
    • Preventive module within medical offices paid for by health system
    • Fluoride varnish twice yearly for high risk children
slide30
Program Specifics
    • School-age
      • Preventive model within schools in urban areas where numbers warrant
      • High risk schools
      • Office-centered preventive model in less-built up areas
slide31
My Field of Dreams
    • “if you build it, they will come”