Presentation: ADVOCATE presenting two papers at iHEA World Congress 2019

The ADVOCATE Team will present two papers at the International Health Associaton World Congress 2019, 13 – 17th July 2019. The first paper explores the development of a planning model for the Oral Health Workforce, while the second paper examines the correlation between the exposure to X-Rays and the dentist’s remuneration.

Needs-based planning for the oral health workforce – development of a planning model

Successful health workforce planning is critical to the sustainability of a healthcare system as it encompasses the delivery of the right care, in the right place, at the right time, by the right number of people, to those most in need. While many health system policymakers recognise the need to better plan human resources, most countries across the globe have struggled to successfully develop and implement health workforce planning models which are fit for purpose. Using a conceptual framework for health needs-based workforce planning ADVOCATE systematically structured a simulation model to illustrate the feasibility of establishing a useful, workable, oral health needs-based workforce planning simulation tool.

Switching the Dentist: Does Patients’ Exposure to X-Rays Depend on Dentist Remuneration?

Medical radiography is associated with a radiation risk for patients. Xrays are recommended to be used only if the patient’s benefits exceed the risks, that is only upon the strict clinical indication. Current dental clinical guidelines in Scotland indicate that dental X-rays should not be part of routine screening. This includes patients visiting a new dentist, especially when a previous dentist has already undertaken intraoral X-rays. The purpose of this study was to assess the impact of dental remuneration on the probability of a patient receiving a dental radiograph when switching to a new dentist.

See the IHEA website for more information on the conference:

Session title: Extracting Better Value Instead of Teeth: The Economics of Preventing and Managing Dental Diseases

  • Presentation a) Needs-based planning for the oral health workforce – development of a planning model.
  • Presentation b) Switching the Dentist: Does Patients’ Exposure to X-Rays Depend on Dentist Remuneration?

2 ADVOCATE papers accepted for publication in Acta Odontologica Scandinavia

The first paper focusses on the design of the ADVOCATE field studies and the concept of improving oral health care using academic detailing. The second paper explores the barriers and facilitators for prevention in Danish Dental Care. Both papers have been accepted for publication on 8th February 2019.

In the December 2018 edition of the ADVOCATE newsletter, we feature an overview of the ADVOCATE field studies and a brief introduction of Denmark’s process of developing a new dental heatlhcaresystem:

Baadoudi F., Duijster D., Maskrey N., Ali F., Listl S., Whelton H., van der Heijden G.J.(2019). Improving oral health care using academic detailing: Design of the ADVOCATE Field Studies. Acta Odontologica Scandinavia.  Accepted for Publication on 8 February 2019.

Rosing K., Leggett H., Vinall Collier K., Csikar J., Douglas G.V., Boge-Christiansen L., Whelton H. (2019) Barriers and facilitators for prevention in Danish Dental Care.  Acta Odontologica Scandinavia.    Accepted for Publication on 8 February 2019.

Speakers of the 22nd Congress of the Hungarian Association for Cranio-Maxillo-Facial Surgery and Scientific Meeting of Dentists, 29 September 2018. Szeged, Hungary.

Presentation: Hungary, as participant of the ADVOCATE

Hungary is leading in orofacial cancer-related death-rate in Europe, while other oral health parameters as dental caries, tooth loss and advanced gum disease are also in the mid-low level, despite the huge preventive oral health strategies, introduced at the end of the 20-the century. Therefore, ADVOCATE partners from the Semmelweis University, (Budapest) expect promising teamwork in improving oral healthcare statistics in Hungary as well as in the other Eastern European countries.

Picture: Speakers of the 22nd Congress of the Hungarian Association for Cranio-Maxillo-Facial Surgery and Scientific Meeting of Dentists, 29 September 2018. Szeged, Hungary.

By Krisztina Márton, Péter Kivovics, Melinda Madléna

ADVOCATE strives to optimise delivery of oral health and wellbeing to the population in EU Member States. This requires a change in oral health care delivery towards prevention. The change will be achieved by developing a model that promotes a preventive rather than restorative oral health care system: The oral health care model 2020.

It has three main objectives: 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.

The project is funded by the EU 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 from oral healthcare insurers in European countries. The project is using big data to see if dental professionals can help push for change towards a more preventive approach. This includes change on an individual level so that members of the public are aware of what measures they can take to prevent oral disease. However, it is oral care professionals who give the public preventive advice and so the project aims to increase the focus on prevention in practice by supporting oral care professionals in delivering effective disease prevention. This approach uses extrinsic and intrinsic motivation to achieve the desired behaviour. Extrinsic motivators will be identified by the project through analysing the impact of historical changes in system design on oral care outcomes, whilst taking account of the context and population characteristics. The comparison of outcomes of diverse oral care systems will also be helpful.

Intrinsic motivation will use a newly developed dashboard which can illustrate variations in oral health, treatment and prevention using both high-level claims data and patient-reported data using an innovative patient engagement application. The dashboard indicators are measures which are considered valid, important and relevant measures for oral health and oral health care and have been developed based on a literature review, an expert meeting, the Delphi method, and a World Café. A diverse stakeholder base was engaged in identifying and defining the most appropriate measures.

Groups consulted included general dental practitioners, patients, insurers, and policymakers from Denmark, Germany, Ireland, Hungary, Netherlands and United Kingdom. The approach is being tested by general dental practitioners in field studies in the six partner countries. Aridhia (one of the partners) has provided a secure electronic template for partners to work on anonymised data. The project’s work in developing an oral healthcare dashboard and a patient app hold clear relevance in these terms. The dashboard brings together data from several European countries, enabling healthcare professionals, policy-makers and the general public to gain deeper insights into important questions around oral healthcare.

As the oral health care delivery system is not as overly complex as other health care systems, the oral health care model 2020 may serve as a blueprint for other health care system reforms.

This abstract was first presented in Hungarian on 29th September 2018 at the 22nd Congress of the Hungarian Association for Canio-Maxillo-Facial Surgery and Scientific Meeting of Dentists Prevention and Public Health Symposium; and at the Romanian Scientifc Dental Congress in Marosvásárhely.

Dr Habil. Márton Krisztina egyetemi docens, Dr. Kivovics Péter és professor Dr Madléna Melinda: “Added value for oral care – Új érték a fogászati ellátásban”. The 22nd Congress of the Hungarian Association for Cranio-Maxillo-Facial Surgery and Scientific Meeting of Dentists, 29 September 2018. Szeged, Hungary.

Paper: Variations in the provision and cost of oral healthcare in 11 European countries: a case study.

There are wide variations between EU Member States in the manner in which oral healthcare is delivered, the cost and the extent to which the cost of treatment is subsidised from state funds or through private insurance. The ADVOCATE team established this in a paper recently published in the International Dental Journal. The case study draws data from a questionnaire answered by policymakers in 12 oral healthcare systems (11 EU-countries) on the portable costs and provision of treatment for a vignette presented as a pre-defined case.

Read the full paper and results here:

Eaton K.A., Ramsdale M., Leggett H., Csikar J., Vinall K., Whelton H., Douglas G. (2018) Variations in the Provision and Cost of Oral Health Care in 11 European Countries – A Case Study International Dental Journal, 19 Sep 2018,, doi: 10.1111/idj.12437.

The data used to visualise the maps below are estimates only. Please see full paper for exact data.

Article: Taking a big bite of healthcare data

Article published by EU Research. The cost of caring for oral diseases in the EU is round 80 billion Euros a year, yet these conditions can be prevented through relatively simple measures. We spoke to Professor Keneth 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.

Read full article on

Presentation: ADVOCATE Field Studies: Using Academic Detailing to Improve Oral Health Care

Academic Detailing is an educational outreach that can be deployed to improve quality of care. This study describes the results of the ADVOCATE Field Studies; a proof of concept study aimed at evaluating whether Academic Detailing, reinforced with feedback information, can be used to intrinsically motivate general dental practitioners (GDPs) towards more prevention-oriented, patient-centred, and evidence-based oral health care delivery.

Read full abstract on

Fatiha Baâdoudi Denise Duijster, Fatima Ali, Neal Maskrey, ADVOCATE consortium, Geert van der Heijden. ADVOCATE Field Studies: Using Academic Detailing to Improve Oral Health Care. 96th General Session & Exhibition of the IADR & IADR Pan European Regional Congress – London, England – July 22-25, 2018. Abstract #0259:

Presentation: Utilization of Oral Prevention in a Market with Free Prices

Warranting preventive- and quality-oriented dental care remains a longstanding and challenging endeavor. In the Netherlands, dentists were allowed to set the prices for their dental services themselves during the year 2012 in replacement of a previously existing price ceiling with maximum tariffs. The ADVOCATE team exploited this unique natural experiment to determine price-elasticities of demand for preventive dental care.

Read the full abstract on

All conference abstracts are available here.

Trescher A, Gabel F, van der Galien O, ADVOCATE Consortium, Listl S, Kalmus O: Utilization of Oral Prevention in a Market with Free Prices. EuHEA 2018 Maastricht, Netherlands.

Paper: Detecting and Resolving Data Conflicts when Using International Claims Data for Research

Using claims data for research is well established. However, most claims data analyses are focused on single countries. Multi-national approaches are scarce. The application of different anonymization techniques before data are shared for research as well as differences in the reimbursement systems hamper the use of claims data from multiple countries. This paper by the ADVOCATE team analyses data conflicts that occur when international claims data sets are used for research and develops a generic process to detect and resolve these conflicts.

Read the full paper at

Haux C, Kalmus O, Trescher A, Gabel F, Listl S, Knaup P. Detecting and resolving data conflicts when using international claims data for research. Medical Informatics Europe 2018, Gothenburg, Sweden.

Presentation: Acquiring routinely collected claims data: Lessons learned

The ADVOCATE team presented their lessons learnt from collecting dental health claims data across Europe for research. Read the summary on (in English):

Haux C, Rosing K, Kalmus O, Knaup P, Listl S. Acquiring routinely collected claims data from multiple European health insurances for dental research: Lessons learned. 62. Jahrestagung der Deutschen Gesellschaft für Medizinische Informatik, Biometrie und Epidemiologie eV (GMDS) Oldenburg, 17-21 September 2017.

Paper: A Consensus-Based Set of Measures for Oral Health Care

The ADVOCATE team published a paper in the Journal of Dental Research titled A Consensus-Based Set of Measures for Oral Health Care

This study aimed to establish measures of oral health for transparent and explicit reporting of routine data to facilitate more patient-centered and prevention-oriented oral health care. To accomplish this, an intermediate objective was to develop a comprehensive list of topics that a range of stakeholders would perceive as valid, important, and relevant for describing oral health and oral health care.

Read the abstract and full article here:

Baadoudi, F., Trescher, A., Duijster, D., Maskrey, N., Gabel, F., Van der Heijden, G. J., & Listl, S. (2017). A Consensus-Based Set of Measures for Oral Health Care. J Dent Res, 96(8) 881–887. doi:10.1177/0022034517702331