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Prisons Dental Academic Unit
The Role of Research in Improving Prison Dental Health
Prisons Dental Academic UnitPrisons Dental Academic Unit
The Role of Research in Improving The Role of Research in Improving Prison Dental HealthPrison Dental Health
Martin TickleMartin TickleResearch Director Research Director
Oral Health Unit Oral Health Unit -- National Primary Care R&D CentreNational Primary Care R&D Centre
Manchester University Dental SchoolManchester University Dental School
StructureStructureStructure
• Why do we need Prison Dental Academic Unit?
• What is the structure of the National Prison Health Research Programme?
• What will the Prison Dental Academic Unit do?
• How to get involved in research?
Why do we need a Prison Dental Academic
Unit?
Why do we need a Why do we need a Prison Dental Academic Prison Dental Academic
Unit?Unit?
Challenges for PCTsChallenges for PCTsChallenges for PCTs
• PCTs inexperience in commissioning prison services
• How can PCTs improve oral health of prisoners?
• How can PCTs provide equivalent care in a restricted environment with restricted resources?
• How do PCTs provide care for two different populations
–– Convicted, long stayConvicted, long stay–– Remand/short stayRemand/short stay
Challenges for prison dental services
Challenges for prison dental Challenges for prison dental servicesservices
• Prisons inexperienced working with PCTs • Part-time service but high need population• Developing clinical governance• Professional isolation • Workforce
–– Recruitment and retentionRecruitment and retention–– SkillmixSkillmix
Contribution from researchContribution from researchContribution from research
• Provides knowledge–– To inform commissioning decisionsTo inform commissioning decisions
–– To inform clinical care delivery To inform clinical care delivery
–– To inform development of clinical To inform development of clinical governancegovernance
Spin off benefits of researchSpin off benefits of researchSpin off benefits of research
• Reduces professional isolation and supports professional development
• Improves quality
• Supports recruitment and retention
Structure of the National Prison Health Research
Programme
Structure of the National Structure of the National Prison Health Research Prison Health Research
ProgrammeProgramme
Prisons research programme Prisons research programme Prisons research programme
• Partnership between–– Mental Health Mental Health Dr Jenny ShawDr Jenny Shaw–– Primary Care Primary Care Prof. Bonnie SibbaldProf. Bonnie Sibbald–– Drugs and alcoholDrugs and alcohol Dr Michael FarrellDr Michael Farrell–– Dental Dental Prof. Martin TickleProf. Martin Tickle
• Jane Senior – programme manager• Formal launch – Sharing Good Practice Conference,
York 4-5th May 2005
Composition of programmeComposition of programmeComposition of programme
• Network of research supportive prisons • Network of research active individuals
working in prisons• Scoping exercise• Small demonstration projects in each area
• National Steering Group
Network of research supportive prisons
Network of research Network of research supportive prisonssupportive prisons
• List in process of being produced
• Profile of all prisons
• To be posted on web sitehttp://www.phrn.nhs.uk/http://www.phrn.nhs.uk/
Network of individualsNetwork of individualsNetwork of individuals
• Web site: http://www.phrn.nhs.uk/http://www.phrn.nhs.uk/• Registration and chat rooms• Workshops and conferences• Funding opportunities• Outcomes of research• Support material
–– ‘‘Go Directly to Jail’Go Directly to Jail’
Scoping exerciseScoping exerciseScoping exercise
• Systematic reviews• Listening exercise
–– WorkshopsWorkshops–– InterviewsInterviews
• Identify and prioritise research needs• Feed into DH research commissioning
frameworks
Demonstration projectsDemonstration projectsDemonstration projects
• Identify problems of undertaking research in prisons and how to overcome them
• Build research capacity and support the networks
• Produce new knowledge – to improve health or services
What will the Prison Dental Academic Unit do?
What will the Prison What will the Prison Dental Academic Unit do?Dental Academic Unit do?
Dental TeamDental TeamDental Team
• Professor Martin Tickle• Dr Keith Milsom• Professor Andy Blinkhorn• Dr Ziad Al-Ani• Katie Buchanan
[email protected]@manchester.ac.uk• Dr Liana Zoitopoulos• Dr Alan Pau & Professor Ray Croucher
Contribution to scoping exercise
Contribution to scoping Contribution to scoping exerciseexercise
• Systematic review of literature
• Only 14 relevant papers!
• All descriptive epidemiology
• No information about effectiveness of interventions
Outcomes of May WorkshopsOutcomes of May WorkshopsOutcomes of May Workshops
• Research priorities
–– Improving dental healthImproving dental health
–– Improving dental servicesImproving dental services
Research priorities: improving dental health
Research priorities: improving Research priorities: improving dental healthdental health
• What interventions are effective in preventing tooth decay?
• Which is the best way to present dental health information?
• Who can most effectively promote oral health?
• How can promotion of healthy eating\smoking cessation be supported?
Research priorities: improving dental services
Research priorities: improving Research priorities: improving dental servicesdental services
• How can the surgery down time be minimised?
• Is screening of prisoners upon entry effective?
• How can skill-mix be used to improve services?
Evaluation of recent policy changes in prison
dentistry
Evaluation of recent Evaluation of recent policy changes in prison policy changes in prison
dentistrydentistry
Evaluation backgroundEvaluation backgroundEvaluation background
• Requirement of CDO’s office
• Strategy for Modernising Dental Services for Prisoners in England – April 2003–– Standards for service deliveryStandards for service delivery
• Over £4.5M injected into prison dental services
• Has strategy\additional funding improved prison dental services?
Evaluation planEvaluation planEvaluation plan
• Build on OPM report • Collect data by questionnaire and
telephone interviews from:–– PHC managersPHC managers–– Prison dental teamPrison dental team–– PrisonersPrisoners–– PCTsPCTs
• Shelf data from DH, DPB• Report in New Year
Developing and testing a Standardised Dental Assessment of Prisoners
Developing and testing a Standardised Dental Assessment of Prisoners
Demonstration projectDemonstration projectDemonstration project
BackgroundBackgroundBackground
• Recently admitted prisoners have severe dental problems
• Remand and short stay prisoners have difficulty keeping appointments
• Most services run part time• On admission all prisoners have 24 hour,
then 48 hour assessment • No standardised system of dental
assessment
Elements of demonstration project
Elements of demonstration Elements of demonstration project project
• Development of standardised assessment tool
• Test validity and reliability
• Understanding the impact of widespread introduction
Development of standardised assessment tool
Development of standardised Development of standardised assessment toolassessment tool
• Collaboration with Queen Mary’s and GKT• Dental Pain Questionnaire (DePaQ)• 2 page questionnaire• Categorises into patients with pain into
three groups–– Identifies those in urgent need of careIdentifies those in urgent need of care
• Successfully tested in NHS
Methods- testing the instrument
MethodsMethods-- testing the testing the instrumentinstrument
• Pilot questionnaire – literacy issues• To be administered by nurses who deliver
48 hour assessment• Results compared against clinical
examinations • N=200 patients attending dental service in
Brixton and Belmarsh
AnalysisAnalysisAnalysis
• Compare results of questionnaire with clinical examinations
• Compare to values obtained in NHS
• Reduced performance due to over-elaboration?
Understanding the impactUnderstanding the impactUnderstanding the impact
• Qualitative approach • Interviews with:
–– 4 prison health care managers4 prison health care managers–– 4 prison dentists4 prison dentists–– 4 prison officers 4 prison officers –– 4 prisoners4 prisoners
• Working in all types of prisons
Potential benefitsPotential benefitsPotential benefits• Prioritise need
• Support efficient management of dental booking
• Results could be transferred with the prisoner
• Requires flexibility to deal with urgent cases
How to get involved in research?
How to get involved in How to get involved in research?research?
Building research capacityBuilding research capacityBuilding research capacity
• Increase numbers involved in research
• Develop research skills
• Develop supporting infrastructure
Building networksBuilding networksBuilding networks
• Supportive and committed clinicians
• Supportive prisons
• Supportive PCTs
• Academic partner
• Educational programme
Support for network buildingSupport for network buildingSupport for network building• Support from PHRN - http://www.phrn.nhs.uk/http://www.phrn.nhs.uk/• Local prison research networks• Teaching & Learning PCTs• Post graduate deaneries• Regional research support units• Academic partner• OHU – NPCRDC – http://www.ohu.ac.uk/http://www.ohu.ac.uk/• Local primary care research networks
Successful partnershipsSuccessful partnershipsSuccessful partnerships
• Trusting relationships
• A strategic perspective
• A focus on outcomes
• A willingness to act
The importance of projectsThe importance of projectsThe importance of projects
• Starts the process
• Act as a focus for partnership
• Builds infrastructure, skills, relationships and trust
• Produces a tangible outcome
Initial projectInitial projectInitial project
• Need to produce quick demonstrable outcome – ‘little victory’
• Inexpensive• Relevant to the Prison\PCT• Relevant to clinicians• Simple methodology• Simple outcomes• Impact on the service
In ConclusionIn ConclusionIn Conclusion
• Prison dentistry needs a research base
• The Prison Dental Academic Unit is a first step
• Progress depends on the enthusiasm of all parties to get involved and develop partnerships