Monitoring oral health of people in Early Intervention for Psychosis (EIP) teams: The extended Three Shires randomised trial

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Abstract

Background

The British Society for Disability and Oral Health guidelines made recommendations for oral health care for people with mental health problems, including providing oral health advice, support, promotion and education. The effectiveness of interventions based on these guidelines on oral health-related outcomes in mental health service users is untested.

Objective

: To acquire basic data on the oral health of people with or at risk of serious mental illness.

To determine the effects of an oral health checklist in routine clinical practice.

Design

Clinician and service user-designed cluster randomised trial.

Settings and participants

The trial compared a simple form for monitoring oral health care with standard care (no form) for outcomes relevant to service use and dental health behaviour for people with suspected psychosis in Mid and North England. Thirty-five teams were divided into two groups and recruited across 2012-3 with one year follow up.

Results

18 intervention teams returned 882 baseline intervention forms and 274 outcome sheets one year later (31%). Control teams (n = 17) returned 366 baseline forms. For the proportion for which data were available at one year we found no significant differences for any outcomes between those allocated to the initial monitoring checklist and people in the control group (Registered with dentist (p = 0.44), routine check-up within last year (p = 0.18), owning a toothbrush (p = 0.99), cleaning teeth twice a day (p = 0.68), requiring urgent dental treatment (p = 0.11).

Conclusion

This trial provides no clear evidence that Care Co-ordinators (largely nursing staff) using an oral health checklist improves oral health behaviour or oral health state in those thought to be at risk of psychosis or with early psychosis.

Section snippets

Background

The UK’s Five Year Forward View for Mental Health (Mental Health Task Force, 2016) highlights that people with mental health problems have poorer physical health than the general population. Often this group are unable to access the physical healthcare they need and experience unnecessary health inequalities. Given this context the UK’s Department of Health (DoH) has produced guidance (Nursing Midwifery and Allied Health Professions Policy Unit, 2016) to address the physical healthcare,

Objectives

To acquire basic data on the oral health of people with or at risk of serious mental illness.

To determine the effects of oral health advice or monitoring in routine clinical practice.

Specifically we wished to examine whether dental monitoring with minimal dental awareness training leads to a clinically significant difference in oral health behaviour of people with serious mental illness.

Methods

Detailed methods are published elsewhere (Jones et al., 2013) but described briefly in the sections below.

Results

Recruitment of teams (n = 35) took place across 2012–3 and follow up was for one year. The intervention teams returned 882 baseline intervention forms and the matching of control group allowed estimation of numbers of clients within the control teams to be broadly similar (Fig. 2). The intervention teams returned 274 outcome sheets one year after their initial baseline form. Two control teams returned no forms, and we gained 366 from the remaining 15 (Fig. 2). Not all returned forms were

Discussion

The demographics of the sample reflect what would be expected in most early intervention teams (Purcell et al., 2015). Around a quarter of our sample felt they were not registered with a dentist. We are unsure of how this compares with the wider population but think this is likely to indicate early signs of disengagement with dental services. Comparison with UK normative data of the 2009 Adult Dental Health Survey (ADHS) highlights how more of this sample had visited a dentist in the preceding

Conclusions

We found no evidence that a reminder checklist had any effect at the end of one year follow up. Our trial had poor follow up and it is possible that this finding is true or false. If true, and generalizable across different health checklists, there remains the possibility of enormous waste of resource in asking health care professionals to undertake such checklists for purposes of audit rather than for any valuable clinical outcome. It is, however, also possible that a real effect was missed by

Funding

This paper presents independent research commissioned by the National Institute for Health research (NIHR) as part of the Collaboration for Leadership in Applied Health Research and Care Nottinghamshire, Derbyshire and Lincolnshire (CLAHRC-NDL).

The views expressed in this paper are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health.

Participants were not paid to participate in the trial but were refunded any costs for travel beyond receiving

Declaration of interest

No authors have any pecuniary interest in the results of this work. There are no conflicts of interest.

Acknowledgements

Dianne Whitham of the NCTU – for support and care well beyond the call of duty. Natalie Murphy, then head of physical healthcare in Notts HC supported the study early on. The late Professor Aubrey Sheiham of the London School of Hygiene and Tropical Medicine had been supportive and provided intermittent advice for the project that has been so useful. All the service users, Care Co-ordinators and team managers who assisted us in conducting this trial and gave us so much of their time and

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