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

katie.buchanan@manchester.ac.ukkatie.buchanan@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