PRACTICE-BASED RESEARCH: CHC vs Private Practice Perspective Jane Gillette, DDS

NIDCR Request to DPBRNs PBRNs should include a range of: Patients and Clinical Conditions Including underserved populations and their dental health care providers

Northwest PRECEDENT PRECEDENT actively recruits CHC practitioners One of 3 NIDCR funded PBRNS PRECEDENT actively recruits CHC practitioners A special focus on encouraging research in underserved populations 22 /267 active PRECEDENT general DDSs are CHC DDSs

My Unique Experience Conducted Study 001 as Dental Director of community clinic Conducted pilot for Study 002 as private practitioner

Unique Practice Organization Qualities in CHCs Patient demographics Increased number of children Low SES Higher non-white Higher female Treatment needs Higher caries rate – including deep caries Increased need for disease prevention Challenging “dental consumer” behavior Financial constraints of patients and CHC

Unique Practice Organization Qualities in CHCs Language barriers – possible barrier to informed consent or dissuades patients from wanting to enroll Volume of patient visits – higher number of patients seen in CHCs Staff availability – sometimes inadequate resources to complete research

Unique Administrative Requirements for Research in CHCs Dentist work arrangement – Full time vs part time Locus of control – Executive Director and Board oversees CHC

Unique Research Requirements of CHCs Study participant selection – difficult with high “no-shows” and walk-ins Research participants follow-up – increased rate of disconnected phone numbers, high migrant tendancy Research interests of DDSs

Health center patients and dentists have different research needs and interests!! 9

Unique Practice Organization Qualities in Private Practice Patient population: Increased white Increased SES Increased insured Increased adults and elderly Treatment needs Cracked teeth Missing teeth Periodontal disease

Unique Practice Organization Qualities in Private Practice Adequate staffing Lower volume of patients Greater expectation of “on time” appointments New patients: not acceptable to enroll Patients may decline participation due to time restrictions

Unique Administrative Requirements for Research in Private Practice Working arrangements: solo practitioners Locus of control: DDS is owner of practice

Unique Research Requirements in Private Practice Study participant selection is more predictable Follow-up of participants is more predictable Research interests from dentists Treatment of cracked teeth Treatment of sensitive teeth Treatment of missing teeth Treatment of periodontal disease

Private practice patients have different research needs too! 14

In Northwest PRECEDENT 22 of 267 (8.2%) active members are in community clinics 22 of 253 (8.7%) who have completed online survey are in community clinics 4 of 101 (3.9%) who completed Study 1 are in community clinics Numbers of dentists and patients in community clinics are small, but illustrate differences from private practice

Age comparison of patients seen in Study 001 (community clinic vs. private practice) Age Community Clinic Private Practice 0-17 years 50% 12.9% 18-64 years 37.5% 33.8% 65+ years 12.5% 53.3% In community clinics, half (50%) of patients seen were children. In private practice, the vast majority (87.1%) of patients were adults, and only 12.9% were children. 16

Volume of patients seen per week Study 001 (CHC vs private practice) % seeing > 50 pts/week % seeing < 50 pts/week CHC 73.7% 26.3% Private DDS 53.1% 46.9% CHC Dentists see more patient per week than private practice DDSs.

Age comparison of patients seen in Study 001 (community clinic vs. private practice) Community Clinic (n=64) Private Practice (n=1839) Mean Age (SD) 23.2 (16.5) 44.4 (20.4) Median Age (min, max) 19.9 (3.0, 66.4) 46.7 (0.5, 92.6) The average age of community clinic patients was half of that of private practice patients 18

Difference in race/ethnicity is striking Demographics of patients seen in Study 001 (community clinic vs. private practice) Community Clinic Private Practice Proportion Male 39.1% 44.9% Proportion non-white 60.7% 14.4% Difference in race/ethnicity is striking 19

Proportion experiencing new caries within past 12 months Oral Health Status/History of Patients seen in Study 001 (community clinic vs. private practice) Community Clinic (n=64) Private Practice (n=1839) Proportion experiencing new caries within past 12 months 75% 54.6% 20

Characteristics of patients seen in Study 001 (community clinic vs Characteristics of patients seen in Study 001 (community clinic vs. private practice) Community Clinic Private Periodontal Bone Loss presented with 16.7% 36.00% Endodontic Treatment in past 12 months 4.9% 9.7% Preventive Treatment in past 12 months 72.1% 31.8% Orthodontic Treatment Ever 17.5% 30.7% Regular Cleaning in past 12 months 73.4% 86.1% Toothache presented with 14.1% 7.7%

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Jane Gillette, DDS 2055 Nth 22nd Ave Ste #3 Bozeman, MT 59718 405. 586 Jane Gillette, DDS 2055 Nth 22nd Ave Ste #3 Bozeman, MT 59718 405.586.5880 tel 406.586.5881 fax 406.868.1549 cel drgillette@refreshingdentistry.com www.refreshingdentistry.com/blog