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

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

3. 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

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

5. 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

6. 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

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

8. 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

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

10. 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

11. 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

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

13. 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

14. Private practice patients have different research needs too!14

15. 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

16. 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

17. 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.

18. 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

19. 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

20. 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

21. 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%

22. 22

23. 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 tel fax cel