Vision 2020 Implementation Workshop. Part 1: collaborative practice
Some 20 delegates assembled in Geneva from 19 to 21 June 2013 for an Implementation Workshop on two themes extracted from FDI’s landmark Vision 2020 initiative: intra- and extra-professional collaborative practice (IPC); and oral health data collection, indicators and surveillance.
The workshop heralded the move from mapping the world of dentistry in terms of threats and opportunities in the coming years—the subject of the original Vision 2020 document—to strategies and objectives in the two fields.
For collaborative practice, the aim was to focus attention on successful IPC models around the world among oral health practitioners and between oral health and other health practitioners.
In data collection, indicators and monitoring, the debate was to identify what data to collect, develop a database, initiate data collection and develop a process to ensure regular update.
Commentators on collaborative practice—day 1 (p.m.) and day 2 (a.m.)—welcomed the opportunity to define the future of dentistry and its relations with other medical professions. They agreed on the need to identify not only successful models but also the models that did not succeed in order to understand why.
They further noted that collaborative practice is not only hampered by the disease specific nature of training and research, but also by lack of understanding of the other’s work, entrenched opinions, professional traditions as well as a variety of political and economic factors.
On the other hand, the current political and economic climate largely favours collaborative practice in health, where the focus is moving from acute care and intervention to preventive care, a medical field where the dental professional is the recognized pioneer.
Models: an open debate
The three day workshop provided a unique opportunity for representatives from academia, working dentists, other oral care practitioners and specialists in public health to openly debate issues, highlight shortcomings and recommend further steps.
Working models presented included a Swiss university hospital with policies favouring intra- and extra-professional collaboration, including not only between the dental and medical team but also social services, common courses during training with the overall aim of mainstreaming oral health into medical practice.
Another model cited from the United States was in the field of HIV/AIDS, a disease which by its nature requires collaboration. Dental teams had acquired a certain level of expertise in identifying oral lesions; however, there would never be enough dental practitioners to keep pace with the epidemic. This inevitably meant pooling expertise among a wide range of medical teams, where professionals learn enough about each other’s areas to work closely together
Expanding the market
A third model from the Netherlands focused on a rebalancing of members of the dental team to reflect the move towards prevention and prophylaxis. Contrary to anticipations, the policy resulted in more than enough work for all oral health practitioners, possibly due to demographics, with increased need for oral care for an ageing population. Thus, collaborative practice may also be a way to expand the market.
A fourth model from the United Kingdom focused on community dental services providing (1) oral care for patients in hospitals—with success driven by factors such as top down political support and bottom up support from nurses—and (2) collaborating with government, schools, the media, etc, to reduce caries among children.
Other issues raised included global guidelines on health education, soon available on the website of the World Health Organization, with a new focus on interprofessional training and case studies.
Workforce planning is also part of the collaborative practice equation, as well as the study of how health systems should work together for optimal results, the role of policy makers in ensuring that programmes are developed and improved collaboration between national dental associations and dental faculties.
Workshop commentators also drew attention to unresolved issues, for example measuring the outcomes of oral health on general health or the yet-to-be debated role of dentists in general health care. Furthermore, indicators to measure oral health are difficult to establish in the absence of a consensual view on what constitutes ‘optimal oral health’ and optimal level of care, as opposed to a minimal level of care to reduce suffering.
The question was asked: what is the goal, who is going to lead the charge and where are the resources; with the caution to dentist that failure to address the issues might lead to a future of being ‘mid-level providers’.
In addition, the perception that models are conviction-based must be countered by real evidence that the new model of care is proving its success in terms of results that can be measured and changes that can be felt. Otherwise, it will be difficult to get support.
Note: This is Part 1 of a two-part report on the Vision 2020 Implementation Workshop. A report on days 2 and 3 of the workshop and resulting action points will appear in the next FDI News.