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The potential for case finding patients with cardiovascular disease in a dental setting

 

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Thursday, 10 June 2021

The potential for case finding patients with cardiovascular disease in a dental setting

The blog this week is by Wendy Crew, PCC adviser, considering the opportunity to case find patients with cardiovascular disease in a dental setting.

The potential for case finding patients with cardiovascular disease in a dental setting

The NHS Long Term Plan set out the case for early detection and treatment of cardio vascular disease (CVD) and is one of the key aims. The case finding does not need to sit within general practice alone. Following the commencement of a pilot scheme in a pharmacy setting, the Office of the Chief Dental Officer (OCDO) for England understood the possibility of the impact of case finding in a dental setting. Whilst patients generally only attend a medical or pharmaceutical setting when they are feeling unwell, patients attend the dental practice on a more regular basis.

The OCDO commissioned a review, funded by the NHSE CVD Team, to test the feasibility of NHS primary care dental providers in England and their teams contributing to case finding patients within the populations they treat for CVD risk factors. This review was looking at the longer-term health economic impact of early detection of a patient cohort who may otherwise not be identified until they were in a more advanced stage of CVD.

Dr Matt Kearney (Programme Director UCLPartners and former National Clinical Director for CVD Prevention) explained why early detection of Hypertension is important. Hypertension is common, affecting more than 1 in 4 adults in England. It is a major cause of cardiovascular disease (CVD), accounting for half of all heart attacks and strokes and many cases of dementia. But it is also highly treatable – reducing blood pressure with lifestyle change and medication is very effective at preventing CVD. Despite this, around a third of people with hypertension are undiagnosed, and because high blood pressure usually causes no symptoms, they are unaware of their increased risk and the need for treatment. Making blood pressure testing more available in community settings outside the doctor's surgery can make a major contribution to the NHS Long Term Plan ambition to prevent heart attacks, strokes and dementia at scale.

PCC were engaged to undertake a health economic review to understand the longer-term impact on the detection of and prevention and/or treatment of CVD patients, as well as the financial element to the NHS it was always recognised the impact that early detection could have on the person themselves.

The health economic review was undertaken by our associate Monica Duncan who systematically reviewed the literature, identified the existing national resources to support an economic review and provided a model to show the potential long term cost savings to the NHS with the early identification of patients with CVD when initially identified in a dental setting, adding to the overall number of patients who are detected for CVD.

As well as the health economic review, PCC were also asked to support the development of an initial service specification and care pathway for the identification of patients within the dental setting, we were supported in this by our adviser Wendy Crew who has experience of designing and implementing service specifications and Dr Matt Kearney.

Following the presentation of the review to the OCDO a pilot is currently being implemented in the North East, and Yorkshire and Humber. Health Education England is supporting the pilot where the pathway (focussing on hypertension and atrial fibrillation) will be tested in early pilot sites in the North, supported by Health Education England and have been endorsed by the British Heart Foundation and the Primary Care Cardiovascular Society

The importance of collaborative working was highlighted by Shabir Shivji, Senior Dental Advisor Dental CVD Prevention Lead in the OCDO, who said “The NHS Long term Plan highlights the importance of collaborative working in the prevention of Cardiovascular Disease. The paper commissioned by the NHSE CVD Team, produced by the OCDO and PCC has been instrumental in developing the appropriate relationships to facilitate the pilot programme. The friendly, accessible support received by the PCC team in responding to the rapidly developing opportunity for the pilot has been pivotal in ensuring the pilot progresses”.

PCC can support service evaluations and economic impact assessments for information on how we can support you contact .