The effectiveness of Dental Health Support Workers at linking families with primary care dental practices: A population-wide data linkage cohort study

• Main Authors: Gnich, W. (Author), Hodgins, F. (Author), Macpherson, L.M.D (Author), Ross, A.J (Author), Sherriff, A. (Author)
• Format: Article
• Language: English
• Published: BioMed Central Ltd. 2018
• Subjects: age; Age Factors; Allied Health Personnel; article; child; Child; Child, Preschool; Childsmile; cohort analysis; Cohort Studies; Community health worker; comparative effectiveness; controlled study; Dental Care for Children; dental practice; dental procedure; Dental public health; evaluation study; experimental design; female; health auxiliary; health care delivery; Health inequality; Health Services Accessibility; human; Humans; infant; Infant; information retrieval; Information Storage and Retrieval; lay health worker; Lay health worker; major clinical study; male; Oral health; paramedical personnel; patient referral; preschool child; primary health care; Primary Health Care; primary medical care; proportional hazards model; Proportional Hazards Models; public health; Referral and Consultation; Scotland; Support worker, dental practice; survival analysis; vulnerable population; Vulnerable Populations
• Online Access: View Fulltext in Publisher

 Background: Link workers (lay health workers, health support workers) based in the community provide additional support to individuals and families to facilitate engagement with primary care and other services and resources. This additional support aims to tackle the wider socio-economic determinants of health that lead to inequalities. To date, there is no clear evidence of the effectiveness of these programmes. This study evaluates the effectiveness of Dental Health Support Workers (DHSW) at linking targeted families with young children to primary care dental practices. The DHSW role is one component of Childsmile, the national oral health improvement programme in Scotland. Methods: A quasi-experimental approach captured the natural variation in the rollout of the DHSW intervention across Scotland in a cohort of children born between 2010 and 2013. Survival analysis explored "time to attendance" at primary care dental practice. Cox's regression models compared attendance rates and time until first attendance between those families who received support from the DHSW and those who did not. Results: The cohort consisted of 35236 children. Thirty-three percent of the cohort (n=11495) were considered to require additional support from a DHSW. Of these, 44% (5087) received that support. These families were more likely to attend a dental practice (Hazard Ratio [95% Confidence Interval] =1.87 [1.8 to 1.9]) and, on average, did so 9 months earlier (median time until first attendance: 8.8months versus 17.8months), compared to families not receiving additional support. Conclusions: Link workers (DHSW) within the Childsmile programme are effective at linking targeted children to primary care dental services and, most notably, at a younger age for prevention. This is the first study of its kind to evaluate the effectiveness of link-worker programmes using a robust quasi-experimental design on three, population-wide, linked datasets. These results will inform future health programmes which aim to improve health and reduce inequalities by reaching and supporting families from more disadvantaged backgrounds. © 2018 The Author(s).