Visiting Patients at Home: Reasons and Efficiency of Dental House Calls
ABSTRACT
This retrospective study analyzes indications for house calls by dentists in a domiciliary setting. Its database consists in 69 visits made by a dentist office in Munich from 1998 to 2013 at the homes of 29 non-institutionalized seniors (≥62 years old, 15 females, 14 males, average age 83.7 years old). The analysis focused on the patients’ general state of health, their dental and oral health, the kinds of dental treatments administered, as well as economic aspects and the quantitative development in the frequency of house calls during the study period. The most frequent pre-existing conditions that made a house call necessary were cardiovascular illnesses (60%) and dementia diseases (36%). Multi-morbidity, dependency on care, accessibility issues, and frailty because of advanced age played a central role. The patients’ oral health was acceptable, with the exception of those with dementia diseases, who were more frequently toothless (40% versus 5.6%) and had a higher percentage of carious and decayed teeth (26.3% versus 10.3%). The most frequent procedures were treatments for denture sores and the repair of removable dentures (53.6%). The main focus was on reparative dentistry. The average house call took 37 minutes including travel time. Thus, the time needed was a multiple of the time necessary for treatment in the dental office. The lack of economic efficiency may be the reason why many dentists in Germany hesitate to make house calls. Despite the introduction of additional fees for the treatment of patients in need of long-term care on April 1, 2013, the number of house calls is low and increases only slowly. At the same time, the need for house calls will rise in the future due to an increasing proportion of elderly persons in the population and a decline in the percentage of toothless elderly.
This retrospective study analyzes indications for house calls by dentists in a domiciliary setting. Its database consists in 69 visits made by a dentist office in Munich from 1998 to 2013 at the homes of 29 non-institutionalized seniors (≥62 years old, 15 females, 14 males, average age 83.7 years old). The analysis focused on the patients’ general state of health, their dental and oral health, the kinds of dental treatments administered, as well as economic aspects and the quantitative development in the frequency of house calls during the study period. The most frequent pre-existing conditions that made a house call necessary were cardiovascular illnesses (60%) and dementia diseases (36%). Multi-morbidity, dependency on care, accessibility issues, and frailty because of advanced age played a central role. The patients’ oral health was acceptable, with the exception of those with dementia diseases, who were more frequently toothless (40% versus 5.6%) and had a higher percentage of carious and decayed teeth (26.3% versus 10.3%). The most frequent procedures were treatments for denture sores and the repair of removable dentures (53.6%). The main focus was on reparative dentistry. The average house call took 37 minutes including travel time. Thus, the time needed was a multiple of the time necessary for treatment in the dental office. The lack of economic efficiency may be the reason why many dentists in Germany hesitate to make house calls. Despite the introduction of additional fees for the treatment of patients in need of long-term care on April 1, 2013, the number of house calls is low and increases only slowly. At the same time, the need for house calls will rise in the future due to an increasing proportion of elderly persons in the population and a decline in the percentage of toothless elderly.
KEYWORDS
Dentist House Calls, Non-Institutionalized Seniors, Reparative Dentistry, High Time Expenditure
Dentist House Calls, Non-Institutionalized Seniors, Reparative Dentistry, High Time Expenditure
Cite this paper
Kretsch, M. and Gresser, U. (2015) Visiting Patients at Home: Reasons and Efficiency of Dental House Calls. Advances in Aging Research, 4, 205-211. doi: 10.4236/aar.2015.46022.
Kretsch, M. and Gresser, U. (2015) Visiting Patients at Home: Reasons and Efficiency of Dental House Calls. Advances in Aging Research, 4, 205-211. doi: 10.4236/aar.2015.46022.
References
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https://www.destatis.de/DE/Publikationen/Thematisch/Gesundheit/Pflege/
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http://dx.doi.org/10.1067/mpr.2002.121203 [6] Helgeson, M. and Glassman, P. (2013) Oral Health Delivery Systems for Older Adults and People with Disabilities. Special Care in Dentistry, 33, 177-189.
http://dx.doi.org/10.1111/scd.12038 [7] Kiyak, H.A. and Reichmuth, M. (2005) Barriers to and Enablers of Older Adults’ Use of Dental Services. Journal of Dental Education, 69, 975-986. [8] Ishikawa, A., Yoneyama, T., Hirota, K., Miyake, Y. and Miyatake, K. (2008) Professional Oral Health Care Reduces the Number of Oropharyngeal Bacteria. Journal of Dental Research, 87, 594-598.
http://dx.doi.org/10.1177/154405910808700602 [9] Azarpazhooh, A. and Leake, J.L. (2006) Systematic Review of the Association between Respiratory Diseases and Oral Health. Journal of Periodontology, 77, 1465-1482.
http://dx.doi.org/10.1902/jop.2006.060010 [10] Yoneyama, T., Yoshida, M., Ohrui, T., Mukaiyama, H., Okamoto, H., Hoshiba, K., Ihara, S., Yanagisawa, S., Ariumi, S., Morita, T., Mizuno, Y., Ohsawa, T., Akagawa, Y., Hashimoto, K. and Sasaki, H. (2002) Oral Care Reduces Pneumonia in Older Patients in Nursing Homes. Journal of the American Geriatrics Society, 50, 430-433.
http://dx.doi.org/10.1046/j.1532-5415.2002.50106.x [11] Terpenning, M. (2005) Geriatric Oral Health and Pneumonia Risk. Clinical Infectious Diseases, 40, 1807-1810.
http://dx.doi.org/10.1086/430603 [12] Nitschke, I. and Reiber, T. (2007) Gerostomatologie—Eine Herausforderung auch für den Öffentlichen Gesundheitsdienst. Gesundheitswesen, 69, 541-547.
http://dx.doi.org/10.1055/s-2007-992770 [13] Nitschke, I. (2005) Experten-Hearing “Präventiver Hausbesuch im Alter”. Conference Präventiver Hausbesuch im Alter, Bonn, Edited by Bundesvereinigung für Gesundheit e.V.
http://www.dip.de/fileadmin/data/pdf/material/Dokumentation_Experten_Hearing.pdf [14] Lee, E.E., Thomas, C.A. and Vu, T. (2001) Mobile and Portable Dentistry. Alternative Treatment Services for the Elderly. Special Care in Dentistry, 21, 153-155.
http://dx.doi.org/10.1111/j.1754-4505.2001.tb00245.x [15] Shahidi, A., Casado, Y. and Friedman, P.K. (2008) Taking Dentistry to the Geriatric Patient: A Home Visit Model. Journal of the Massachusetts Dental Society, 57, 46-48. [16] Vigild, M. (1987) Denture Status and Need for Prosthodontic Treatment among Institutionalized Elderly in Denmark. Community Dentistry and Oral Epidemiology, 15, 128-133.
http://dx.doi.org/10.1111/j.1600-0528.1987.tb00499.x [17] Benz, C. and Haffner, C. (2009) Zahnmedizin in der Pflege—Das Teamwerk-Projekt. IDZ Information, 4, 1-23. [18] Nitschke, I., Ilgner, A., Meissner, G. and Reiber, T. (2003) Zahngesundheit von Bewohnern in ländlichen und städtischen Senioreneinrichtungen. Deutsche Zahnärztliche Zeitschrift, 58, 457-462. [19] MacEntee, M.I. (2006) Missing Links in Oral Health care for Frail Elderly People. Journal of the Canadian Dental Association, 72, 421-425. [20] Krüger, K. (2008) Mundgesundheit und prothetischer Versorgungsgrad von Senioren in häuslicher Pflege in der Stadt Greifswald. Dr. med. dent. Thesis, Department of Prosthetic Dentistry, Ernst-Moritz-Arndt-Universität, Greifswald. [21] McDermott, R., Gillespie, S.M., Nelson, D., Newman, C. and Shah, M.N. (2012) Characteristics and Acute Care Use Patterns of Patients in a Senior Living Community Medical Practice. Journal of the American Medical Directors Association, 13, 260-263.
http://dx.doi.org/10.1016/j.jamda.2010.10.007 [22] Scott, T.M., Peter, I., Tucker, K.L., Arsenault, L., Bergethon, P., Bhadelia, R. et al. (2006) The Nutrition, Aging, and Memory in Elders (NAME) Study: Design and Methods for a Study of Micronutrients and Cognitive Function in a Homebound Elderly Population. International Journal of Geriatric Psychiatry, 21, 519-528.
http://dx.doi.org/10.1002/gps.1503 [23] Statistisches Bundesamt (2013) Todesursachen.
https://www.destatis.de/DE/ZahlenFakten/GesellschaftStaat/Gesundheit/Todesursachen/Todesursachen.html [24] ReiBmann, D.R., Heydecke, G. and van den Bussche, H. (2010) Die zahnärztliche Versorgung von Pflegeheimbewohnern in Deutschland—Eine kritische Würdigung der vorliegenden Studien. Deutsche Zahnärztliche Zeitschrift, 65, 647-653. [25] Hallauer, J., Bienstein, C., Lehr, U. and Rönsch, H. (2005) SÄVIP-Studie zur ärztlichen Versorgung in Pflegeheimen. Vincentz Network Marketing Service, Hannover, 5-50.
http://www.zukunftsforum-demenz.com/pdf/SAEVIP_studie.pdf [26] Bourgeois, D., Nihtila, A. and Mersel, A. (1998) Prevalence of Caries and Edentulousness among 65-74-Year-Olds in Europe. Bulletin of the World Health Organ, 76, 413-417. [27] Corsalini, M., Di Venere, D., Stefanachi, G., Tafuri, S. and Pettini, F. (2014) Clinical Evaluation and Orodental Status in a Group of Elderly Institutionalised Patients. Advances in Aging Research, 3, 199-207.
http://dx.doi.org/10.4236/aar.2014.33028 [28] Katsoulis, J., Huber, S., Zumsteg, P., Pazera, P. and Mericske-Stern, R. (2009) Gerodontologischer Konsiliardienst bei stationären. Geriatriepatienten: Zahnmedizinischer Befund und zahnärztliche Massnahmen (II). Schweizer Monatsschrift für Zahnmedizin, 119, 688-694. [29] Micheelis, W. and Schiffner, U. (2006) Vierte Deutsche Mundgesundheitsstudie (DMS IV). Deutscher Ärzte-Verlag, Kön. [30] Wöstmann, B. (2003) Zahnersatz und Gesundheit bei Senioren. Zahnärztliche Mitteilungen, 93, 44-46. [31] Elsig, F., Schimmel, M., Duvernay, E., Giannelli, S.V., Graf, C.E., Carlier, S., Herrmann, F.R., Michel, J.P., Gold, G., Zekry, D. and Müller, F. (2015) Tooth Loss, Chewing Efficiency and Cognitive Impairment in Geriatric Patients. Gerodontology, 32, 149-156.
http://dx.doi.org/10.1111/ger.12079 [32] Kassenzahnärztliche Bundesvereinigung (2015) Zahnärzte und Bevälkerungszahlen (Kapitel 6). In: Jahrbuch 2014: Statistische Basisdaten zur vertragszahnörztlichen Versorgung, KZBV, Käln, 154. [33] Nitschke, I., Ilgner, A., Wilde, F.J., Ritter, J. and Reiber, T. (2005) Zur Versorgung immobiler Patienten—Eine Befragung der Zahnärzte in Westfalen-Lippe. Deutsche Zahnärztliche Zeitschrift, 60, 292-297. [34] De Visschere, L.M. and Vanobbergen, J.N. (2006) Oral Health Care for Frail Elderly People: Actual State and Opinions of Dentists towards a Well-Organised Community Approach. Gerodontology, 23, 170-176.
http://dx.doi.org/10.1111/j.1741-2358.2006.00126.x [35] Kassenzahnärztliche Bundesvereinigung (2008) Betriebswirtschaftliche Daten der Zahnarztpraxen. In: Jahrbuch 2007: Statistische Basisdaten zur vertragszahnärztlichen Versorgung, KZBV, Köln, 98-100. [36] Ludwig, E. (2014) Alterszahnheilkunde und Prophylaxe: Wie sollte die Versorgung von Senioren heute und in Zukunft aussehen?
https://www.seniorfirst.de/pdf/interviews/Interview-Dr-Ludwig.pdf [37] Fiske, J. (2000) The Delivery of Oral Care Services to Elderly People Living in a Noninstitutionalized Setting. Journal of Public Health Dentistry, 60, 321-325.
http://dx.doi.org/10.1111/j.1752-7325.2000.tb03342.x
[1] Statistisches Bundesamt (2014) Pflegestatistik 2011: Pflege im Rahmen der Pflegeversicherung Deutschlandergebnisse.
https://www.destatis.de/DE/Publikationen/Thematisch/Gesundheit/Pflege/
PflegeDeutschlandergebnisse5224001119004.pdf?__blob=publicationFile [2] Holm-Pedersen, P., Vigild, M., Nitschke, I. and Berkey, D. (2005) Dental Care for Aging Populations in Denmark, Sweden, Norway, United Kingdom and Germany. Journal of Dental Education, 69, 987-997. [3] Katsoulis, J., Huber, S. and Mericske-Stern, R. (2009) Gerodontologischer Konsiliardienst bei stationären Geriatriepatienten: Allgemeinmedizinischer Zustand (I). Schweizer Monatsschrift für Zahnmedizin, 119, 12-18. [4] Dolan, T.A., Atchison, K. and Huynh, T.N. (2005) Access to Dental Care among Older Adults in the United States. Journal of Dental Education, 68, 961-974. [5] Douglass, C.W., Shih, A. and Ostry, L. (2002) Will There Be a Need for Complete Dentures in the United States in 2020? The Journal of Prosthetic Dentistry, 87, 5-8.
http://dx.doi.org/10.1067/mpr.2002.121203 [6] Helgeson, M. and Glassman, P. (2013) Oral Health Delivery Systems for Older Adults and People with Disabilities. Special Care in Dentistry, 33, 177-189.
http://dx.doi.org/10.1111/scd.12038 [7] Kiyak, H.A. and Reichmuth, M. (2005) Barriers to and Enablers of Older Adults’ Use of Dental Services. Journal of Dental Education, 69, 975-986. [8] Ishikawa, A., Yoneyama, T., Hirota, K., Miyake, Y. and Miyatake, K. (2008) Professional Oral Health Care Reduces the Number of Oropharyngeal Bacteria. Journal of Dental Research, 87, 594-598.
http://dx.doi.org/10.1177/154405910808700602 [9] Azarpazhooh, A. and Leake, J.L. (2006) Systematic Review of the Association between Respiratory Diseases and Oral Health. Journal of Periodontology, 77, 1465-1482.
http://dx.doi.org/10.1902/jop.2006.060010 [10] Yoneyama, T., Yoshida, M., Ohrui, T., Mukaiyama, H., Okamoto, H., Hoshiba, K., Ihara, S., Yanagisawa, S., Ariumi, S., Morita, T., Mizuno, Y., Ohsawa, T., Akagawa, Y., Hashimoto, K. and Sasaki, H. (2002) Oral Care Reduces Pneumonia in Older Patients in Nursing Homes. Journal of the American Geriatrics Society, 50, 430-433.
http://dx.doi.org/10.1046/j.1532-5415.2002.50106.x [11] Terpenning, M. (2005) Geriatric Oral Health and Pneumonia Risk. Clinical Infectious Diseases, 40, 1807-1810.
http://dx.doi.org/10.1086/430603 [12] Nitschke, I. and Reiber, T. (2007) Gerostomatologie—Eine Herausforderung auch für den Öffentlichen Gesundheitsdienst. Gesundheitswesen, 69, 541-547.
http://dx.doi.org/10.1055/s-2007-992770 [13] Nitschke, I. (2005) Experten-Hearing “Präventiver Hausbesuch im Alter”. Conference Präventiver Hausbesuch im Alter, Bonn, Edited by Bundesvereinigung für Gesundheit e.V.
http://www.dip.de/fileadmin/data/pdf/material/Dokumentation_Experten_Hearing.pdf [14] Lee, E.E., Thomas, C.A. and Vu, T. (2001) Mobile and Portable Dentistry. Alternative Treatment Services for the Elderly. Special Care in Dentistry, 21, 153-155.
http://dx.doi.org/10.1111/j.1754-4505.2001.tb00245.x [15] Shahidi, A., Casado, Y. and Friedman, P.K. (2008) Taking Dentistry to the Geriatric Patient: A Home Visit Model. Journal of the Massachusetts Dental Society, 57, 46-48. [16] Vigild, M. (1987) Denture Status and Need for Prosthodontic Treatment among Institutionalized Elderly in Denmark. Community Dentistry and Oral Epidemiology, 15, 128-133.
http://dx.doi.org/10.1111/j.1600-0528.1987.tb00499.x [17] Benz, C. and Haffner, C. (2009) Zahnmedizin in der Pflege—Das Teamwerk-Projekt. IDZ Information, 4, 1-23. [18] Nitschke, I., Ilgner, A., Meissner, G. and Reiber, T. (2003) Zahngesundheit von Bewohnern in ländlichen und städtischen Senioreneinrichtungen. Deutsche Zahnärztliche Zeitschrift, 58, 457-462. [19] MacEntee, M.I. (2006) Missing Links in Oral Health care for Frail Elderly People. Journal of the Canadian Dental Association, 72, 421-425. [20] Krüger, K. (2008) Mundgesundheit und prothetischer Versorgungsgrad von Senioren in häuslicher Pflege in der Stadt Greifswald. Dr. med. dent. Thesis, Department of Prosthetic Dentistry, Ernst-Moritz-Arndt-Universität, Greifswald. [21] McDermott, R., Gillespie, S.M., Nelson, D., Newman, C. and Shah, M.N. (2012) Characteristics and Acute Care Use Patterns of Patients in a Senior Living Community Medical Practice. Journal of the American Medical Directors Association, 13, 260-263.
http://dx.doi.org/10.1016/j.jamda.2010.10.007 [22] Scott, T.M., Peter, I., Tucker, K.L., Arsenault, L., Bergethon, P., Bhadelia, R. et al. (2006) The Nutrition, Aging, and Memory in Elders (NAME) Study: Design and Methods for a Study of Micronutrients and Cognitive Function in a Homebound Elderly Population. International Journal of Geriatric Psychiatry, 21, 519-528.
http://dx.doi.org/10.1002/gps.1503 [23] Statistisches Bundesamt (2013) Todesursachen.
https://www.destatis.de/DE/ZahlenFakten/GesellschaftStaat/Gesundheit/Todesursachen/Todesursachen.html [24] ReiBmann, D.R., Heydecke, G. and van den Bussche, H. (2010) Die zahnärztliche Versorgung von Pflegeheimbewohnern in Deutschland—Eine kritische Würdigung der vorliegenden Studien. Deutsche Zahnärztliche Zeitschrift, 65, 647-653. [25] Hallauer, J., Bienstein, C., Lehr, U. and Rönsch, H. (2005) SÄVIP-Studie zur ärztlichen Versorgung in Pflegeheimen. Vincentz Network Marketing Service, Hannover, 5-50.
http://www.zukunftsforum-demenz.com/pdf/SAEVIP_studie.pdf [26] Bourgeois, D., Nihtila, A. and Mersel, A. (1998) Prevalence of Caries and Edentulousness among 65-74-Year-Olds in Europe. Bulletin of the World Health Organ, 76, 413-417. [27] Corsalini, M., Di Venere, D., Stefanachi, G., Tafuri, S. and Pettini, F. (2014) Clinical Evaluation and Orodental Status in a Group of Elderly Institutionalised Patients. Advances in Aging Research, 3, 199-207.
http://dx.doi.org/10.4236/aar.2014.33028 [28] Katsoulis, J., Huber, S., Zumsteg, P., Pazera, P. and Mericske-Stern, R. (2009) Gerodontologischer Konsiliardienst bei stationären. Geriatriepatienten: Zahnmedizinischer Befund und zahnärztliche Massnahmen (II). Schweizer Monatsschrift für Zahnmedizin, 119, 688-694. [29] Micheelis, W. and Schiffner, U. (2006) Vierte Deutsche Mundgesundheitsstudie (DMS IV). Deutscher Ärzte-Verlag, Kön. [30] Wöstmann, B. (2003) Zahnersatz und Gesundheit bei Senioren. Zahnärztliche Mitteilungen, 93, 44-46. [31] Elsig, F., Schimmel, M., Duvernay, E., Giannelli, S.V., Graf, C.E., Carlier, S., Herrmann, F.R., Michel, J.P., Gold, G., Zekry, D. and Müller, F. (2015) Tooth Loss, Chewing Efficiency and Cognitive Impairment in Geriatric Patients. Gerodontology, 32, 149-156.
http://dx.doi.org/10.1111/ger.12079 [32] Kassenzahnärztliche Bundesvereinigung (2015) Zahnärzte und Bevälkerungszahlen (Kapitel 6). In: Jahrbuch 2014: Statistische Basisdaten zur vertragszahnörztlichen Versorgung, KZBV, Käln, 154. [33] Nitschke, I., Ilgner, A., Wilde, F.J., Ritter, J. and Reiber, T. (2005) Zur Versorgung immobiler Patienten—Eine Befragung der Zahnärzte in Westfalen-Lippe. Deutsche Zahnärztliche Zeitschrift, 60, 292-297. [34] De Visschere, L.M. and Vanobbergen, J.N. (2006) Oral Health Care for Frail Elderly People: Actual State and Opinions of Dentists towards a Well-Organised Community Approach. Gerodontology, 23, 170-176.
http://dx.doi.org/10.1111/j.1741-2358.2006.00126.x [35] Kassenzahnärztliche Bundesvereinigung (2008) Betriebswirtschaftliche Daten der Zahnarztpraxen. In: Jahrbuch 2007: Statistische Basisdaten zur vertragszahnärztlichen Versorgung, KZBV, Köln, 98-100. [36] Ludwig, E. (2014) Alterszahnheilkunde und Prophylaxe: Wie sollte die Versorgung von Senioren heute und in Zukunft aussehen?
https://www.seniorfirst.de/pdf/interviews/Interview-Dr-Ludwig.pdf [37] Fiske, J. (2000) The Delivery of Oral Care Services to Elderly People Living in a Noninstitutionalized Setting. Journal of Public Health Dentistry, 60, 321-325.
http://dx.doi.org/10.1111/j.1752-7325.2000.tb03342.x