Utilization of dental care after onset of home care : an insurance claims data analysis

Abstract

Background and state of research: Persons in need of care face difficulties to maintain their oral health and organize routine dental visits as their mobility decreases. Accordingly, an increase in the level of care is associated with a decrease in utilization of dental care.

Research question and objectives, hypothesis: This study is part of an interdisciplinary research project investigating need, provision, and utilization of oral healthcare, systemic morbidity, and clinical status of oral cavity in older people. In the current study, we aim to analyze how utilization of oral healthcare changes after the onset of home care. We hypothesize that the onset of home care is associated with an increased discontinuation of routine oral healthcare and fewer visits to a dentist.

Methods: We designed a retrospective cohort study with anonymous health insurance claims data from 2015-2020 from the DAK-Gesundheit. We compared persons aged 60 or older with an incident need for home care in 2017 (study group) with a control group without need for home care in the entire study period. Both groups were observed for a 3-year follow-up and showed a regular utilization of routine dental visits (visits for which treatment codes “BEMA” 01 or 04 were reimbursed) during the preceding 2-year baseline period. We applied entropy balancing to adjust for baseline differences in patient characteristics between both groups. We report percentages of discontinuation and number of (routine) dental visits during follow-up. Further, inferential analyses will comprehensively investigate the discontinuation and number of (routine) dental visits during follow-up as well as the role of several covarying factors such as population density of the place of residency.

Results: In a descriptive analysis, we identified 13,617 persons with incident need for home care in 2017 and obtained a control group of 155,171 persons. For this preliminary analysis, we excluded all persons who died or were transferred to a long-term care facility during follow-up. We found that 6.6% of the control group and 13.4% of the study group discontinued routine dental visits during follow-up. Accordingly, mean routine dental visits were 2.7 in the study group and 3.4 in the control group and total (routine and other) dental visits were 4.3 in the study and 5.1 in the control group during 3-year follow-up.

Discussion: Our analysis suggests that the onset of home care was associated with an increased discontinuation of routine oral healthcare and fewer visits to a dentist, which would confirm findings from literature. Investigating associations with covariates might provide a nuanced view on oral healthcare utilization for people in home care and help to identify vulnerable patients who might especially benefit from an improved oral healthcare.