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The Collaborative Centre for Cardiometabolic Health in Psychosis (ccCHiP) – An integrated care model for oral health of people living with severe mental illness

Authors:

Shilpi Ajwani ,

Sydney Local Health District Oral Health Services Sydney Dental Hospital, AU
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Premala Sureshkumar,

Sydney Medical School, University of Sydney, AU
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Woosung Sohn,

Sydney Dental Hospital, AU
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Sameer Bhole,

Sydney Local Health District Oral Health Services Sydney Dental Hospital, AU
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Tim Lambert

Sydney Medical School, University of Sydney, AU
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Abstract

Introduction: People with serious mental illness (SMI) such as schizophrenia or bipolar disorder have worse health outcomes than rest of the population. In Australia, people with SMI are likely to have an overall life expectancy of 14-23 years less than the general population and die from largely preventable physical health conditions. Those with SMI experience poor oral health (OH) which is associated with higher risk of cardiometabolic diseases. Although, international guidelines recommend providing OH advice and education to address client’s OH needs, these approaches alone may not be sufficient to see discernible effects. There needs to be a stronger focus on integrating oral and systemic health and recognising that multiple interacting risk factors should be assessed and managed. This has led to development of a new model of care – the ccCHiP, based in NSW, Australia. It involves medical, dental and allied health clinicians providing a discipline-specific assessment of the patient’s cardiovascular risk and early intervention.

Aim: The study aims to describe the model, role of the OH team within this innovative model and OH of people seen at ccCHiP.

ccCHiP Model: A care model to improve long-term outcomes, particularly prolonged morbidity and premature mortality is challenging to assess and costly to achieve. Existing models largely offer screening, however, an effective care model should include a review, data interpretation and formulating an appropriate multidisciplinary intervention in addition to screening. Critical to the ccCHiP model is the importance of effective care-coordination by a case manager to enable comprehensive care and the role of peer-support workers. The ccCHiP model brings together the patients, case managers and interdisciplinary teams in one place to provide assessment and intervention to improve cardiometabolic outcomes.

OH team: A dentist-led OH team is an integral part of ccCHiP interdisciplinary team that patient sees in addition to other specialists at their ccCHiP appointment. OH findings form part of the patient’s comprehensive summary provided to their doctor. At the appointment, an oral health therapist and a dental assistant undertake examination, OH promotion and referral. Due to high-risk for cardiometabolic and dental diseases and difficulty to access services, free comprehensive dental treatment is provided to SMI patients at the nearest public dental clinic.

OH findings: From June 2016 to December 2020, 1058 patients were seen and 845 patients (79.8%) underwent OH screening at ccCHiP clinics. Majority were male (63%) with mean age 43.4 (SD=12.7) years. Oral hygiene practices reported were good; 70% brushed their teeth 1-2 times/day and 55% had seen a dentist in last 2 years. Gingival health was poor with visible plaque recorded in over 90%. Although, caries experience was high (mean DMFT 12.7+8.6), active decay was low (mean 1.9+3.4) and only 13 participants had no teeth.

Conclusion: Coordinated comprehensive care integrating specialist medical and dental intervention is an innovative model for addressing cardiometabolic risk factors and improving life expectancy of people with SMI. Follow-up studies investigating efficacy of this model and comparing effects of OH screening and intervention with conventional care are needed to determine measurable health outcomes.

How to Cite: Ajwani S, Sureshkumar P, Sohn W, Bhole S, Lambert T. The Collaborative Centre for Cardiometabolic Health in Psychosis (ccCHiP) – An integrated care model for oral health of people living with severe mental illness. International Journal of Integrated Care. 2022;22(S3):207. DOI: http://doi.org/10.5334/ijic.ICIC22101
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Published on 04 Nov 2022.

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