If We Focus on Patient Outcomes, there are No Bad Ideas…

     The Fall has historically held a sense of “New Beginnings”; a sentiment that lingers from the recurring   academic   year.   Many  of  us  tend   to  look   at   our   professional   office   with   fresh  eyes, looking for ways to improve our craft and the manner in which we provide care for our patients.I just   read   an   excellent   article (Sleep   Medicine   Care   Under   One   Roof:  A  Proposed   Model   for   Integrating Dentistry and Medicine: J Clin Sleep Med 2013;9(8):827-833)  that discusses the care and management of Sleep patients. It documents the many difficulties that have stood in the way of providing the best care possible for these patients; some quotes…
“Dentists who provide appliance therapy…are seemingly few in number.”
“…only about 200 dentists (7 in Ontario) have obtained Diplomate Status with the ABDSM.”
“Dental schools recently surveyed reported only 3 hours of curriculum time devoted to sleep.”
“Education to sleep physicians… technologists about oral appliances… virtually nonexistent.”
“Communication between sleep physicians and dentists…suboptimal in most…settings.”
“Co-treatment…with dental clinicians…viewed as vaguely competitive to some physicians”
“Referrals… discouraged by the lack of, or limited re-imbursement for, oral appliances”
“Many patients are reluctant to return to the referring physician for follow-up evaluation”
     Notwithstanding this being an American article, the issues quoted above have been, and continue to be obstacles to optimum patient care in Canada. The article goes on to state…
“It is, therefore, in the best interest of sleep medicine that a dialogue on innovative improved models of care be reviewed, discussed, and implemented to address the above-mentioned barriers to achieve comprehensive care”.
 As a possible solution to “fragmentation of care and limited communication”, the authors propose   a  “care-under-one-roof”  concept.   Of  course,   their   model   adheres  to   both  AASM   and AADSM protocols, and involves a dentist that has obtained Diplomate status with the ABDSM. The benefits associated with all professionals being located under one roof are obvious. However, most of us do not work in this setting. Nevertheless, as professionals we can work together on these issues and through collaborative effort remedy them in our own environment. I believe that this   article   provides   much   insight   into   areas   demanding   our   attention.   Our   office   constantly reviews and revises protocols in an effort to facilitate the communication required to best manage our Sleep patients. We not only welcome, but very much appreciate suggestions or feedback from our Medical colleagues. Common issues we deal with are patients not returning for follow-up
appointments or going for efficacy sleep studies once they feel their Orthotic is working for them. We make every effort to reinforce the importance of these events and welcome any collaborative effort from our Medical colleagues to facilitate their occurrence. A mentor of mine once told me, “If we focus on Patient Outcomes, there are no Bad Ideas”.
John Viviano B.Sc. DDS Diplomate ABDSM; obtained his credentials from U of T in 1983, he provides conservative therapy for snoring and sleep apnea in his Clinic Limited to the Management of Breathing Related Sleep Disorders. A member of various sleep organizations, he is a Credentialed Diplomate of the American Board of Dental Sleep Medicine, and has lectured internationally regarding management of Sleep-Disordered Breathing and the use of Acoustic Reflection. Dr Viviano has also conducted original research, authored and established   protocols on the use of Acoustic Reflection for assessing the Upper Airway and its Normalization.

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