REGISTRY-BASED RESEARCH In the dental care sector, good progress is being made in building an enormous national quality registry for periodontitis, a disease that causes tooth loss and tooth decay. At present, it contains up-to-date information on more than half of the Swedish population and is updated automatically every night. Researchers studying other diseases in the body will also find the registry useful.
The registry is called SKaPa (the Swedish Quality Registry for caries and periodontal disease). Värmland County Council is responsible for administering the registry, but it has clear ties with the University of Gothenburg. Several members of the registry’s board either have a doctoral degree or a professorship in Gothenburg. Soon, when the current registrar Hans Östholm retires, the position will be taken over by Lars Gahnberg, adjunct professor at the University of Gothenburg.
The registry was established nearly a decade ago by Jörgen Paulander and Inger von Bültzingslöwen, both PhDs at the University of Gothenburg, together with Hans Östholm, Head of Dental Care in the region of Värmland.
“They had the brilliant idea of utilising the fact that all dentists enter information regarding status, diagnoses and treatment for all patients in computerised records, linked to Försäkringskassan’s compensation system. It has thereby been possible to build what is essentially a fully comprehensive national quality registry with no requirements for extra initiatives from care providers. It is also interesting that the registry can provide data which is updated daily, as it is updated automatically every 24 hours,” establishes Jan Wennström, senior professor at the Institute of Odontology and member of SKaPa’s board of directors and scientific council.
Close to six million Swedes
It is primarily the Swedish Public Dental Service’s clinics that are linked to SKaPa, but more and more private actors are now choosing to connect to SKaPa. Of all county councils, Gotland is the only one not linked to SKaPa. This is due to the fact that Gotland does not yet have a compatible medical record system. By the end of 2016, almost 6 million Swedish people were entered in the registry – a figure which continues to rise as more private care providers connect.
Research is one of the purposes of the registry, but its primary aim is to increase knowledge of how dental care actually works, and to help to raise its quality. On a national level, SKaPa can for example highlight knowledge gaps as well as differences in treatment and outcome from one county council to the next. On a clinic level, statistics from SKaPa can be used by a clinic to compare itself with others, and in order to identify areas of patient care that need to be developed. One lesson learned from the registry is that investigation and diagnostics regarding periodontal diseases vary significantly from one county council and clinic to the next.
“There is a great deal of interest for SKaPa within the dental care sector. A number of projects based on data from SKaPa have been launched, in which dental clinics are aiming to improve their care. Today, the registry can offer six years’ worth of data as a basis for dental clinics to follow the development of the quality of care longitudinally. The aim is that a person who is logged in to SKaPas report portal will soon be able to receive data in real time,” Jan Wennström explains.
Mouth and body
SKaPa also provides entirely unique opportunities for research. At the Institute of Odontology, several projects based on data from the quality registry are underway, including national follow-up of individuals who have received treatment with dental implants in general practice.
“In previous studies, we have performed follow-up examinations of patients ourselves or requested information from the dentists who have treated them. Naturally, it makes matters much easier now with SKaPa, as we can gain access to longitudinal data from examinations for a new follow-up study,” says Jan Wennström.
SKaPa has also gained the attention of researchers in areas other than odontology.
“As SKaPa has such a high degree of coverage and because we can follow individuals over time, we have entirely new conditions for linking data from SKaPa to data from other registries in order to study factors that interact in the development of disease,” explains Jan Wennström, providing the example of the SCAPIS project led by Sahlgrenska University Hospital.
“SCAPIS studies 30,000 Swedes with the goal of being able to reduce the morbidity from pulmonary heart disease. The majority of those examined in SCAPIS can probably be found in SKaPa’s huge database as well. It is becoming increasingly clear that there are links between inflammation in the oral tissues and pulmonary heart disease, for example, and there is major potential for collaboration between registries to contribute to new and valuable knowledge. We hope that more researchers will recognise the opportunities that SKaPa offers for the analysis of potential connections between systemic diseases and pathological processes in the oral cavity.
Read more about the national quality registry SKaPa on their website: www.skapareg.se.
