Dental practices today provide services to people who have varying health problems. This reality can present complications for dental diagnosis and treatment. With the extensive scope of services available in dentistry today and the wide range of medical factors affecting care, it is increasingly important to design appropriate treatment management systems to embrace diversity and customize care. This article focuses on designing systems to attract patients with diabetes to the dental office and to manage their care effectively.
Proper and effective management of patients with diabetes requires that the practice evaluate all aspects of patient interaction.
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PRACTICE PRODUCTION AND PATIENTS WITH DIABETES
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Before addressing factors specific to patients with diabetes, it is important to review daily management of dental practices. The reality is that most dental practices are not run as streamlined businesses. Rarely does a practice use statistical analysis and business methodology to design daily systems and train dental staff to manage and operate those systems. Instead, most practices operate with basic systems that are based on doctor and staff habit patterns. The majority of these systems change with time to accommodate variable growth. Rarely are systems developed sufficiently to accommodate niche populations in the practice.
While it may appear unusual to focus on dental practice management systems for a specific population of patients with a medical condition, most health care institutions are built on this premise. Hospitals, surgical centers and physicians market preventive and interventional treatments to people with specific medical needs. Many medical providers specialize in specific illnesses and build their practices accordingly.
Responsible leadership demands that dentists not only provide excellent oral care, but also achieve production goals. It has become evident that effective management is not the sole key to a successful or financially healthy dental practice. Numerous factors affect practice performance significantly.1 One variable is service mix, which refers to the type of services provided by the practice and the measurement of the quantity of those services. The difference in service mix for most practices corresponds to a 50 to 100 percent production variance based on properly designed and executed mathematical models.
Service mix plays a major role in practice production and profitability. Dentists who endeavor to increase their practice production without increasing their work hours must analyze their service mix and alter it to achieve goals. An innovative approach to expanding the service mix is to introduce a focus on patients with diabetes. The reason is that patients with diabetes often require a different level of attention on the part of both doctor and dental team.
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MANAGING THE DENTAL PATIENT WITH DIABETES
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A practice interested in promoting its dental services for patients with diabetes should establish systems to manage their care. Clearly, patients with diabetes have distinct clinical issues, which are discussed in the articles contained in this special edition to JADA.2-9 Nonetheless, it is critical for dentists to establish specific patient care parameters and document step-by-step management systems and accompanying scripts for patient communication. These efforts can result in the highest level of effectiveness, predictable results, improved quality control and consistent team training. Customized systems for managing patients with diabetes are outlined below.
Initial telephone call and office visit.
A practice focused on dental services for patients with diabetes should incorporate into the new-patient telephone call script a question such as, "Do you have any medical complications of which we should be aware?" In the past, dentists accumulated this information during the health history review with the patient. While that method still is acceptable, it does not allow the dental team to customize the first appointment for patients with diabetes. Initial appointments for these patients should provide ample time to assess their medical condition and to emphasize oral diagnosis and patient education.
By using a higher level of information gathering during telephone screening, staff members can schedule a longer initial appointment when a patient indicates that he or she has diabetes, as well as reassure the patient that this dental practice has experience in addressing this condition. It is important to remind such patients to bring a list of all medications, physician contacts and any other information regarding their diabetic condition to the first office visit.5 Ask patients with diabetes to arrive at the office 20 minutes before the appointment to complete the written health history form.
Diagnosis.
The time needed to review the detailed medical history and complications of patients with diabetes generally is more extensive than that needed for other patients. Making a complete diagnosis usually takes longer as well. To compensate, dentists can increase the new patient appointment time by 30 percent for patients with diabetes. Furthermore, patients with diabetes should be placed on the dentist’s schedule so that a complete diagnosis by the dentist can be secured. If the patient is brought into the dental office through the hygiene schedule, the dentist may not have enough time for a comprehensive examination. Proper and comprehensive diagnosis is vital to serving patients with diabetes.
The most common oral manifestation of diabetes is periodontal disease, and practitioners must be cognizant of the importance of the periodontal examination in managing patients with diabetes.3,4 Patients with diabetes often experience significant periodontal consequences, so a complete periodontal examination and treatment plan are essential, as is a system sensitized to the knowledge that the patient with diabetes will be susceptible to periodontal diseases. Numerous elements should be considered when developing treatment protocols, including initial therapy, antibiotic therapy, length of time between recall visits, interaction between general dentists and periodontists, and communication between dentists and physicians.
Coordination with physicians.
Dentists providing care to patients with diabetes should coordinate treatment with the patient’s physicians. Following a complete dental examination and preliminary diagnosis, the dentist may find it necessary to gather information from the patient’s physicians. Drug complications and interactions, diabetes complications and other factors all can contribute to the dental treatment plan. In addition to the benefits of contacting physicians about specific patients and sending follow-up reports to emphasize that the practice has a focus on patients with diabetes, it is clinically necessary to obtain and maintain complete information. The practice may need to schedule time for the dentist to communicate with physicians regarding patients with diabetes.
Maintenance of patient records.
Maintaining meticulous patient records is critical to avoid losing or ignoring pertinent information. Dental records of patients with diabetes can become voluminous if they are not carefully organized.
Follow-up visits.
Patients with diabetes should be asked to update their medical histories at every dental visit, because diabetes and its systemic complications tend to increase in severity over time. Failure to complete regular medical updates for a dental patient with diabetes can result in inappropriate diagnosis, problematic treatment planning or poor treatment outcomes.
Communication.
Patients with diabetes may require extensive time for discussing the dental diagnosis and potential treatment.
Time and fees.
Time is a factor in treating patients with diabetes and should be considered in scheduling procedures and establishing fees. It is useful to adopt a separate set of management systems based on the needs of this population and to recognize that the increased time provided to these patients must be commensurate with reasonable compensation. Otherwise, the practice may find that it is not providing sufficient time for these patients, leading to scheduling and management issues, or that the time allotted is significantly reducing the practice’s overall production.
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MARKETING STRATEGIES FOR ATTRACTING PATIENTS WITH DIABETES
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The key to marketing is developing a comprehensive campaign. A common failure in dental marketing is that it often is done as a single-point activity. This means that a practice will try one marketing tactic such as an advertisement or direct mail. Marketing is more effective when it is created as a multifaceted campaign—for example, a series and/or combinations of advertisements, direct mail pieces, networking activities or referral-based marketing tactics.
Finding the audience.
Typically, patients with diabetes are under strict medical care. They may take insulin or oral hypoglycemic agents, or they may have a special diet and exercise regimen. Patients with diabetes must be tracked carefully and seen regularly by physicians, and many patients require constant reminders to monitor their disease.
Because of these factors, patients with diabetes can be identified on the basis of their point of contact with the health care profession. Dentists should consider who the recipients of the marketing messages should be before they create their campaigns. In the case of patients with diabetes, recipients of the marketing message should include health care providers such as physicians, hospitals, nutritionists and pharmacists who regularly interact with and have the ability to refer patients with diabetes to the dental practice.
Another source of potential recipients of the marketing message for patients with diabetes is the dental practice itself. Most practices have 1,000 or more active patients, some of whom have diabetes. Certainly, many patients know people or have family members who have diabetes. A dentist who wants to increase services to patients with diabetes can identify those patients within the practice population and other patients who know people who have diabetes.
This article focuses on marketing strategies aimed at reaching health care professionals who work with patients with diabetes. Physicians, like dentists, are extremely busy and frequently overwhelmed. They receive an enormous number of mail and telephone messages each day and must maintain familiarity with current medical protocols, drugs and health care regulations. These factors make it challenging to reach these people with the appropriate marketing message.
Refining the message.
One goal of a marketing campaign targeted at physicians regarding patients with diabetes is to create a level of awareness. Diabetes is associated with numerous oral health problems. It is the dentist’s responsibility to educate physicians and other health care providers that the oral implications of patients with diabetes can be severe and that proper prevention and regular treatment are necessary.5,6
When a campaign successfully educates physicians regarding a medical illness such as diabetes, the resulting interest level seems higher. Physicians who become aware of the oral implications and manifestations of diabetes may be more likely to educate patients regarding the need for regular dental care and prevention. These physicians are further inclined to refer patients to a dental practice with a focus in this area.
Before discussing the parameters of a campaign geared to physicians of patients with diabetes, it is important to understand that the dental practice itself must develop a philosophy or niche in this area. To simply create a marketing campaign message stating that the practice will diagnose and treat patients with diabetes is a positive yet insufficient initial step. The marketing campaign will be far more effective if the targeted physicians understand that this particular dental practice has a strong focus on, and commitment to, patients with diabetes and has expertise in this area. This information should be part of the marketing message to help physicians understand the benefits of referring their patients to the practice.
Dental professionals can broaden the targeted audience to reach more physicians by including hospitals, diabetic education centers, diabetic associations, pharmacies and any other centralized diabetes services on their list.
Vehicles for the message.
Several potential vehicles to disseminate the marketing message should be considered.
Television.
Most dentists do not use television advertising because it is expensive and is unable to target a narrowly defined, specific audience. While television is a powerful medium, the high cost of advertising and the wide scope of audience provides for a low return on investment for advertisers of limited services.
Radio.
Radio is a powerful medium for dentistry in that it is more affordable than television and it reaches a large audience. Radio commercials can be scheduled to reach listeners who fall into specific audiences. It is critical to select appropriate radio stations and produce a professional campaign that conveys the desired message and information.
Direct mail.
Direct mail is another powerful tool when the audience or recipient group is clearly identified. The problem is that it is not easy to purchase local mailing lists of patients with diabetes. Dental practice staff might try contacting the local chapter of a diabetes society to determine if this information is available. Direct mail is most effective when it sends a clear message regarding a special promotional offer or another specific call to action.
If a dentist decides to launch a direct mail campaign, he or she should first develop a compassionate and persuasive letter or brochure that clearly explains the importance of oral care for patients with diabetes and why the reader should choose this dental office.7,8 The goal is to inform patients with diabetes that the office has designed services especially for them. The message also must motivate recipients to act.
Effective direct mail campaigns involve multiple exposures to the message. Direct mail can be thought of as not merely marketing, but also as a public relations tool. Many dentists are disappointed when they try any type of marketing; however, their expectations are usually unrealistic. Often, the first or second round of direct marketing does not bring a phenomenal result. Again, dentists should keep in mind that direct mail works only over a significant period of time, and that the standard marketing response rates of between 1.5 and 2.5 percent are much more myth than reality. In fact, many direct mail pieces have absolutely no measurable response rate and lose money. This is not because they are bad direct mail pieces, but because of the inherently low level of influence that direct mail generates.
Among the best audiences to target with direct mail are physician groups, diabetic centers, diabetic support groups and related organizations, and hospital departments focused on patients with diabetes. Dental practice staff can compile this target list and develop a series of effective communications to deliver. For example, the dentist could develop a set of fact sheets about oral care and diabetes and send them routinely. By contacting these groups regularly and including information about the dental practice and its services, the dentist increases the possibility of being recognized as an expert and receiving subsequent patient referrals.
Magazines.
Many communities have a local magazine, which is an excellent medium to run a series of informative advertisements focusing on oral care for patients with diabetes. Very few, if any, advertisements of this type currently appear in these types of magazines. This means that a practice that chooses to focus on expanding its diabetes services through this vehicle could be at a competitive advantage by having the first, only or one of the few advertisements of this type in the magazine. Special issues devoted to health offer excellent opportunities to advertise these services.
Newspapers.
This may be the medium with the most predictable positive results for dentists’ advertisements and public relations messages. The obvious reason is that newspapers are published daily and reach broad populations. Although newspaper advertising is not inexpensive, it probably is less expensive per consumer than any of the other options mentioned above. Newspaper advertising can be extremely effective because dental practices more easily can afford frequent and well-placed ads. Health or lifestyle sections tend to provide the best opportunities for placement of dental practice ads.
Advertising in large cities’ newspapers can be expensive. Fortunately, advertising in community newspapers is less expensive and has the added benefit of reaching members of the local community. Dentists also can explore the option of receiving discounts by purchasing a set of advertisements, such as a lot of 10.
Networking with patients with diabetes.
Another version of external marketing is networking. One approach to try is to contact physicians to promote a series of short informational meetings to describe the practice’s focus on providing dental services for patients with diabetes. Dentists can ask that the physicians specifically invite their patients to attend. The sessions could include lunch or refreshments and present educational information that pertains to physicians, nurses, dieticians and other health care professionals, as well as patients and additional laypeople. By combining this approach with a coordinated direct mail campaign targeted to diabetes health care workers and organizations, dentists are likely to reap positive results.
Moreover, offering short educational seminars to senior centers, community organizations and other groups can be a highly beneficial way to network. Dentists can capitalize on the public’s elevated awareness of and interest in dentistry that have resulted from the prevalence of cosmetic services, by providing a spinoff to describe dental services for patients with diabetes.
Although many other vehicles to advertise in the community exist, those described here represent a mainstay of opportunities. It is important to stress that advertising is expensive and often produces a slow or long-term result. Many advertising campaigns have fallen far short of expectations, failed to provide a return on investment and, essentially, lost money.10 Advertising is a combination of science and creative design, with no guarantees of results.
Candidly, oral care for patients with diabetes is not one of the most exciting topics to promote, and it is less likely that dentists will be successful at creating a strong public relations campaign using the mass media. Conversely, owing to the low media profile of oral care for patients with diabetes, dentists who decide to pursue external marketing in this service area will find that they are either the only one or one of the few involved, enhancing their opportunity to become branded and recognized for this particular service area.
As discussed above, it is critical to be aware that a marketing campaign is more than a solitary event. It requires continual repetition and various strategies to generate the proper effect. Using multiple vehicles to convey the message increases the expense, yet it also enhances the exposure.
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CONCLUSION
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Developing a dental practice niche for patients with diabetes certainly can be viewed as a tremendous benefit to this patient population. However, as with any change in the dental practice, it requires a complete development process that includes both management and marketing components. An increasing amount of information is available regarding dental care for patients with diabetes.7,8 Dentists who develop proper systems to accommodate these patients and create awareness in the medical and local community that these services exist will significantly increase the potential of their practice to expand services to patients with diabetes.
As dentistry evolves, it is focusing more on niches within the practice. This trend is evidenced by the growth during the last 15 years in the areas of cosmetic and implant dentistry. The biomedical model of dentistry will continue to expand. Whether this expansion focuses on systemic drugs, localized oral drug therapy or medical-dental combinations, it is clear that the future of dentistry is closely tied to medical and pharmaceutical progress.
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PRACTICE PRODUCTION AND PATIENTS...
