Re-engaging Patients in Dental Care
•
0 likes•58 views
The COVID-19 pandemic has created several challenges for our country’s health care infrastructure, and the community health center workforce is no exception. Join us as we describe strategies to get patients back into dental care. Along with these strategies, participants will learn how to recognize challenges in dental practices, as well as how to engage the interdisciplinary care team through role redesign and integration to increase access to comprehensive care.
Recommended
Recommended
More Related Content
Similar to Re-engaging Patients in Dental Care
Similar to Re-engaging Patients in Dental Care (20)
More from CHC Connecticut
More from CHC Connecticut (20)
Recently uploaded
Recently uploaded (20)
Re-engaging Patients in Dental Care
- 1. Re-engaging Patients in Dental Care Thursday, June 8, 2023 2:00-3:00pm Eastern / 11:00am-12:00pm Pacific 1
- 2. 2 Moses/Weitzman Health System Affiliates
- 3. Continuing Education Credits In support of improving patient care, Community Health Center, Inc. / Weitzman Institute is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team. A comprehensive certificate will be available after the end of the series, Summer 2023. 3
- 4. Disclosure • With respect to the following presentation, there has been no relevant (direct or indirect) financial relationship between the party listed above (or spouse/partner) and any for-profit company in the past 12 months which would be considered a conflict of interest. • The views expressed in this presentation are those of the presenters and may not reflect official policy of Community Health Center, Inc. and its Weitzman Institute. • We are obligated to disclose any products which are off-label, unlabeled, experimental, and/or under investigation (not FDA approved) and any limitations on the information hat we present, such as data that are preliminary or that represent ongoing research, interim analyses, and/or unsupported opinion. • This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) as part of an award totaling $137,500 with 0% financed with non-governmental sources. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by HRSA, HHS, or the U.S. Government. For more information, please visit HRSA.gov. 4
- 5. At the Weitzman Institute, we value a culture of equity, inclusiveness, diversity, and mutually respectful dialogue. We want to ensure that all feel welcome. If there is anything said in our program that makes you feel uncomfortable, please let us know via email at nca@chc1.com 5
- 6. National Training and Technical Assistance Partnership Clinical Workforce Development Provides free training and technical assistance to health centers across the nation through national webinars, learning collaboratives, activity sessions, trainings, research, publications, etc. 6
- 7. 7 CHC Profile Founding year: 1972 Primary care hubs: 16; 204 sites Staff: 1,500 Patients/year: 102,275 (UDS 2022) Visits/year: 550,000 Specialties: onsite psychiatry, podiatry, chiropractic Elements of Model Fully integrated teams and data Integration of key populations Data driven performance “Wherever You Are” approach Community Health Center, Inc. (CHC) Locations and Service Sites in Connecticut
- 8. Salud Family Health • Founding year: 1970 • Migrant Health Center and FQHC • Serves over 68,000 patients annually • Provide over 266,000 patient visits annually • 14 clinics in 10 counties • 10 clinics have Dental • Provide services in over 100 schools • 650 employees 8
- 9. Speakers 9 Dr. Sheela Tummala, DDS, MPH Chief Dental Officer, Community Health Center, Inc. Dr. Ethan Kerns, DDS Chief Dental Officer, Salud Family Health Candace Hsu Owen, RDH, MS, MPH National Network for Oral Health Access (NNOHA) Education Director
- 10. About NNOHA • Founded in 1991 by FQHC Dental Directors who identified a need for peer-to-peer networking, collaboration, research, and support • Membership now includes more than 5,000 dentists, dental hygienists, supporters, and partners 10
- 11. HRSA NTTAP Grantee • Learning Collaboratives • Annual Conference • Webinars • NNOHA Listserv • NNOHA Oral Health Leadership Institute (NOHLI) • Resources – Operations manuals, dental forms library, publications, and more www.nnoha.org or email info@nnoha.org 11
- 12. Objectives • Understand the national landscape of dental in community health centers • Describe strategies to engage patients and the interdisciplinary care team in dental care post pandemic • Identify challenges in your dental practice pre/post pandemic 12
- 13. Poll: Have you seen an increase in dental disease? • Yes • No 13
- 14. Pre Pandemic • Oral diseases nearly effect 3.5 billion people • Untreated dental caries in permanent teeth affect 2 billion people • On average 4-5 visits needed to complete treatment 14 Global Burden of Disease, 2019. Special issue of dentistry and covid-19 challenges and opportunities for providing safe care
- 15. COVID Impact on Dental Health and Disease 15 Source: Special issue Dentistry and Covid- 19 Article Published 5th October 2022 Important factors affecting health during COVID • Social Isolation • Stress & Anxiety • Loneliness • Wearing Masks Health risk behaviors • Unhealthy Diet • Alcohol Intake • Higher Smoking Frequency • Changes In Dietary Habits Decreased access
- 16. Dental Public Health Challenges Workforce Digital Technologies Geographical Distance Barriers 16
- 17. Loss of Workforce • 68% of health centers surveyed report losing 5- 25% of their workforce in the last six months. • Dental is tied for the third highest amount of workforce loss. NACHC Workforce Survey Report (2022) 17
- 18. National Dental Program | FTEs 2016-2021 2016 2017 2018 2019 2020 2021 Dentists 4,474.48 4,882.42 5,099.72 5,323.83 4,872.92 5,097.87 RDH 2,200.39 2,497.90 2,682.75 2,855.58 2,485.49 2,653.49 Other Dental Personnel (DA/Tech) 9,441.24 10,390.13 10,895.30 11,482.66 10,193.86 10,949.53 4,474.48 4,882.42 5,099.72 5,323.83 4,872.92 5,097.87 2,200.39 2,497.90 2,682.75 2,855.58 2,485.49 2,653.49 9,441.24 10,390.13 10,895.30 11,482.66 10,193.86 10,949.53 0.00 2,000.00 4,000.00 6,000.00 8,000.00 10,000.00 12,000.00 14,000.00 Dentists RDH Other Dental Personnel (DA/Tech) * 2021 HRSA Uniform Data Systems 18
- 19. Health Center Users (2016-2021) 2016 2017 2018 2019 2020 2021 Total Users 25,860,296 27,174,372 28,379,680 29,836,613 28,590,897 30,193,278 Medical Users 21,880,295 22,866,468 23,827,122 25,029,835 24,529,374 25,759,024 Dental Users 5,656,190 6,116,732 6,406,667 6,712,204 5,155,619 5,701,053 0 5,000,000 10,000,000 15,000,000 20,000,000 25,000,000 30,000,000 35,000,000 Total Users Medical Users Dental Users * 2021 HRSA Uniform Data Systems 19
- 20. Strategies • Reassured patients of safety and high level of infection control procedures • Encouraged staff to vaccinate • PPE- N-95 Respirators, Isolations gowns, face shields • HEPA Filters 20
- 21. Text Campaigns • Campaign Volume: 197 • Total Campaign Response Rate (%): 7% • Total Appointments Scheduled vs. Campaign Volume (%) 5.6% • Communicating scheduled appointments with patients 21
- 22. Different Populations • Senior Outreach • Multidisciplinary approach • School-based • How many patients scheduled appointments? • Case Manager – tracking, scheduling, following up 22
- 23. Closing the Care Gaps 23 → Accomplishing treatment → Preventative visits → Increasing access → Community events → Reach out to patient by text or phone
- 24. Patient 24 • 18 years+: • Oral cancer screening • Risk assessments: • Pre-diabetes • Systemic diseases: • Diabetes • Hypertension
- 25. Warm Hand-off Case 25 Patient: 48 y/o Male PMH Includes: • Anxiety • Panic Disorder • Agoraphobia • Cigarette Smoker Dental History: • Partial Edentulism • Dental Anxiety • Radiographic Bine Loss • Subgingival Dental Calculus • Inconsistent Dental Care • Ill Fitting Dentures Fabricated Outside Dental Office
- 26. 26
- 27. 27
- 28. 28
- 29. Poll: Are you prepared for the next pandemic? •Yes •No 29
- 30. Recommendations • Disease-centered model to patient-centered care • Oral health is linked to medical and behavioral services diseases that manifest in mouth • Encourage patients to receive dental care • Trying to do as much as possible (accomplish exams, restorations, sealants) when patients come in • Open up more hours – access, Saturdays, evening hours, fill opening • What is the technology that will help us keep going forward? 30
- 31. Ideas to Think About 31 The implementation of modern technology in dentistry Revolution in oral health prevention Teledentistry — remote provision of oral health care Aging population New oral cancer screening devices A multidisciplinary approach
- 32. Resources NNOHA Workforce Resources www.nnoha.org/pages-1/resources-%7C-workforce NNOHA COVID-19 Resources www.nnoha.org/pages-1/resources-%7C-covid-19 NNOHA Access to Care Resources www.nnoha.org/pages-1/resources-%7C-access-to-care 32
- 33. Questions 33
- 34. Contact Information 34 For information on future webinars, activity sessions, and learning mom: please reach out to nca@chc1.com or visit www.chc1.com/nca
Editor's Notes
- Bianca 2:00-2:02
- Bianca 2:00-2:02
- Bianca 2:00-2:02
- Bianca 2:00-2:02
- Bianca 2:00-2:02
- Bianca 2:00-2:02
- Bianca 2:00-2:02
- Bianca 2:00-2:02
- Bianca 2:00-2:02 Dr. Tummala: Dr. Kerns: Dr. Kerns is the Chief Dental Officer for Salud Family Health and he oversees ten dental clinics across northeast Colorado. In this role, he is responsible for the leadership of a large FQHC dental department that has over 40 dental providers. Dr. Kerns supervises multiple programs at his FQHC such as their teledental model, a large school-based preventive program that includes over 100 schools, numerous undergrad student rotations, and an AEGD residency program. Dr. Kerns also oversees the credentialing and privileging process and all care management services for Salud Family Health. Dr. Kerns is active in organized dentistry and is currently the chair of the Government Relations Council for the Colorado Dental Association and is the current President for the NNOHA Board. Candace Hsu Owen, RDH, MS, MPH National Network for Oral Health Access
- Ethan 2:02-2:04
- Ethan 2:02-2:04
- Sheela 2:04-2:06 This has existed pre-pandemic, this is what is now – how are we handling the situation now in regards to volume, patient care, and other interdisciplinary efforts + technology Dental disease Lost a lot of patients in the mist of this – how as an organization (CHC), what did we do to re-engage patients What have we learned? What do we want to sustain and keep going? How are we sustaining? Traditional with modifications? What are the changes? Medical Integration Grant [figure out if we want to comment on this] Margaret – overall picture Sheela – clinical Clinical Aspect – dental disease Post-COVID Lost a lot of patients in the mist of this – how as an organization (CHC), what did we do to re-engage patients Text Campaigns Senior Outreach – grants (Andrea Dobrozenky) Now want to focus on pediatric patients – school-based population – could not go into the schools Clinical Dashboard (Nick Ciaburri) Medical Integration Grant [figure out if we want to comment on this]
- Sheela 2:04-2:06 Sheela (3-5 min poll) ~8 min Zoom poll
- Sheela 2:04-2:06 2019 - 29,836,613 2020 - 28,590,897 2021 - 30,193,278 ESTIMATE of 2022 (4% increase) – 31,401,009 Stephanie Ivers Enter photo from covid dr ramos Average number of visits to complete treatment for patient What is the trend we’re seeing now? Research – increase of dental disease (google scholar, ADA, American Association of Pediatric Dentistry) Trends in the diversity of the populations How many vaccinations we gave, tests done, dental emergencies we had, kind of dental
- Sheela Current landscape Margaret wanted a comment on the Decreased access – closed schools, most practices both private and public closed for a little period of time. American Dental Association The COVID-19 pandemic, by affecting many aspects of everyday life, including eating habits, caring for oral hygiene, and avoiding regular visits to the dentist, may generate an increase in oral diseases. What is the manifestations we are seeing now in the pandemic era and how should dental providers prepare Now vs back then and how to handle situations now in pandemic
- 3-5 mins Sheela – digital technologies, geographical distance barriers Ethan – comments, then workforce
- Ethan An additional 15% of health centers report losing 25-50% of their workforce. Urban health centers reported slightly higher rates of workforce loss than rural health centers, as did larger health centers compared to the smallest health centers. This category was followed by Administrative Staff (financial services, scheduling, front office staff), Behavioral Health Staff (Psychiatrists, Social Workers, and others), Dental Staff (Dentists, Dental Assistants, and Dental Hygienists), a Based on last year’s hires, we averaged 32 days for dentist, 23 for hygienist and 15 for dental assistants.
- Ethan This graph’s data is also from the HRSA UDS. It shows the number of dental program FTE by team member type. We can see that all types of professionals have seen a drop from 2019-2020. The orange line are dentists, the yellow is dental hygienists, the green is other dental personnel like dental assistants and dental techs.
- Ethan This graph shows the number of users in health centers over the last 5 years. The green line represents the total number of health center users. The Medical users are blue, dental users are yellow. There has been steady growth over the last 5 years for each category, but all areas took a drop last year. Dental users account for 18% of all health center patients and 21% of all medical patients.
- Ethan Returned to being on-site Screening covid questions Suctions Dental was the one department that already always wore a mask, always wore gowns, always had strong infection control procedures.
- Sheela Waiting for Sydney Kennedy response
- Sheela 9/1/22-4/19/23 - Follow up appts for mobile pts in need (defined as pts seen by mobile hygiene in a school based setting for prophy and presenting with pain, swelling, or signs of infection and/or 5 or more carious lesions) Those scheduled for a main site clinic for exam/treatment=127 Also referred for non-CHC support/scheduling with outside providers. Coordination of care with Connecticut Dental Health Partnership/DCF/specialty care (oral surgeon/endodontist/pediatric providers= additional 14
- Sheela – 1.5-2 min
- Sheela Oral cancer is a significant global healthcare problem. It is the sixth most common cancer. We understand the risk factors of tobacco, alcohol, age, gender, sunlight, and HPV. So most of these can be prevented by early detection and screening at regular preventive visits. The late-stage presentation is expected. It is a painless exam and can be done quickly in less than a minute by our dental professionals. Another risk factor we should be aware of is the increased use of this drug, whether medically or for recreational purposes. Generally, cannabis users have poor oral health; they have Xerostomia or dry mouth and an increased risk of dental caries. Marijuana smoke is associated with changes in the epithelium of the oral mucosa and can be linked to premalignant lesions, including leukoplakia and erythroplakia. It is essential to understand the trends of these substance uses and refer the patients appropriately. The risk assessments are done in dental with the implementation of the grant, and appropriate referrals are given to the patient. Here is an example of a patient that I came across recently. A young patient, 27 years presents for a routine dental exam. We took vitals in the dental and noticed high BP. The patient’s medical history also shows that he took BP medications recently. When inquired, he has not seen PCP or been followed for his condition. I took a few minutes from the busy visit and helped him to understand that increased BP could be from a variety of reasons, and asked the PSA to make an appointment with the PCP.
- Sheela Would like to share one example - of bidirectional referral who was successful. His CC – Ill fitting dentures, requesting new dentures. Pt has dental anxiety that results in intermittent dental care appointments. His agoraphobia prevents him from presenting for dental appointments due to the potential of having to wait in the waiting room with other patients. His ill fitting dentures can impair his ability to eat and chew properly placing him at risk for maintaining adequate nutritional intake. His medical provider and this dental provider established a collaborative plan of care so that both his medical, emotional, and dental needs were met appropriately. In this instance, his dental needs require more than only re-fabrication of the dentures, but together his medical provider and dentist are working together to ensure he is successful in receiving the care he needs.
- Sheela Here is an example of how our BI team has been able to assist the medical team in identifying pediatric patients that could be referred for dental care. Bianca Just make title: planned care dashboard, and “MDIP refer to dental”
- Sheela Here is an example of how our BI team has been able to assist the medical team in identifying pediatric patients that could be referred for dental care.
- Sheela Again, as you see here is the identification of an adult patient for a dental referral.
- Ethan –Where do you see yourself helping the patient? Tackle complete picture of the patient
- Ethan
- Ethan – teledentistry 2-3 min Hand-off to Sheela
- Candace
- Candace How is your health center handling the increase/volume of disease in your patients? Sheela/Ethan What is the vision for teledentistry moving forward? Ethan How are you adapting to an environment with the workforce shortage? (Training) Candace/Sheela/Ethan What teaching moments that we can takeaway from this pandemic? Sheela/Ethan
- Bianca