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Telehealth Brings Dental Care to Underserved Populations:
The Virtual Dental Home
Maureen Harrington, MPHMaureen Harrington, MPH
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Goal
Discuss critical elements of a Virtual Dental Home system of Virtual Dental Home system of care in various settings.
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U.S. Surgeon General’s Report on Oral Health in America
“Although there have been gains in oral health status for the population as a whole, they have not been evenly distributed across subpopulations.”
• Profound health disparities exist among populations • Profound health disparities exist among populations including:– Racial and ethnic minorities– Individuals with disabilities– Elderly individuals– Individuals with complicated medical and social
conditions and situations
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Dental Disease in the U.S.
Most common childhood illness in US
– Pain and infection
– Nutrition and speech development
– Higher rates of absenteeism among students – Higher rates of absenteeism among students and parents
– School performance
– Social engagement
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Challenges with Access
• Insurance status
• Access to providers
• Transportation
• Hours of practice• Hours of practice
• Dental literacy
• Cultural differences
• Dental fear
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Possible Solutions
• Same as always? Refer unsuccessfully? Monitor untreated disease year after year?
• Or change to new models
– IOM reports– IOM reports
– New technology
– Community based care
– Workforce
Pacific Center for Special Care
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Virtual Dental Home• Innovative system of care
• Practiced in California schools, group homes, long term care facilities, rural and low income communities
• Onsite care using portable equipment• Onsite care using portable equipment
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VDH Concept Model
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Acute Care/Surgical Intervention Chronic Disease Management
Care Approaches
• Provider-centric model• Care delivered in fixed offices
and clinics• “Treatment” based on discrete
procedure-based episodes of care
• Patient-centric model• Care delivered where
people are to the extent possible
• “Management” based on maintaining health across the life-cycle of a conditioncare
• Payment based on discrete procedure-based episodes of care
• Emphasis on surgical interventions
the life-cycle of a condition• Payment based on value of
health improvement across life-cycle of a condition
• Emphasis on risk assessment, prevention, and early intervention, using biological, medical, behavioral, and social tools
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What happens at a practice site?
• Dental hygienist provides:
– clinical services to students, residents or patients
– education to patient, students, parents, school – education to patient, students, parents, school administration, faculty, and staff
– referral support for those who need specialized care
• Telehealth technology facilitates communication with dentist
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Electronic Health Record
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Practice site on campus –School nurse’s office
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Integration
• Hygienist: clinical care, case management, referral, and education
• Site health care provider or school nurse: supports for referral, education and diet supports for referral, education and diet changes
• Counselor: patient and parent interaction
• Teachers: consent form support
• Administration: champion
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Clinical Visits
• Recall schedule is based on risk level of each patient
• Patient receive a recommendation of ongoing care at the facility/school site or ongoing care at the facility/school site or treatment by the dentist
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Interim Therapeutic Restoration (ITR)
AAPD Policy on Interim Therapeutic Restorations (ITR)
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Experience
~ Parent satisfaction is very high.
~ Site administrators indicate 100% satisfaction due to:
• convenience
• reduced time away from school
• increased knowledge of personal oral health prevention practices
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Providers’ Experiences
• Appreciate this model as it provides care to underserved communities
• Enjoy challenge of a new practice setting
• Value interprofessional experiences• Value interprofessional experiences
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Not scared!
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Community-Based TelehealthEnabled Dental Teams
Considerations for Adoption:
– Uses existing workforce of underemployed RDHs & RDHAPs
– Low training costs
– Low deployment costs– Low deployment costs
– Low political costs
– Requires dentists or health centers willing to serve as collaborating dentists
– Requires dentists or health centers willing to accept referrals for advanced procedures
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Next Steps
• Regulations: practice options
• Policies: community sites, school districts, dental boards, and public health departmentsdepartments
• Scope of practice change for hygienists
• Providers valuing dental health
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Untreated dental disease is a public health epidemic
• Get activated
• Be prepared to disrupt status quo as it is contributing to the neglect of children
Pacific Center for Special Care