filling the gap: running a large scale clinic
TRANSCRIPT
Filling the Gap: Running
a large scale clinic
Dr. Alyssa Hayes
BDent (Hons), MSc, FRCD(C)
College of Dentistry, University of Saskatchewan
Outline
Demand for care
Filling the Gap Clinic
Lessons Learned
Future Directions
Health of Immigrants and Refugees in
Saskatchewan2
Category DMFT (mean) Perceived Barriers to
Care
Immigrants (Pakistan) 3.52 (1.55 FT) Lack of Money (14%)
Lack of Insurance (14%)
Refugees (Burma) 5.80 (0.48 FT) Lack of Money (32%)
Lack of Insurance (24%)
2 Hoover J, Vatanparast H, Uswak G. Risk determinants of dental caries and oral hygiene status in 3-15 year-old recent immigrant and refugee children in Saskatchewan, Canada: A pilot study.
J Immigrant Minority Health 2016. doi 10.1007-s10903-016-0452-9
Demand for Care
Saskatchewan received over 1,000 Syrian refugees1
Over 400 in the Saskatoon area
Refugee Clinic (Joint Initiative between SODS and GGP)
Initial check up and vaccinations
Referrals as need
Oral health needs identified
1http://www.cbc.ca/news/canada/saskatchewan/1094-syrian-refugees-saskatchewan-1.3471906
Filling the Gap Clinic
College of Dentistry (CoD) response to a need within Saskatoon and
surrounding area
Began within three weeks of being asked
Academic year was just ending
Ran clinic from May 3rd to 11th
Needed to develop a system to handle large scale referrals
Consultations with:
Settlement groups
Clinic director and staff
Local dental society
Filling the Gap Clinic
Filling the Gap Clinic – Initial Process
Settlement Agency Referral
CoD contacted settlement agency with appointment
time
Settlement agency advised patient
and arranged taxi
CoD ensured interpreter on site for appointment
IFHP benefits maximized
Patient rebooked if needed
CoD became dental home
Filling the Gap Clinic
To help remove additional barriers to care the CoD provided:
Interpreters
Travel (initial appointments)
Treatment provided by:
Three 4th year students
Supervision by community dentists
Provided treatment for 112 patients
Care provided on a family basis (2-12 people)
Provided over $15,000.00 in treatment
Overview of Treatment Provided
Adults (n=49)
19 + years
Most common findings
Pain
Caries
Periodontal disease
Overview of Treatment Provided
Child Population (n=63)
0-18 years
Most common findings
Pain
Early Childhood Caries (incl. severe)
Extractions
Orthodontic treatment
All needed oral hygiene instruction, education around the oral health care system
Overview of Treatment Provided
Most common codes
01205 (emergency exam)
02111/02112/02142/02601 (radiographs)
20111 (caries, trauma and pain control)
21221/21212/21223 (restorations)
71101/71109 (extractions)
Referrals for:
Surgical extractions
General anesthetic
Filling the Gap Clinic – Early Lessons
Logistical challenges
Difficulty in dealing with Medavie Blue Cross
Up to 7 weeks for pre-determinations (pre-D)
Need ≠ Demand
Removal of barriers ≠ Utilization
Refusal of treatment
Arabic language oral health material needed
Filling the Gap Clinic – Early Lessons
Confusion around IFHP coverage
Education of students, staff and faculty
Expectations around delivery and costs of oral health care
More efficient process needed to be developed
Thought required about long term provision of care
Towards More Comprehensive Care
Refugee patients transitioned into our student pool
For the 2016-17 academic year the CoD will provide, at no cost:
Pediatric treatment
Periodontal treatment (excl. surgery)
Restorative treatment (excl. esthetic, non-functional needs)
Created pool of volunteer interpreters from the wider University Community
Future Directions
College of Dentistry remains dental home for those in need
Formalized program manual developed
Outlined processes for staff, student and faculty
Future Directions
Evaluate clinic processes
Work to develop stronger relationship with settlement agencies
Extend care to other new Canadians
Develop more robust referral pathways (e.g., for specialist care)
Maintain clinic in response to need
Translate oral health materials into Arabic and other languages identified by
settlement agencies
Thank You!!