incorporating dental education for primary care

---

INCORPORATING DENTAL EDUCATION FOR PRIMARY CARE THROUGH INTERPROFESSIONAL COLLABORATIVE PRACTICE

Timothy Martinez, DMD Jenny Sun Tjahjono, DMD ADEA 2015 Contributing authors: Bertha Olivia Alarcon, DDS Elizabeth Maugh, MS, PA-C Yawen Peng, DMD Effuah Harris, DDS Brooke Bodart, RDH, MPA Marc Bernardo, MPH

LEARNING OBJECTIVES Upon completion of this session, participants will… ¢ 

¢ 

¢ 

Effectively compose an interprofessional curriculum to incorporate dental education into primary care providers’ education. Implement the collaborative experience with hands-on interactive practice to their target population. Assess the impact of the curriculum through the changes in the community's quality of life.

Interprofessional Education (IPE)

WHY IPE? Changes in the U.S. health care system. —  Rapid increases in cost of care. —  Variability in quality produced by our fragmented health care system. —  Existence of health disparities among different populations of people.

**Glassman P. Oral Health in the Era of Accountability. 2013 DQA Conference.

AFFORDABLE CARE ACT: THE TRIPLE AIM ¢  Improving

patient experience of care.

¢  Improving

the health of individuals and populations.

¢  Reducing

the per capita cost of health care.

“Interprofessional education (IPE) occurs when students from two or more professions learn about, from and with each other to enable effective collaboration and improve health outcomes..” ** World Health Organization (2010): Framework for Action on Interprofessional Education & Collaborative Practice

WORLD HEALTH ORGANIZATION (WHO) ON IPE ¢ 

¢ 

¢ 

¢ 

Effective Interprofessional Education enables effective collaborative practice. Collaborative practice strengthens health systems & improves health outcomes Health policy benefits •  Improved patient outcomes •  Improved workplace practices & productivity •  Raised morale •  Better access to health care Effective IPE includes: —  Supporting champions —  A resolve to change the culture and attitudes of health workers —  A willingness to update, renew and revise current curriculum —  Legislation that eliminates barriers to collaborative practice

**World Health Organization 2010: Framework for Action on IPE & Collaborative practice.

WESTERN UNIVERSITY OF HEALTH SCIENCES (WESTERNU) Pomona College of Osteopathic Medicine College of Dental Medicine College of Allied Health Professions Physician Assistant College of Allied Health Professions Physical Therapy College of Optometry College of Pharmacy College of Graduate Nursing College of Podiatric Medicine College of Veterinary Medicine Oregon College of Osteopathic Medicine Linn Benton Community College Nursing Program Linn Benton Community Medical Assisting Program Oregon State University Corvallis College of Pharmacy        

IPE Initiative Mission Statement: ¢ 

To produce humanistic healthcare professionals who provide and promote collaborative patient-centered care & coordinated health care management.

IPE Program Outcomes -- The WesternU graduate will: ¢  Demonstrate an understanding of other health professionals ¢  Provide and promote team approach to patient care and health care management ¢  Exemplify a health care practitioner with a patient-centered health care focus IPE Program Schedule ¢  July 23, 2007, the formal planning process for Western University of Health Science’s Interprofessional Education ¢  Fall 2009, First use of IPE in Curriculum

WESTERNU IPE CORE COMPETENCY DOMAINS 1.  2.  3.  4.  5. 

Communication Collaboration Teams and teamwork in health care Scope of practice One health

**Tegzes J, Callard P. WesternU IPE 5000 Syllabus. Fall 2014.

WESTERNU CDM CURRICULUM BUILDING BLOCKS

Comprehensive Patient Care

Community Based Dental Education

Interprofessional Education Basic and Biomedical Sciences

Dental Sciences

WESTERNU IPE PHASE 1

WESTERNU IPE PHASE 2 Consultation request

Unique cases for each professional program

Consultation reply & feedback

**Tegzes J, Yumori J. WesternU IPE 6000 Syllabus. Fall 2014.

WESTERNU IPE PHASE 3

Case conference

Standardized patient

CASE STUDY Dental history: A 50-year-old male presents to Patient Care Center for a comprehensive oral exam with chief complaint “I got bad breath.” Patient reports bad breath “runs in his family” including his dog. He experiences generalized dull pain throughout his gingiva, and some of his teeth are loose or missing. Patient reports brushing his teeth once a day but does not floss. Patient snacks on junk food frequently and shares his food with his dog. Patient has not seen a dentist for the past 10 years due to a lack of transportation. Since the opening of the Patient Care Center, patient is able to now walk to his appointments. Medical history: Patient reports a history of type II diabetes and describes his health as “poor”. Patient reports having joint and foot pain which causes him to have difficulty walking. Patient has not been to a medical office since he lost his health insurance 5 years ago. Patient ran out of his medications and cannot recall the names of his medications. He denies any allergy to medication or food. Patient has a 20 pack-year history of smoking and drinks beers on the weekends. Vital signs are 160/95, pulse 80. BMI is 30. ASA III.

CASE STUDY QUESTIONS: 1. 

Describe how your profession could be involved in this case.

2. 

List the other healthcare professions you need in your team in order to resolve all the safety issues.

**Tegzes J, Yumori J. WesternU IPE 6000 Syllabus. Fall 2014.

No time for IPE? Have students involved.

IPE PHASE 2 CASE: TOXOPLASMOSIS

Interprofessional Collaborative Practice (IPCP)

“Collaborative practice happens when multiple health workers from different professional backgrounds work together with patients, families, carers and communities to deliver the highest quality of care.” ** World Health Organization (2010): Framework for Action on Interprofessional Education & Collaborative Practice

PRIMARY CARE: ¢ 

¢ 

A primary care practice serves as the patient's first point of entry into the health care system and as the continuing focal point for all needed health care services. Primary care includes health promotion, disease prevention, health maintenance, counseling, patient education, diagnosis and treatment of acute and chronic illnesses in a variety of health care settings.

**Primary Care. AAPF Policies 2014.

Integration of Oral Health and Primary Care Practice (IOHPCP) U.S. Department of Health and Human Services Health Resources and Services Administration February 2014

HRSA IOHPCP ¢ 

¢ 

¢ 

¢ 

Lack of access to oral health care contributes to profound and enduring oral health disparities in the U.S. Children are only one of the many vulnerable and underserved populations that face persistent, systemic barriers to accessing oral health care. The U.S. health care system is able to provide acute care but continues to struggle to address the need for ongoing care especially for vulnerable populations such as the elderly, disabled, mentally ill, and special needs populations. The IOHPCP initiative strives to improve access for early detection and preventive interventions by expanding oral health clinical competency of primary care clinicians, leading to improved oral health.

HRSA IOHPCP ¢ 

¢ 

¢ 

¢ 

The IOHPCP focuses on frontline primary care health professionals, specifically nurse practitioners, nurse midwives, physicians and physician assistants. These primary care practitioners are members of the existing delivery system who could incorporate oral health core clinical competencies into their existing scope of practice. The IOHPCP interprofessional efforts facilitate change in the clinical practice of primary care practitioners in the safety net community. The safety net practitioners are most likely to see vulnerable and underserved populations without , or with limited access to dental services.

HRSA IHOPCP FIVE DOMAINS OF CLINICAL COMPETENCIES: 1. Risk assessment —  Identify factors that impact oral health and overall health. —  Conduct patient-specific, oral health risk assessments on all patients. —  Integrate epidemiology of caries, periodontal diseases, oral cancer, and common oral trauma into the risk assessment.

HRSA IHOPCP FIVE DOMAINS OF CLINICAL COMPETENCIES: 2. Oral Health Evaluation —  Integrate subjective and objective findings based on completion of a focused oral health history, risk assessment, and performance of clinical oral screening. 3. Preventive Intervention —  Recognize the options and strategies to address oral health needs. —  Implement appropriate patient-centered preventive oral health interventions.

HRSA IHOPCP FIVE DOMAINS OF CLINICAL COMPETENCIES: 4. Communication and Education —  Provide targeted patient education about importance of oral health and how to maintain good oral health, which considers oral health literacy, nutrition, and patient’s perceived oral health barriers, in a culturally sensitive manner. 5. Interprofessional Collaborative Practice —  Exchange meaningful information among health care providers to identify and implement appropriate high quality care of patients, based on comprehensive evaluations and options available within the local health delivery and referral system. —  Facilitate patient navigation in the oral health care delivery system.

**Friedrichsen S, Martinez T, Hostetler J, Tang J. Innovations in Interprofessional Education: Building Collaborative Practice Skills. CDA Journal. Vol 42.No 9.Sept 2014.

¢  “Coordinate

with community health providers, other health science colleges and state and local partners to develop collaborative practices and interdisciplinary teams.” ¢  “Graduates will be able to draw on interdisciplinary experiences and apply this training their future practices to improve the health of children, families and communities” **Friedrichsen S, Martinez T, Hostetler J, Tang J. Innovations in Interprofessional Education: Building Collaborative Practice Skills. CDA Journal. Vol 42. No 9. Sept 2014.

WESTERNU CDM CURRICULUM BUILDING BLOCKS

Comprehensive Patient Care

Community Based Dental Education Interprofessional Education/ Collaborative Practice

Basic and Biomedical Sciences

Dental Sciences

**Integration of Oral Health and Primary Care Practice. HRSA. Feb 2014.

WesternU CDM Curriculum Implementation Model

Attachment 11- Logic Model – WesternU College of Dental Medicine INPUTS' WHAT%WE%INVEST% ___________________________% ' WesternU.Applicant'and'Lead' ! College%of%Dental% Medicine% % ' Develop'Partnerships:' Develop/formalize%partnerships' ' ' ' ' ' Non.Dental'Primary'Healthcare' Organization' ! College%of%Graduate% Nursing% ! College%of%Allied% Health/PA% % Community'Based'Primary'Care' Delivery'Sites'' ! Dessert%friends%of%the% Developmentally% Disabled% ! Sacramento%Native% American%Health%Center% % Community'Based'Organization' • Well%in%the%Dessert%' ' ' ' %

ACTIVITIES' WHAT%WE%DO% __________________________% % 'Identify,'Develop'and'Promote' Effective'Inter.professional' Training'Models' ! Obtain%input%from% stakeholders% ! Identify%and%promote%criteria% for%effective%models% ! Engage%partners%in%planning% and%implementation%to%align% and%integrate%efforts% ! Produce%scientific%reports,% resources%and%tools% Deliver'Education'and'Training% ! Identify%workforce%and% access%needs% ! Identify%gaps%in%knowledge% and%skill% ! Design,%develop%and% implement%integrated%oral% health/primary%healthcare% workforce%training%model(s)% ! Prepare/deliver%interM professional%didactic%and% experiential%training%% ! Identify/deliver%educational% opportunities%for%partners% Collect'Data'–Study.Evaluate' Expand'the'Evidence'Base' ! Identify%research%needs%and% their%policy%implications% ! Engage%the%research% community%to%advance% health%services%research%' Transfer'Science'to'Practice' ! Identify/promote%evidence% based%policies%

Western University of Health Sciences

OUTPUT' WHO%WE%REACH% _______________% % Students'' Pre.doctoral'dental'' ! PreMdoctoral%dental% ! Dental%Residents% ! Nurse%Practitioners% ! Physician%Assistants% Licensed'Providers' ! Dental/Medical% ! Primary%Care%Org% ! Community%Based%Org% ! FQHCs% ! Hospitals% Policy'Makers' ! Government%Admin' ! National%Org' ! DentiCal% ! Title%V% ! HIVMAIDS%Program% Payers.State'Contractors' ! Liberty% ! Delta%Dental%of%CA% Consumers/Patients' ! Medicaid%beneficiaries% ! LowMincome,% vulnerable,%under% served,%rural% communities% ! CSHCN% ! Pregnant%Women% ! Intellectual%Disabled% ! HIVMAIDS%pts%

1

OUTPUTS' PRODUCTSM ACCOMPLISHMENTS% ________________________% Advanced'Inter.professional' Didactic'and'Experiential' Training'Program. Advancing%3%models:' • Models%engaging' communityMbased% organizations' • Models%engaging% NonMdental%primary% care%training% programs%' • Models%engaging% communityMbased% primary%care% delivery%sites' Expert'Faculty.Integrated% healthcare'' Primary'Trainees'competent% in%interprofession% healthcare% Other'Trainerrs'competent%in% interprofession%healthcare' Research'Agenda'addressing% integrated%Healthcare'' Online'Library'of'Resources'' ! Faculty%resources%for% integrated%healthcare%% ! Student%resources%% ! Library%of%evidence% based%models%for% integrated%oral%health% and%primary%healthcare% ! Policy%briefs%and%white% papers%that%promote% successful%model% implementation%%% ! Linkages%to%resources,% policies,%guidelines%and% resources% %

OUTCOMES' IMPACT% ____________________________% ' Short.term:' ! New%integrated%community% sites%% ! Improved%collaboration% among%stakeholders%% ! Achieved%competency%among% Primary%and%Other%Health% Trainees% ! Increased%interest%and% awareness%of%systems% integration%% ! Improved%cultural% competency%among%Primary% and%Other%Health%Trainees% ! Improved%Health%Literacy% among%target%communities%% ' Intermediate:''' ! Increased%integration%among% professional%dental%and% primary%training%institutions% ! Increase%use%of%data%and% informatics%for%quality% improvement% ! Improved%quality%in% educational%and%training% programs%for%preMdoctoral% healthcare%providers%% ! Increased%access%to%quality% care% Long.term:'' ! Improved%oral%health%status% for%vulnerable,%undeserved% and%rural%communities% ! Improved%national% infrastructure%and%capacity%to% serve%vulnerable,%underserved% and%rural%communities%% ! Improved%healthcare%delivery% system% ! Decreased%oral%health% disparities% ' '

WESTERNU CDM SCHOOL BASED ORAL HEALTH CENTERS IN POMONA, EL MONTE, LOS ANGELES UNIFIED SCHOOL DISTRICTS

El Monte

Pomona

WESTERNU CDM IPCP COLLABORATION COLLEGE OF GRADUATE NURSING

Nursing faculty

Dental student

Nursing student Dental faculty Dental student Patient Patient

Dental faculty

Nursing student

WESTERNU CDM IPCP COLLABORATION COLLEGE OF ALLIED HEALTH PROFESSIONS DEPARTMENT OF PHYSICIAN ASSISTANT EDUCATION Dental student

Physician assistant student Dental faculty

Discussion

Hands on

WESTERNU CDM IPCP COLLABORATION POMONA VALLEY HOSPITAL MEDICAL CENTER FAMILY MEDICINE RESIDENCY PROGRAM

Interprofessional Collaborative Practice Home visits to special heath care needs population

WESTERNU CDM IPCP COLLABORATION SPECIAL HEALTH CARE NEEDS POPULATION HOME VISITS Dental hygienist

Dental student

Nursing faculty Dental faculty

Parent Home nurse

Parent

IPCP PATIENT CARE IPCP patient care

FEEDBACK FROM FAMILY MEDICINE RESIDENTS FMR feedback

IPCP IMPACT ON PATIENTS’ QUALITY OF LIFE

Patient Feedback

FEEDBACK FROM PHYSICIAN ASSISTANT STUDENTS ¢ 

I have a better appreciation for all the work Dentists do and the need for oral health. I felt like I learned more in those couple of hours [in clinic] than what could have been spent in the classroom for way longer. -- Darin,MSPA2015

¢ 

This experience made me realize that I want to be a well-rounded provider and learn as much as I can from all the different health professions. -- Kaitlin, MSPA 2015

¢ 

I learned that as a PA you could learn a lot from a dentist that improves the quality of care you give to your patients. -- Desirae, MSPA 2015

¢ 

I learned that it is important to take advantage of any opportunity to learn from other professions because they may have insight I would not be able to get anywhere else. -- Shannon, MSPA 2015

WHAT’S NEXT?

WUCDM IPCP COMMUNITY HEALTH CENTER

WUCDM IPCP GLOBAL OUTREACH EFFORT GHANA PHYSICIANS AND SURGEONS FOUNDATION

WUCDM IPCP GLOBAL OUTREACH EFFORT UNIVERSIDAD DE CONCEPCIÓN, CHILE

For more information: www.westernu.edu

www.wucdcp.org