Your SlideShare is downloading. ×
Innovations in providing oral health services to hiv positive persons
Upcoming SlideShare
Loading in...5

Thanks for flagging this SlideShare!

Oops! An error has occurred.

Saving this for later? Get the SlideShare app to save on your phone or tablet. Read anywhere, anytime – even offline.
Text the download link to your phone
Standard text messaging rates apply

Innovations in providing oral health services to hiv positive persons


Published on

Published in: Health & Medicine, Business

  • Be the first to comment

  • Be the first to like this

No Downloads
Total Views
On Slideshare
From Embeds
Number of Embeds
Embeds 0
No embeds

Report content
Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

No notes for slide
  • 2503 is not the final N. We are working on finalizing the database. The N will be lower once we remove those patients who have withdrawn their consent.1.2% (30) of our sample is transgendered and 15 of those are from SF.
  • Cleaning only w/o any problem was 49%
  • Cleaning only w/o any problem was 49%
  • Transcript

    • 2.
    • 3. East Texas Dental/OralCare Services
    • 4. Special Health Resources for Texas
      Was established in 1995 as an HIV/AIDS Service Organization serving HIV + and Substance Abusing Persons in East Texas.
      In 2006 serving 1,200 HIV + persons with comprehensive medical and case management care, we believed that increasing our dental services from 1 day per week to 2 would make a difference in the health care outcomes of those we serve.
    • 5. Special Programs of National Significance (SPNS) Grant
      15 sites around the country were recipients of this grant, SHRT is the only one in Texas.
      Innovation in Oral Health Care Initiative for HIV positive people in partnership with the ECHO research team at Boston University.
    • 6. DENTAL Servicesto HIV Positive Patients
      Longview /Tyler /Texarkana
      DDS Services
      Oral Health Case Management
      Dental Hygiene
      Oral Health Education
    • 7. Implementation
      SHRT model integrates the delivery of comprehensive dental/oral health care into a primary health care services.
      Hired Project Director, Nancy Young, LCDC.
      Contracted with Dr. Damon Spencer from Baylor College of Dentistry in Dallas as our dentist.
      Partnership with Texas A&M University Baylor College of Dentistry provides Dental Student Internship placement in SHRT dental clinics, supervised by Damon Spencer, DDS.
      Hired Oral Health Case Manager, Ernesto Guevara, bilingual, who had 5 years RW Medical Case Management experience.
    • 8. Implementation
      Hired Registered Dental Hygienist.
      Increased dental chairs from 2 to 7.
      Recruitment has been from within our own agency through Ryan White Medical Case Managers utilizing our referral and follow-up tracking process.
      All newly identified positive persons enrolled in services are referred for a comprehensive oral health exam.
      Partnership with Stephen F. Austin State University as our evaluators.
    • 9. Implementation
      Unique to this program are the intensive oral health case management services provided during the Baseline and Follow-up Interviews.
      Patient retention rate 88%, due to SHRT one stop shop where patients receive medical services, case management, housing, transportation, medication assistance, substance abuse and mental health services.
      SHRT serves 23 counties in rural East Texas.
    • 10. Initial Results From the Multisite Study
    • 11. Baseline Results
      2494 in database from all sites
      Mean age of patients is 44 years old
      Mean years HIV positive is 10 years
      Patients are: 40% Black, 33% White, 21% Latino and 75% Male
      53% of patients had not received dental care in 2 or more years.
    • 12. Additional Demographics
    • 13. HIV Status - Baseline
      • 51% have an undetectable Viral Load
      • 14. 57% have a CD4 of 350 or greater
      • 15. 78% report current ART use
      • 16. 98% have a regular place for HIV care
      • 17. 85% have an HIV case manager
      • 18. 94% have seen HIV provider in past 6 months
    • What brings you here today?
      55% reported at least one or more presenting problem
      Teeth filled or replaced – 47%
      Relief of pain – 35%
      Denture work – 25%
      Teeth pulled – 22%
      Gum treatment – 15%
      39% reported coming in for a cleaning only
    • 19. Symptoms in the past 12 months?
      Tooth decay/cavity 52%
      Sensitivity 50%
      Dissatisfied with appearance 50%
      Toothache 43%
      Bleeding gums 36%
    • 20. How would you describe the health of your teeth and gums?
    • Overall, how would you rate your health in the past 4 weeks?
    • Baseline Practices
      • 96% report brushing in the past 30 days; 82% report once a day
      • 30. 46% flossing in the past 30 days; 19% report once a day
      • 31. 52% report smoking in the past 30 days
      • 32. 71% report drinking sugary sodas and 62% eat hard candy or chew gum with sugar
    • Ancillary services: update
      Total number of encounters: 15,129
      Total number of patients with ancillary data:
      1891 (87% of enrolled eligible patients, ranges from 20%-98% cross sites)
    • 33. Ancillary services: update
      Most frequently reported ancillary services
      • Schedule dental appointments/coordinate referrals
      • 34. Dental appointment reminders
      • 35. Provide transportation
      • 36. Link with HIV case management
      • 37. Provide meal/snack AND
      • 38. Provide Oral health treatment or self-care information
    • Ancillary services: Staff
    • 39. Qualitative Study
      39 patients with Initial & Follow-up interviews
      6 sites participate in the study
      From the patient perspective
      How does this SPNS program impact client oral health care, knowledge, and practices?
      What is the role of dental staff (case manager/patient navigator)?
    • 40. Preliminary Analysis: participation in SPNS program
      Did you learn something new about HIV and oral health care?
      Good Oral Hygiene = Good HIV Health
      “I've learned that it's important to brush your teeth, gargle and always check your mouth, your tongue and your gums to see if you have any sores because a lot of times you can have a sore in your mouth and not know you have the sore.”
    • 41. Preliminary Analysis: participation in SPNS program
      Improvements in oral health care practices
      Better brushing & flossing techniques & frequency
      “ Now I buy lots of toothbrushes and use them for a short time and replace them.”
      “I brush everyday instead of 3 times a week… I floss a lot more”
      “I brush longer”
    • 42. Preliminary Analysis: participation in SPNS program
      Improvements in oral health care practices
      Reduce or stop smoking/tobacco use
      “ I still use snuff but I cut back a little and don’t leave it in my mouth as long...”
      Reduce soda intake
    • 43. Preliminary Analysis: participation in SPNS program
      Biggest difference from receiving care
      Relief of pain
      Can eat
      Improved appearance
      “Can eat so I gain weight…look better”
      “Smile more.. No holes”
      Dental staff
      High quality
      Easier access to care
      “I can see dentist on a regular basis”
    • 44. Preliminary Analysis: participation in SPNS program
      Changes to overall HIV health
      Mixed; some noticed no changes
      Others; feel their oral health helped improved overall health
      “Physically, I feel better now. My teeth don’t hurt and stuff like that like they used to. It’s a lot changed, a lot, I feel emotionally I’m able to get out and enjoy myself more. I like to smile, I like to talk and stuff, I mean I can do that now. No, no pain at all. I like it.”
    • 45. Preliminary Analysis: participation in SPNS program
      The role of the dental case manager
      Access to oral health care
      “I would not have dental care if it wasn’t for (name of Dental case manager)
      He (dental case manager) got me into the program and it has been good to me
      Better retained in dental care
      “ I feel comfortable with her and makes me want to come to appointments
      Helped patient communicate with dental and medical providers
      Explains how to take care of mouth and teeth & shares information
    • 46. Preliminary Analysis: participation in SPNS program
      Advice to others living with HIV about oral health care
      Importance of oral health in overall HIV health care
      “Need to keep up with physical, mental and ORAL health.. All are connected..”
      “if you do not know how to take care of your teeth and you are not willing to spend the time and the energy to do proper daily oral hygiene, then you don’t need your teeth. You need to get some wooden teeth or something. You can die.”
      “I would tell them that they need to go because if your teeth are healthier that means you’ll be more healthier and that’ll help on your CD4 counts and stuff like that a lot. After I got my teeth and stuff fixed my CD4 cells they skyrocketed.”
      “Your oral healthcare does affect your other health, your health in general, your HIV health in general. You need to keep care of your teeth and if your teeth are in good shape then you should be all right as far as avoiding any infections or anything like that.”
    • 47. Successes and Challenges
      350 Persons living with HIV received quality dental care
      189 HIV + Persons enrolled in SPNS study while receiving intensive oral health case management.
      595 people received oral health education
      Each patient received referrals as needed, meeting with OHCM at least 3x per year
      Partnership with Stephen F. Austin State University as evaluators of Quality of Life study
      Focus Groups in Longview, Tyler, Texarkana
    • 48. Meeting the Challenge
      Innovative dental care by Dentist with 14 years experience in HIV dental care
      Dental hygiene care
      Intensive Oral Health Case Management
      Comprehensive Oral Health education
      One stop shop care for HIV positive clients
      Multidisciplinary staffing of patients
      Purchased a van for transporting patients