Dental Case Management


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The goal of Integrating HIV Innovative Practices (IHIP) is to enable health care providers to implement proven innovations in HIV care and services within their own practices. This Webinar is the second in a three-part series exploring innovative approaches to delivering oral health care and services to people living with HIV/AIDS, featuring grantees of the Health Resources and Services Administration’s Special Projects of National Significance (SPNS) Innovations in Oral Health Care Initiative (Oral Health Initiative).

This Webinar outlines dental case management programs at the AIDS Care Group (ACG) in Chester, PA and the Native American Health Center (NAHC) in San Francisco, CA. The presenters include Dr. Howell Strauss and Mr. Nelson Diaz from ACG; and Dr. Carolyn Brown and Ms. Lucy Wright, RDH, representing the NAHC. The presentation details the pros, cons, and considerations of dental case management from administrative and clinical perspectives. The presenters also provide tips for being a good dental case manager and how this can result in improved health outcomes.

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  • .
  • Good morning. This is Dr. Carolyn Brown and Lucy Wright, RDA from the Native American Health Center in San Francisco. Our agency is a community health center located in the city’s Mission District. We have been providers of excellent dental care for Persons Living with HIV/AIDS since the 1980’s.
  • NAHC receives referrals from many, many agencies. We receive funding for only 75 unique dental patients per year, which is about 5 times less than the number of active dental patients with HIV/AIDS on record here.
  • Thank you for your time
    -My contact information and the Impact Marketing + Communications Website are at the bottom, so please feel free to reach out any time if you have questions about our firm, the IHIP work or any other HRSA deliverables we’ve created, or if there are any marketing or communications projects we can help you with.
    - At this time, I’d be happy to take any questions you have about the IHIP project. We will also turn to Q&A with the other presenters.
  • Dental Case Management

    1. 1. SPNS IHIP Oral Health Webinar Series: Dental Case Management ………………. Presented by Dr. Howell Strauss and Nelson Diaz of AIDS Care Group and Dr. Carolyn Brown and Lucy Wright of the Native American Health Center January 9, 2014
    2. 2. Agenda ■ Introduction to SPNS Integrating HIV Innovative Practices (IHIP) project ■ ■ Sarah Cook-Raymond, Managing Director of Impact Marketing + Communications Presentations ■ AIDS Care Group of Chester, PA ■ ■ ■ Native American Health Center of San Francisco, CA ■ ■ ■ Dr. Howell Strauss, Executive Director & Dentist Nelson Orlando Diaz, Dental Case Manager & Community Health Worker Dr. Carolyn Brown, Dental Director, Programs & Development Lucy Wright, RDA, Dental Program Coordinator & Former Patient Navigator Q&A
    3. 3. IHIP Resources on TARGET Center Website
    4. 4. IHIP Oral Health Resources ■Training Manual ■Curriculum ■Pocket Guide ■Webinar ■ ■ ■ Series Healthy Mouth, Healthy Body (Held Dec. 13) Dental Case Management Clinical Aspects of Oral Health Care for PLWHA Recording and slides for all Webinars will be uploaded to TARGET Center Web site following the live event:
    5. 5. Other IHIP Resources ■ Buprenorphine Therapy ■ ■ Engaging Hard-to-Reach Populations ■ ■ Training Manual, Curriculum, and Webinars on engaging hardto-reach populations Jail Linkages ■ ■ Training Manual, Curriculum, Monograph, and Webinars on implementing buprenorphine in primary care settings Training Manual, Curriculum, Pocket Guide, and Webinars on enhancing linkages to HIV care in jails settings UPCOMING: Hepatitis C Treatment Expansion ■ In Spring/Summer 2014, look for training materials on increasing access to and completion of Hepatitis C treatment for PLWHA on the TARGET Center Web site.
    6. 6. AIDS Care Group Outreach and Dental Case Management
    7. 7. Clinical services       Medicine Dentistry Medical case management Nutrition Psychiatry Psychosocial services
    8. 8. Social and Medical Factors Affect Individual and Community Health There is poverty, joblessness, homelessness, and despair. Crime, substance abuse behaviors, and/or mental health conditions affect access to and retention in care. Dental care historically lacking in this targeted population.
    9. 9. Historical Review of Access to Dental Care  1980s: Regardless of ability to pay, dental care was inaccessible.  Early 1990s: One of two dental schools in Philadelphia accepted HIV positive patients.  Middle 1990s: Americans with Disabilities Act: All dental practices are offices of public accommodation.
    10. 10. History continues  New ways devised to deny dental care: “This office does not accept Medicaid dental insurance.”
    11. 11. Barriers to Care      Fear of the dentist Inability to pay Need to be asleep No way to get there Other family and health issues
    12. 12. Newly Constructed Barriers  To get care in the Ryan White setting, you must present your papers.  “Papers, please.”
    13. 13. Special Projects The AIDS Care Group was awarded a Special Projects of National Significance grant for “Oral Health Care – Outreach Project” A new clinic was established in Coatesville in October, 2006
    14. 14. Dental Case Management  Outreach stresses the need to go where people are receiving the most basic of their needs.  It can mean meeting people in hospitals, food distribution centers, religious meeting places, or social service agencies. It can also mean meeting people in prisons and jails, drug and alcohol treatment centers, or crack-houses.  The dental case manager is the glue that keeps the program together.
    15. 15. Linked patients, papers, and providers. Liaison between medical and social services providers, family members, and dental staff. Transportation: New van logged 35,000 miles in first year of operation; exclusively for the dental outreach program. Other enhancements: food, clothing, gas cards, chief kibbitzer.
    16. 16.        New dental clinic established. New dentist hired. Staff added from the community. Outreach provided to multiple communities. Start-up time: 4 months. Full patient schedule within 6 months. Over 600 patients treated.
    17. 17.  Program sustained to this day, using the same model of outreach and removing barriers to care.
    18. 18. 2014 HRSA/SPNS IHIP Dental Case Management Webinar Native American Health Center Carolyn Brown, DDS Dental Director Lucy Wright,RDA Dental Program Coordinator Former Patient Navigator
    19. 19. Building the Case for NAHC’s Patient Navigator (Pre-2006)  Wide range of dental services offered at NAHC – Compact dental team focusing on clinical services  Referrals for HIV+ persons from 14+ agencies to NAHC dental  Sporadic success in managing dental treatment – Sometimes resulted in incomplete appointments, missed appointments – Confusion on the part of the patient, NAHC and referring agency – Dentist or over burdened receptionist often requesting + med info – Most treatment plan completions for patients with the least amount of access issues – 35% no-show rate for dental appointments from HIV+ patients referred from partner agencies1 1- Goddard G, Brown C, and Ahmad S: Oral Disease Prevalence among HIV-Positive Native American Indians in an Urban Clinic, Journal of Psychoactive Drugs, Vol 37 (3), Sept 2005. PMID: 16295015
    20. 20. Creating Dental Case Management The chicken or the egg? Option 1: Dental staff and train for case management Option 2: Case manager and upgrade dental i.q.
    21. 21. Patient NavigatorGOALS  Increase Access – Identify barriers to care during interviews, and treatment; customize support or ancillary services  Intro the idea of a dental home – Patient will identify with NAHC, their dentist, and dental case manager as THEIR provider, fostering understanding and motivation towards treatment plan completion  Build Team Mentality – – – – Build cohesiveness of the dental team Bridge resources with medical case managers Bridge resources for referrals Partner w. the patient, and care givers to meet their needs and accomplish their dental goals – Identify other medical or community resources for the patient
    22. 22. Patient NavigatorA Day in the Life of… 9a -HIVQUAL audit prep 930a- Pick up food from Food Bank 10a- Accompany patient to the oral surgeon 11a- Call 10 patients for appt reminder; Remind 1 patient to bring lab work 1130a-Coordinate with oral sx’s office on patient’s f/u instructions 12p- Answer patient’s email who is confused about appt time; review incoming faxes and lab work 2p- Intake 2 new patients; f/up with 1+ 3p- Meet with DDS to review tx plan progress 4p- Review treatment plans with DDS 430a- Call patient from oral surgery appt; follow-up 5p- Meet with 1 patient after dental appointment
    23. 23. Findings from the SPNS projects Clinical: Improvement in overall health status More likely to complete Phase 1 treatment plans More likely to be retained in dental care Patients: Availability of DCM Increase access Knowledge Empathy and offer comfort Patients credited overall health improvement to DCM LeMay, Tobias, Umez-Eronini, Brown,McCluskey, Fox, Bednarsh and Cabral.Dental case manager encounters: the association with retention in dental care and treatment plan completion. Spec Care Dentist. 2013 Mar-Apr;33(2):70-7. LeMay, Cashman, McDonald, Graves. A new approach to ensuring oral health care for people living with HIV/AIDS: the dental case manager. Prev Chronic Dis. 2012;9:E158.
    24. 24. NAHC HOPE/SPNS Study 2007- 2010 Results  DCM (n= 85) and non-DCM patients (n=205) very similar populations  DCM patients had significantly higher: – – – – – Phase 1 treatment plan completion Low intensity preventative treatments Higher number of dental appointments/yr Higher likelihood of keeping appt. Higher reported oral health quality of life Brown C, Ponnala S, Kim J. Oral Presentation: “Maximizing Clinical and Health Outcomes: HIV+ Dental Case Management”. International Association for Dental Research, Miami, FL. April 1-4, 2009.
    25. 25. NAHC’s Patient Navigator Success  No show rate for HIV+ dental patients at 5% from 35% over 4 years  118 patients who have been out of care recruited and retained  88+ specialty referral appointments kept and treatment received  Close partnership with 10 medical clinics specializing in HIV+ care  Added 2nd Dental Case Manager; Ratio was 40-50 patients : 1 DCM
    26. 26. The State and Future of HIV Research Goal #3: Optimizing treatment and care of the HIV-infected individual “I never really had good teeth, but my T cells have actually gone up to 600 since I’ve been here getting my teeth fixed. My health improved so much; I’m so grateful! I never realized that I needed help in getting here. I love Lucy, my DCM.” Mike M.
    27. 27. Strategies for Success NAHC SPNS Team Sridevi Ponnala, DDS, Clinical Director Carolyn Brown, DDS, Dental Director Eulalia Valerio, Director, Projects & Evaluation Lucy Wright, RDA, Dental Patient Navigator Gloryanna Valerio-Leonce, Data & Intake Manager
    28. 28. Next Oral Health Webinar Clinical Aspects of Oral Health Care for PLWHA January 22, 2014 at 3 PM EST More information available at: • Presenters: • • Dr. David Reznik, HIVDent and Grady Health System of Atlanta, GA Ms. Helene Bednarsh, RDH, MPH, HIVDent and Boston Public Health Commission of Boston, MA
    29. 29. Q&A To be informed about Webinars and other upcoming IHIP resources, sign up for the IHIP listserv by emailing IHIP Web site: Connect with Us Sarah Cook-Raymond, Managing Director |Impact Marketing + Communications Twitter: @impactmc1| Facebook: ImpactMarCom | | 202-588-0300