Improving Access to Oral Health Care for Vulnerable and Underserved Populations (2011) / Chapter Skim
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6 A Vision for the Delivery of Oral Health Care to Vulnerable and Underserved Populations
6 A Vision for the Delivery of Oral Health Care to Vulnerable and Underserved Populations
Pages 229-254
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From page 229... ...
oral health care for vulnerable and underserved populations is delivered in myriad settings and through varied institutional structures, with limited common goals and no coherent, organizing system; (4) there is no agreed-upon set of essential oral health services with which to evaluate the success of efforts designed to improve access; and (5)
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From page 230... ...
population is able to routinely obtain oral health care in traditional dental practice settings, millions of Americans have unmet oral health needs due, in part, to major barriers in access to care. This is especially true for the nation's vulnerable and underserved populations.
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From page 231... ...
This strategy will help groups that are unable to obtain oral health services in traditional dental practice settings to receive care from the range of health care professionals that they encounter more routinely. For populations that rarely visit dentists, nondental health care professionals may be in the best position to provide oral health education, screening, and prevention.
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From page 232... ...
The core set of oral health competencies for nondental health care professionals needs to be developed with input from a variety of stakeholders to ensure that they are appropriately broad and, therefore, applicable to many health professions. The competencies also need to reflect the collective expertise and experience of dental professionals and their nondental health care professional counterparts to ensure that the competencies prepare professionals to provide care that meets appropriate standards of quality (i.e., care that is safe, timely, effective, efficient, equitable, and patient-centered)
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From page 233... ...
The committee concludes the best way to incorporate the oral health competencies into health professional education is for accrediting and certification bodies to require them for accreditation and maintenance of certification. Therefore, the committee recommends RECOMMENDATION 1b: Following the development of a core set of oral health competencies for nondental health care professionals • Accrediting bodies for undergraduate and graduate-level nondental health care professional education programs should integrate these core competencies into their requirements for accreditation; and • All certification and maintenance of certification for health care professionals should include demonstration of competence in oral health care as a criterion.
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From page 234... ...
The registered dental hygienist in alternative practice license in California, which allows dental hygienists to practice in certain community settings without a dentist's direct supervision, was a result of this process. California also has a current project evaluating the placement of Interim Therapeutic Restorations by Dental Hygienists and Dental Assistants under general supervision in community settings.
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From page 235... ...
This recommendation will enable an array of health care professionals to work in community settings, change supervision requirements to levels supported by evidence, and allow the use of telehealth technologies to reach underserved populations with care that is as effective as that delivered in person. By allowing an array of health care professionals to address basic oral health needs, dentists will be able to dedicate themselves to providing more complex care and treating more patients with complex needs.
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From page 236... ...
• Foundations, professional organizations, and public policy orga nizations can support states by issuing "best practices" briefs to highlight what each state is doing and what impact it is having on access. Improving Dental Education and Training The committee's vision supports changes to dental education and training that will ensure that current and future generations of dental professionals can deliver quality care to diverse populations, in a variety of settings, using a variety of service-delivery mechanisms, and across the life cycle.
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From page 237... ...
Therefore, the committee recommends RECOMMENDATION 3: Dental professional education programs should • Increase recruitment and support for enrollment of students from underrepresented minority, lower-income, and rural populations; • Require all students to participate in community-based education rotations with opportunities to work with interdisciplinary teams; and • Recruit and retain faculty with experience and expertise in caring for underserved and vulnerable populations. To support Recommendation 3, the committee further recommends RECOMMENDATION 4: HRSA should dedicate Title VII funding to • Support the development, implementation, and maintenance of substantial community-based education rotations, and
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Promoting Advanced Practical Experience As discussed throughout this report, underserved and vulnerable populations have both distinct and heterogeneous needs. Therefore, all oral health care professionals need to be sufficiently educated and trained to care for a broad range of individuals and populations.
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From page 239... ...
Moreover, the evidence reviewed in Chapter 3 demonstrates that additional training is needed to better prepare oral health care professionals to care for underserved and vulnerable populations. Postgraduate dental education is seen as an opportunity to address these needs.
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From page 240... ...
• The public and private sectors can support efforts to identify and address barriers to having all states make postgraduate education a requirement for licensure. • Hospitals and dental schools can increase the number of formal relationships with community-based care settings (such as FQHCs, nursing homes, state and local health departments, and prisons)
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From page 241... ...
publicly funded programs should not separate oral health from overall health, and (2) because publicly funded programs are the primary source of coverage for underserved and vulnerable populations, Medicaid cannot properly address the issue of access if oral health services are excluded from Medicaid benefits.
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From page 242... ...
However, efforts to improve access through financing strategies will necessarily be multifaceted and will be one component of broader efforts to improve access. For example, studies have demonstrated that increasing reimbursement rates alone is not sufficient in improving access to care.
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From page 243... ...
• CMS can ensure that Medicaid beneficiaries have equitable ac cess to essential oral health services by appointing and convening a committee of key stakeholders to establish an essential dental benefits package for Medicaid. There is a precedent for this type of enhanced federal match, most recently in the Patient Protection and Affordable Care Act (ACA)
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From page 244... ...
In addition, within the dental professions, several new models seek to develop new types of dental professionals, or expand the role of existing dental professionals. For example, as discussed in Chapter 3, evaluations of the dental health aide therapist program in Alaska to date point to the quality and acceptability of dental therapists in providing care to remote populations.
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From page 245... ...
While concerns have been raised for the quality of care provided by dental professionals that are not dentists, there is little ability to assess the technical competence, practice procedures, and quality of care and outcomes of care provided by any dental professionals, which makes comparison of care rendered by different types of professionals even more challenging. Finally, as alluded to earlier, little has been done to investigate better methods of financing and regulation that might lead to improvements in dental coverage, access to oral health care, and, again, improvements in oral health status.
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From page 246... ...
• Given the need for further research, the committee concludes that a variety of stakeholders will need to take additional actions to support this recommendation, including • Federal agencies can increase funding for programs that success fully provide education and preventive and treatment services to vulnerable and underserved populations such as Head Start, the WIC program, and school-based health centers. • HRSA can support the research agenda by providing funding for oral health demonstration projects that use a new delivery system -- including new workforce models -- that will successfully provide education, prevention, and treatment services to under served populations through Head Start, WIC, and school-based health centers.
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From page 247... ...
. The impact of other functions of state oral health programs (e.g., planning and supporting community water fluoridation, dental sealant programs, fluoride varnish programs, dental screening programs, and oral health programs specifically for pregnant women)
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From page 248... ...
• Private foundations can partner with public agencies to develop, implement, and evaluate public education and oral health literacy campaigns. Capitalizing on Federally Qualified Health Centers FQHCs play an important role in increasing access to oral health care for vulnerable and underserved populations.
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From page 249... ...
Furthermore, because FQHCs employ both dental and nondental health professionals, clinics can engage additional members the health care team in providing basic oral health care to the populations they serve. The committee, therefore, recommends RECOMMENDATION 10: To expand the capacity of FQHCs to de liver essential oral health services, HRSA should • Support the use of a variety of oral health care professionals; • Enhance financial incentives to attract and retain more oral health care professionals; • Provide guidance to implement best practices in management, op eration, and efficiency; and • Assist FQHCs in all states to operate programs outside their physi cal facilities and take advantage of new systems to improve the oral health of the population they serve.
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250 IMPROVING ACCESS TO ORAL HEALTH CARE BOX 6-2 Summary of Key Implementation Strategies for the Committee's Recommendations Health Resources and Services Administration (HRSA) • equire that Title VII–funded programs include interprofessional edu R cation on oral health to promote the integration of oral health core competencies in nondental health professional education programs.
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From page 251... ...
To be most effective, Congress can require that an enhanced match be tied to efforts by states to streamline administrative procedures related to provider and patient participation in Medicaid. • und the Oral Healthcare Prevention Education Campaign authorized F by the Patient Protection and Affordable Care Act (ACA)
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From page 252... ...
In the midst of these changes, the distinct deficits faced by vulnerable and underserved populations deserve particular attention. As the nation struggles to address the larger systemic issues of access to health care, greater effort will be needed to ensure that oral health is included in this conversation.
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From page 253... ...
2010. Synopses of state dental public health programs: Data for FY 2008-2009.
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2011. Health centers: 2009 at-a-glance.
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