Improving Access to Oral Health Care for Vulnerable and Underserved Populations (2011) / Chapter Skim
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In addition, endemic low levels of oral health literacy among the public and many in the health care professions may limit their ability to understand the importance of good oral health to overall health status. Furthermore, low oral health literacy creates additional obstacles to recognizing risk for oral diseases as well as seeking and receiving needed oral health care.
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population is able to routinely obtain oral health care in traditional dental practice settings, a disproportionate number of vulnerable and underserved individuals cannot. An array of providers and population-based public health programs -- collectively referred to as the safety net -- has emerged through uncoordinated attempts to reach these individuals.
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2. Oral health promotion and disease prevention are essential to any strategies aimed at improving access to care.
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Therefore, the committee makes recommendations in key areas, suggests actions that various stakeholders can take, and identifies the relevant policy levers that are most likely to produce both short-term and long-term change. RECOMMENDATIONS Integrating Oral Health Care into Overall Health Care Nondental health care professionals need to take a role in oral health care.3 Young children, for example, visit pediatricians and family physicians earlier and more frequently than they visit dentists.
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RECOMMENDATION 1b: Following the development of a core set of oral health competencies • Accrediting bodies for undergraduate and graduate-level nondental health 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. The minimum core competencies will need to prepare graduates to • Recognize risk for oral disease through competent oral examinations, • Provide basic oral health information, • Integrate oral health information with diet and lifestyle counseling, and • Make and track referrals to dental professionals.
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Some states have altered their scope-of-practice and supervision regulations to allow a broader range of competent oral health care professionals to treat patients, or for existing oral health care professionals to perform a wider range of procedures under various levels of supervision. When expansions to existing scopes of practice are proposed, concerns inevitably arise about the quality of care provided when patients are treated by individuals with less training.4 However, many have called for state practice acts to be expanded in alignment with professional competence.
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Diversity in the health care workforce is associated with expanded access to care for racial and ethnic minority patients, greater patient choice and satisfaction, better patient–provider communication, and better educational experiences for all students. Furthermore, all dental professionals need to develop the necessary skills to work in a variety of community-based settings and with vulnerable and underserved populations, such as the ability to work in interprofessional teams with general health, education, and social service professionals; the ability to work in dental professional teams; and the ability to use new service-delivery mechanisms such as telehealth technologies for supervision, consultation, and collaboration.
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Finally, schools will require more faculty members with experience and expertise in caring for vulnerable and underserved populations to adequately prepare students in this manner. 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 interprofessional teams; and • Recruit and retain faculty with experience and expertise in caring for underserved and vulnerable populations.
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To be optimally effective, dental residency programs especially need to include clinical experiences with young children, individuals with special health care needs, and older adults. For this reason, these residency programs need to be located in settings where services to these and other vulnerable and underserved populations are most needed.
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Recognizing that publicly funded programs are the primary source of coverage for underserved and vulnerable populations, the committee concludes that Medicaid cannot properly address access to oral health services if it excludes oral health benefits. However, in the absence of a comprehensive cost-benefit analysis and in a climate of significantly limited resources, the committee lacks the necessary evidence base and appropriate fiscal conditions to recommend that all states be required to cover essential dental benefits for all Medicaid beneficiaries.
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The committee suggests the following strategies: • CMS can ensure that Medicaid beneficiaries receive the appropri ate level of care by appointing and convening a committee of key stakeholders to establish an essential dental benefits package for Medicaid. • CMS can provide technical assistance and oversight to state-based demonstration projects including guidance on program design ele ments that address the specialized needs of targeted beneficiaries and consultation on program evaluation and monitoring systems.
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To this end, there are a number of programs currently under way designed to deliver oral health care through innovations in the workforce and in delivery of care in nontraditional settings. First, as discussed earlier, research is needed on how to best include nondental health care professionals in oral health care.
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Because of the limited infrastructure and the current paucity of measures in use to assess the technical competence, practice procedures, and quality of care and outcomes of care provided by any dental professionals, making comparisons of care rendered by different types of professionals is even more challenging. Finally, 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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also have a positive impact on oral health. According to the Association of State and Territorial Dental Directors, with expanded infrastructure and capacity, state oral health programs are better able to monitor oral health status, address high-risk populations, increase population-based prevention activities, and extend resources to local health agencies and communities in order to implement oral health strategies.
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The committee concludes that with adequate support, FQHCs are well positioned to significantly expand the delivery of oral health care to vulnerable and underserved populations. 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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This report envisions an integrated delivery system that provides quality oral health care to vulnerable and underserved people where they live, work, and learn through changes in the education, financing, and regulation of oral health care. The recommendations support the creation of a diverse workforce that is competent, compensated, and authorized to serve vulnerable and underserved populations across the life cycle.
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