The Case for Change: Incorporating Oral Health in - PowerPoint Presentation

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The Case for Change:

Incorporating Oral Health in

Routine Medical Care

Objectives

Make the case that oral health is an essential component of primary care.Present a practical framework for how to deliver preventive oral healthcare as a component of routine medical care.Share resources to implement this in our practice setting.

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Why Focus on Oral Health?

Oral health is an essential component of overall health.Oral disease is a transmissible and chronic infectious disease that affects our patients.It’s possible to intervene and changethe trajectory.

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What Is the Problem We Are Trying to Solve? A Prevention Gap

Dental caries (cavities) and periodontal disease (gum disease) are largely preventable.Yet nationwide, among all ages, incomes, and life experiences, we have an unacceptably high burden of these chronic diseases.We’ve seen little improvement in oral health status over the past 20 years, and pervasive disparities remain: Poor and near-poor 5-year-olds are more than two times as likely to have tooth decay than their middle-income peers.

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The Burden of Oral

Disease: Children

Decay: Tooth decay is the most common chronic disease of childhood.Pain and infection can result in impaired nutrition and growth.Untreated decay puts children at risk for dental disease in adulthood.

Ages 2–525%

Ages 12–1550%

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The Burden of Oral Disease: Adults

Cumulative result?

25% of adults 65 and older have no

teeth.

25% ages 20–64 have

untreated caries.19% ages 35–44 have destructive periodontal diseases.

Oral cancer kills over 8,000 people each year, the number who die of cervical cancer, a major preventive care focus.

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Oral Disease Impacts Overall Health

New evidence is demonstrating a relationship between periodontal disease and:DiabetesIschemic vascular diseasePre-term delivery and low birth weight

“The mouth is a mirror for the body.” U.S. Surgeon General

Oral complications reflect, exacerbate, and may even initiate other health problems.

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Poor Oral Health Compromises More Than Health…

Adults lose 164 million work hours each year due to oral complications and dental care.Older adults with missing or no teeth report lower overall quality of life.Adults with missing teeth are more likely to report trouble finding employment.

Children lose 54 million school hours each year due to oral complications and dental care.Poor oral health = higher school absence and poorer academic performance. Poor oral health impacts language and self-esteem.

Oral pain can restrict activity, impair nutrition, and disturb sleep.

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Access and Affordability Challenges

In most communities, dental care is the most common unmet health need.40% of the population lacks dental insurance, the percentage of those lacking medical insurance.Many patients turn to the ER as a last resort; most are sent home with painkillers and antibiotics, but their problem hasn’t been solved.Late-stage interventions (e.g., extractions) waste valuable healthcare resources and introduce unnecessary risksfor patients.

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In Our Community

ADD CONTENT HERE

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How Can

W

e

I

mprove

T

his

P

icture?

Expand

the oral disease prevention

workforce

by engaging primary care teams in the

fight against oral disease.

Why Us?

We have regular contact

with high-risk groups:

Children

Pregnant women

Adults with diabetesWe are well equipped for the work:We routinely assess risk, screen for disease, offer preventive interventions, and refer patients to specialists when treatment is needed. We can apply these core competencies to oral disease.

Population receiving regular medical care

Total population at risk for caries and periodontal disease

Population receiving regular dental care

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Provide information about healthy diet, measure BMI. Advise on sunscreen, look for suspicious moles.Oral disease is a common problem with serious health impacts.Patient and family behavior (self-care) is key.Most problems can be recognized early and treated to reduce impact.

This Is a

Natural Extension of What We Already Do…

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What Can We Do and How?

Incorporate preventive oral healthcare in routine medical care for all patients. Organize dental referrals as we do for medical-surgical referrals.

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Oral Health Delivery Framework

Five

actions primary care teams can take to protect and promote their patients’ oral health. Within the scope of practice for primary care, possible to implement in diverse practice settings.

Citation: Hummel J, Phillips KE, Holt B, Hayes C.

Oral Health: An Essential Component of Primary Care. Seattle, WA: Qualis Health; June 2015

Preventive interventions: Fluoride therapy, dietary counseling to protect teeth and gums, oral hygiene training, therapy for substance use, medication changes to address dry mouth.

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Our Plan

Decide on a population of patients to target: adults with diabetes, pediatrics, pregnant women, other?Clinical assessmentWorkflow analysis: current and future statePlanning for structured referralsEHR modifications and report creation

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Additional Resources

Oral Health Implementation GuideSections 1 and 2: Introduction and the Case for Change

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White paper, published June 2015A call to action:Case for changeOral Health Delivery FrameworkSupporting actions from stakeholdersCase examples from early leaders: Confluence Health, The Child and Adolescent Clinic, Marshfield ClinicAvailable at: http://www.safetynetmedicalhome.org/change-concepts/organized-evidence-based-care/oral-health

Oral Health: An Essential Component of Primary Care

Hummel

J, Phillips KE, Holt B, Hayes C. Oral Health: An Essential Component of Primary Care. Seattle, WA: Qualis Health; June 2015

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About the Oral Health Integration in Primary Care Project

The

Organized, Evidence-Based Care Supplement: Oral Health Integration

joins the Safety Net Medical Home Initiative Implementation Guide Series.

The goal of the Oral Health Integration in Primary Care Project was to prepare primary care teams to address oral health and to improve referrals to dentistry through the development and testing of a framework and toolset. The project was administered by

Qualis Health and built upon the learnings from 19 field-testing sites in Washington, Oregon, Kansas, Missouri, and Massachusetts, who received implementation support from their primary care association. Organized, Evidence-Based Care Supplement: Oral Health Integration built upon the Oral Health Delivery Framework published in Oral Health: An Essential Component of Primary Care, and was informed by the field-testing sites’ work, experiences, and feedback. Field-testing sites in Kansas, Massachusetts, and Oregon also received technical assistance from their state’s primary care association.The Oral Health Integration in Primary Care Project was sponsored by the National Interprofessional Initiative on Oral Health, a consortium of funders and health professionals who share a vision that dental disease can be eradicated, and funded by the DentaQuest Foundation, the REACH Healthcare Foundation, and the Washington Dental Service Foundation. For more information about the project sponsors and funders, refer to: National Interprofessional Initiative on Oral Health: www.niioh.org. DentaQuest Foundation: www.dentaquestfoundation.org. REACH Healthcare Foundation: www.reachhealth.org. Washington Dental Service Foundation: www.deltadentalwa.com/foundation.

The guide has been added to a series published by the Safety Net Medical Home Initiative, which was sponsored by The Commonwealth Fund,

supported by local and regional foundations, and administered by Qualis Health in partnership with the MacColl Center for Health Care Innovation. For more information about the Safety Net Medical Home Initiative, refer to www.safetynetmedicalhome.org.

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