Bringing Oral Assessment to a Health Clinic Near You · Primary care physician roles in health...
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Bringing Oral Assessment to a Health Clinic Near You NNOHA ANNUAL CONFERENCE 2018 CHRISTINE COGIL, DNP, FNP-BC
Transcript of Bringing Oral Assessment to a Health Clinic Near You · Primary care physician roles in health...
BringingOralAssessmenttoaHealth
ClinicNearYouNNOHAANNUALCONFERENCE2018
CHRISTINECOGIL,DNP,FNP-BC
DisclaimerIdonothaveanyfinancialconflictsrelatedtotheinformationinthispresentationanddonotreceiveanycompensation,whetherdirectorindirect,from,oranygiftofgoods,services,ortravelfromanycompany.
ThisprojectissupportedbytheHealthResourcesandServicesAdministration(HRSA)oftheU.S.DepartmentofHealthandHumanServices(HHS),GrantNumberH47MC28481.Information,contentandconclusionsarethoseoftheauthorsandshouldnotbeconstruedastheofficialpositionorpolicyof,norshouldanyendorsementsbeinferredbyHRSA,HHSortheU.S.Government.
ObjectivesAttheconclusionofthispresentation,participantswillbeableto:
•Identifytherolesofmedicalclinicprovidersandstaffforimplementationoforalassessmentandpatienteducation.
•Assembleeducationaltoolsforpatientsthatassistwithpromotionofimprovedoralcare
OralAssessmentinaPrimaryCareClinic…”What’sthatabout?”
Whenwelook,here’swhatisfound
24% 7%
25% 33%
51% 60%
RiskOutcomesforDental/OralissuesLowRisk ModerateRisk HighRisk
6yearsandundern=63
Beyond6yearsofagen =411
Challenges• Medicalandnursinghealthcareproviderslackofcompetencywithanoralexam
• Noreimbursementforperforminganoralexam
• “Ittakestoomuchtimetoaddsomethingtomyalreadyoverfullpatientvisit.”
• Traditionally,“Thisisthedentist’sdomain.Iknownothingaboutthemouth.”(AKA– “andIdon’twanttoputmyfingersinsomeoneelse’smouth.”
• “WhatifIfindsomething?Idon’tknowwhattodo…andtowhomcanIrefer?”
• Longheldpatientbeliefs…medicalcareisanecessity;oralcareisoptional
• Overarchingmyth…thereisnoconnectionbetweenoralandsystemicdiseases
• LimitationsofdentalinsuranceIFthepatientevenhasit
• Noconnectionbetweenmedicalanddentalelectronichealthrecordsystemsthus,referralprocesses
FirstStepsTowardIntegrationofOralAssessmentintoPrimaryCare
• ChangeRequiresChampions• Changeessentialsincludeneededsupportfrom:• ClinicAdministrator• MedicalDirector• ChangeChampion(s)◦ Healthcareprovider◦ Nurse◦ MedicalAssistant◦ CommunityHealthWorker
ProviderEducationandEngagement• “WHY”incorporationoforalassessmentimprovesoutcomes• Howtoperformoralexams• Whattreatmentsareappropriateinprimarycare• Whoarethedentalreferralsources• Whentoperformtheoralexam• wellchildvisits• establishcareandnewOBvisits• annualexams• patientswithdiabetes
• Provideongoingeducation
EducationforStaff• Receptionist,MedicalAssistant(MA),Nurses,CommunityHealthWorkers• Assistpatienttocollectoralhistoryinformation
• Informpatientthatanoralexamispartofthephysicalexam
• Assistpatienttofeelcomfortablewithoralexamanddispelmyths
• MAlaysoutglovesandgauzetoremindprovidertocompleteanoralexam
• Facilitatingreferralstodentalproviders• Educationandmaterialsfororalhealthpromotion
• MAornurselearnhowtoapplyfluoridevarnish
AdditionalSteps
• Billing/Coding
• Whatmedicalcodescanbeusedtoincreasereimbursement?
• Doesyourstatepayforfluoridevarnishandapplicationfor0-3yearoldpatients?
• Ifso,howcodedtoreceivepayment
• Providerdocumentationneededtomeetbilling/codingrequirementsfor
reimbursement
PromotingAdoptionofNewSkillsandServices
• EstablishasaQualityImprovementInitiative
• Areprovidersaddingoralassessmenttotheirroutines?
• Monitordocumentationforoccurrence
• Ifnotperforming,whatarethebarriers?
• Explorewithprovidersand/orstaffhowchallengescanbeaddressed
• Provideincentives,ifpossible,toencourageadoptionoforalassessment
ImplementationintoPractice:Willthiseverhappen….?
• Patience• Realpracticechangemaytakeuptooneyear…ormore…butitwillhappen
• Initially,changemayoccurattheindividualprovider,nottheinstitutionallevel
• Providersneedtoseeoutcomesoftheiroralassessments/treatments
• ImprovedHgbA1clevelsinpatientswithdiabetes
• Earlyidentificationofanoralmalignancy/STI
• Fewerchildrenreferredfor“fullmouthrehab"
Tips,TricksandToolsfortheTrade
PatientOralHealthHistory
OralExamination
4LsOralExamü Lift/LowertheLips
üLookatTeeth
üLaparoundthegumsandpalate
üLassotheTongue
(videoofgumline,dentalmarginsandbuccalmucosa)
DentalReferralFormal
ElectronicorPaper
Developcollaboratively
Trackandcoordinate
DentistrybelongstoDentistsandDentalHygienists…
BUTOralhealthpromotionbelongs
toeveryone!
ReferencesAtchison,K.A.,&Weintraub,J.A.(2017).Integratingoralhealthandprimarycareinthechanginghealthcarelandscape. NorthCarolinamedicaljournal, 78(6),
406-409.
CaliforniaDentalAssociation[CDA]Foundation.(2010).Oralhealthduringpregnancy&earlychildhood:Evidence-basedguidelinesforhealthprofessionals.Retrievedfromhttp://www.cdafoundation.org/portals/0/pdfs/poh_guidelines.pdf
CentersforDiseaseControlandPrevention.(2016).WorkingtoImproveOralHealthforAllAmericansAtAGlance2016.Retrievedfromhttps://www.cdc.gov/chronicdisease/resources/publications/aag/oral-health.htm
DepartmentofHealthandHumanServices.(2000).OralhealthinAmerica:AreportoftheSurgeonGeneral.WashingtonD.C: Author. Retrievedfromhttp://www2.nidcr.nih.gov/sgr/sgrohweb/home.htm
Harnagea,H.,Couturier,Y.,Shrivastava,R.,Girard,F.,Lamothe,L.,Bedos,C.P.,&Emami,E.(2017).Barriersandfacilitatorsintheintegrationoforalhealthintoprimarycare:ascopingreview. BMJOpen, 7(9),e016078.doi:10.1136/bmjopen-2017-016078
Kirk,C.D.,Goodson,S.,Armijo,D.,VanHarrison,R.,Makris,G.J.,&Pratap,S.(2018).TransformingthePrimaryCareOralHealthLandscapethroughQualityImprovement.AmericanAcademyofPediatrics142(1),426. doi: 10.1542/peds.142.1_MeetingAbstract.426
Maxey,H.L.,Norwood,C.W.,&Weaver,D.L.(2017).Primarycarephysicianrolesinhealthcenterswithoralhealthcareunits. TheJournaloftheAmericanBoardofFamilyMedicine, 30(4),491-504.doi:10.3122/jabfm.2017.04.170106
Phillips,K.E.,&Hummel,J.(2016).OralHealthinPrimaryCareAFrameworkforAction.JDRClinical&TranslationalResearch,doi:10.1177/2380084415625634
Ramos-Gomez,F.J.,Crystal,Y.O.,Ng,M.W.,Crall,J.J.,&Featherstone,J.D.(2010).Pediatricdentalcare:preventionandmanagementprotocolsbasedoncariesriskassessment. JournaloftheCaliforniaDentalAssociation, 38(10),746.
Silk,H.(2017).Thefutureoforalhealthcareprovidedbyphysiciansandalliedprofessionals. Journalofdentaleducation, 81(8),eS171-eS179.doi:10.21815/JDE.017.024
