Telehealth Brings Dental Care to Underserved Populations:

The Virtual Dental Home

Maureen Harrington, MPHMaureen Harrington, MPH

Goal

Discuss critical elements of a Virtual Dental Home system of Virtual Dental Home system of care in various settings.

U.S. Surgeon General’s Report on Oral Health in America

“Although there have been gains in oral health status for the population as a whole, they have not been evenly distributed across subpopulations.”

• Profound health disparities exist among populations • Profound health disparities exist among populations including:– Racial and ethnic minorities– Individuals with disabilities– Elderly individuals– Individuals with complicated medical and social

conditions and situations

Dental Disease in the U.S.

Most common childhood illness in US

– Pain and infection

– Nutrition and speech development

– Higher rates of absenteeism among students – Higher rates of absenteeism among students and parents

– School performance

– Social engagement

Challenges with Access

• Insurance status

• Access to providers

• Transportation

• Hours of practice• Hours of practice

• Dental literacy

• Cultural differences

• Dental fear

Possible Solutions

• Same as always? Refer unsuccessfully? Monitor untreated disease year after year?

• Or change to new models

– IOM reports– IOM reports

– New technology

– Community based care

– Workforce

Pacific Center for Special Care

Virtual Dental Home• Innovative system of care

• Practiced in California schools, group homes, long term care facilities, rural and low income communities

• Onsite care using portable equipment• Onsite care using portable equipment

VDH Concept Model

Acute Care/Surgical Intervention Chronic Disease Management

Care Approaches

• Provider-centric model• Care delivered in fixed offices

and clinics• “Treatment” based on discrete

procedure-based episodes of care

• Patient-centric model• Care delivered where

people are to the extent possible

• “Management” based on maintaining health across the life-cycle of a conditioncare

• Payment based on discrete procedure-based episodes of care

• Emphasis on surgical interventions

the life-cycle of a condition• Payment based on value of

health improvement across life-cycle of a condition

• Emphasis on risk assessment, prevention, and early intervention, using biological, medical, behavioral, and social tools

What happens at a practice site?

• Dental hygienist provides:

– clinical services to students, residents or patients

– education to patient, students, parents, school – education to patient, students, parents, school administration, faculty, and staff

– referral support for those who need specialized care

• Telehealth technology facilitates communication with dentist

Electronic Health Record

Practice site on campus –School nurse’s office

Integration

• Hygienist: clinical care, case management, referral, and education

• Site health care provider or school nurse: supports for referral, education and diet supports for referral, education and diet changes

• Counselor: patient and parent interaction

• Teachers: consent form support

• Administration: champion

Clinical Visits

• Recall schedule is based on risk level of each patient

• Patient receive a recommendation of ongoing care at the facility/school site or ongoing care at the facility/school site or treatment by the dentist

Interim Therapeutic Restoration (ITR)

AAPD Policy on Interim Therapeutic Restorations (ITR)

Experience

~ Parent satisfaction is very high.

~ Site administrators indicate 100% satisfaction due to:

• convenience

• reduced time away from school

• increased knowledge of personal oral health prevention practices

Providers’ Experiences

• Appreciate this model as it provides care to underserved communities

• Enjoy challenge of a new practice setting

• Value interprofessional experiences• Value interprofessional experiences

Not scared!

Community-Based TelehealthEnabled Dental Teams

Considerations for Adoption:

– Uses existing workforce of underemployed RDHs & RDHAPs

– Low training costs

– Low deployment costs– Low deployment costs

– Low political costs

– Requires dentists or health centers willing to serve as collaborating dentists

– Requires dentists or health centers willing to accept referrals for advanced procedures

Next Steps

• Regulations: practice options

• Policies: community sites, school districts, dental boards, and public health departmentsdepartments

• Scope of practice change for hygienists

• Providers valuing dental health

Untreated dental disease is a public health epidemic

• Get activated

• Be prepared to disrupt status quo as it is contributing to the neglect of children

Pacific Center for Special Care

Thank you!

Maureen Harrington, MPH

mharrington@pacific.edu

415-385-5017