Mobilized Funds. By working with multiple Ryan White
grantees, the University secured funding to fill a “wish list” of dental needs.
Created a Network of Agency Supporters. Educating
agencies about dental care issues created a referral network for clients and a
cadre of advocates for better dental care.
Expanded Clinic Sites. The University built a rural
site, augmenting services provided in their urban clinic site in Louisville.
Addressed Transportation Barriers. The University helped
rural clients get to care by collaborating with Part B care coordinators, who
distributed gas vouchers and secured volunteer drivers.
Partners
University of Louisville, School of Dentistry
Family Health Centers
WINGS Ryan White Program Parts C and D
Matthew 25 Ryan White Program Parts B and C
Kentucky
University of Louisville, School of Dentistry
Working Together to Access Resources, Bridge Limited Services
The University of Louisville’s School of Dentistry is serving both urban and
rural areas under its Ryan White Dental Partnership. That’s a matter of being
pulled in two directions, geographically speaking. The biggest factor that helps
is their ability to access funds from multiple sources. The University of
Louisville worked with agencies funded under multiple Ryan White Parts, securing
funding to help pay for items on a “wish list” of dental needs. Additionally,
the University collaborated with the Louisville Part C grantee to expand access
to dental specialty care provided by private practitioners.
As for their rural service area, which includes over 30 counties covering the
western and southern regions of the State, they do some rather straightforward
things that really work: lots of driving, outreach to get stigma-averse clients
interested in coming in for care, the provision of gas vouchers and volunteer
drivers (provided by Part B care coordinators), and collaboration with partner
agencies to share in the workload and even cut down on distance barriers.
The University also managed to open a permanent oral health clinic in western
Kentucky, adding to their urban site in Louisville, overcoming a lack of space,
loss of a lease due to razing of the office building, and a major flood.
Services: Leveraging Resources
Accessing funds from multiple Ryan White Parts has been the
University of Louisville’s greatest success. What made this possible?
Long-standing relationships with various grantees and cultivation of those
connections, as follows:
The dental school is at the table—literally. Their
project director was appointed to the Governor’s statewide HIV/AIDS advisory
body, the Kentucky HIV/AIDS Planning and Advisory Council. Dental issues are
more visible before consumers and providers as a result.
The dental school’s project director and all members of
the dental program cultivate relationships by calling agencies and key staff to
inform them about dental needs. Each member of the dental team also works with
other agencies to help ensure that clients get their needs met.
Agencies in the area know about dental care needs
because needs assessment data, specifically, the Kentucky HIV/AIDS Statewide
Coordinated Statement of Need, document dental services as one of the most
common unmet needs for PLWH in the State.
Having these relationships in place made a difference when
additional one-time funding became available to devote to gaps in oral HIV care.
Partner agencies thought of the University’s dental services and helped to
fulfill a “wish list” of how funds could be used to expand dental services and
purchase durable dental equipment (two dental chairs) to expand capacity to
deliver dental services. The University of Louisville recommends having such a
list at the ready for those who may ask what needs exist and how help can be
provided.
How many agencies does it take to serve 58 counties in Kentucky and southern
Indiana, with an estimated 1,700 clients in need of HIV-related dental care? The
numbers are not magic, but what works in this region are two community-based
dental-providing entities. Each clinic has its own intake procedures and also
takes HIV client referrals from four Ryan White agencies and private physicians
in the area. With such a mix of agencies, communication is essential and
especially so since there are two systems for delivery of dental care—the
University and the county. Mechanisms that work best include:
Semi-annual meetings, covering issues related to access
and quality of care, such as review of problems that create barriers to
efficient intake and access. One such problem was coordinating various pieces of
information needed from the patient, care coordinator, and medical provider. In
response, the project created a streamlined form and a process whereby the care
coordinator gathers needed information in one place and then sends it to the
dental clinic in advance of the initial dental appointment. Each dental clinic
is able to use the data accordingly during their intake process. As a result,
treatment planning and any emergency dental treatment can be initiated at the
first appointment.
Email and phone communications among dentists and other
staff (e.g., case managers who do follow-up to ensure that appointments are kept
with dentists and primary care clinicians).
Communication is not just about getting dental care. It is also about the dental
provider’s role in helping retain clients in medical care. Again, there is not a
magic answer, although some steps have worked well, including:
Collection of medical information from the primary care
provider before the first appointment as a way to check in on the new client’s
connection to care.
Regular phone and letter consultations to collect
medical information that is needed in the course of providing dental care, such
as changes in medications or lab values. The need for information provides a
secondary opportunity to do a check-in on the dental patient’s primary care
status.
Communication with care coordinators, medical providers,
and clients to provide feedback on an individual’s oral health status and how an
individual’s systemic health can be enhanced by good oral health.
Services: Keeping Clients Engaged in Care
Multiple methods are used by the University to keep clients coming back for
dental care:
Patient-Centered Care. The University asks patients to
help make decisions about the care they are receiving by explaining procedures
and options and asking for feedback or even asking if clients have questions
about their care.
Support from Care Coordinators and Medical Providers.
Dental care conferences with medical, dental, and social services staff take
into consideration an array of potential needs to create a patient-centered plan
to overcome barriers to remaining in care. For example, a dental treatment plan
takes into consideration the medical status of the patient, transportation or
childcare needs, and the complexity of dental treatment needed and anxiety
associated with dental care.
Consumer Feedback. Patients have the chance to provide
feedback via community forums, through consumer groups at partner agencies and
the dental clinics. The feedback provides the basis for continuous quality
improvement initiatives aimed at improving access and retention in care.
Patients also provide individual feedback by patient surveys that are available
onsite at the dental clinics. Surveys may be dropped into a secure box or
mailed.
