Centralized Appointment System. This system is used to
handle referrals to dental and other services, track receipt of referred
services, and assist with long-term monitoring of patients.
Web-Based Learning Curriculum. This online tool is part
of the formal training for dental school residents about HIV dental care.
Patient Satisfaction Survey. Developed by Lutheran
Medical Center/El Rio Community Health Centers, Dental Department/Special
Immunology Associates. To obtain a copy, contact
Carolyn Gray.
Partners
Lutheran Medical Center
El Rio Community Health Centers
Southern Arizona AIDS Foundation
Arizona to New York and Back
Lutheran Medical Center Department of Dentistry
Sites Integrate Dental and Primary Care
Lutheran Medical Center, located in New York City, works with agencies across
the U.S. to place dental residents in underserved communities. In Arizona,
Lutheran’s Ryan White project has a partnership with El Rio Community Health
Center in Tucson. El Rio has Federal Qualified Health Center (FQHC) status and
is a major provider of health services in Tucson and other parts of Southern
Arizona, serving insured, uninsured and Medicaid-eligible clients. Their 14
clinics provide an array of primary medical care and other services.
Services: Centralized Networks Links Patients to Services
HIV care at El Rio happens through their Special Immunology Associates clinic, a
standalone site with a caseload of 1,400 HIV-infected clients. Patients with HIV
needing dental services are referred out to El Rio’s dental clinics, which
operate at three different and convenient sites. Factors that facilitate
delivery of dental services to PLWH include the following:
Centralized Appointment System.
Physicians, nurses, and dentists at El Rio use a centralized
appointment system to make referrals and do follow-up. The referral authorizes
care for patients and contains for the referring provider: name, supervisor,
department, degree of urgency, appointment date, authorization, estimated number
of visits, and the expiration date of the referral. Information about the
provider to whom the patient is being referred includes name, specialty, clinic
name, and location. The referral form also contains patient information: name,
address, phone, language preference, need for interpreter, insurance, and
special needs. Finally, the referral describes needed action and includes
attachments such a laboratory values, x-rays or other diagnostic images, and
charts/letters.
Statewide Referral Network.
Working with the Southern Arizona AIDS Foundation (SAAF), which holds the
Statewide contract to manage the Arizona Oral Health Care Services Program,
Lutheran Medical Center and El Rio have developed an inter-agency referral
system to ensure that HIV-infected persons have access to and use all of the
financial resources available to them for oral health care. All eligible El Rio
patients are encouraged to enroll in SAAF. By doing so, patients can take
advantage of the dental benefits SAAF has arranged with Delta Dental of Arizona.
After exhausting the coverage from Delta, the patient has access to the
financial benefits available through the Dental Partnership. Patients use the
resources from both programs while receiving oral health services at one of the
El Rio dental clinics.
Shared Vision. Medical and dental
directors of El Rio and their dental department are focused on the care and
treatment of HIV-infected persons, consistent with the mission of El Rio to
provide ready access to health care for those in need. Both directors have acted
on their vision by supporting the implementation of the referral system,
sponsoring inter-staff training, and planning special educational programs for
HIV-infected clients.
Agency Networking. El Rio
collaborates with several community based agencies in Tucson and helps link
these clients to dental services by participating in program planning and
implementation and participating in leadership roles. Agencies form a tightly
knit and supportive community in the city and surrounding county.
Having expanded the number of residents in El Rio, Lutheran’s Dental Partnership
has achieved strong momentum in establishing a cooperative referral process
within El Rio’s various services, which comprise the majority of HIV services
for the area. In addition, as the Partnership can effectively track patients,
they are looking forward to increasing their outreach efforts and enrolling a
greater number of patients in the future.
Patient Education and Involvement: Advisory Board, Focus Groups Among Techniques
Multiple methods are used to involve and educate patients.
Patient Advisory Board.
El Rio clients are invited to join the board, which advises providers on
program development, client services, and outcomes. Dental Partnership staff
members meet occasionally with the board to review the status of the project and
gain insights for future efforts.
Focus Groups. In
early 2008, consumers participated in the first focus group on oral health
services. The group discussed topics such as their patient status at El Rio, the
ease of getting dental care, waiting time, staff attitudes, financial matters
and related issues such as condition of the facilities, confidentiality and
likes and dislikes about El Rio. This feedback will be incorporated into future
planning.
Patient Education. Multiple
patient education methods are used at the El Rio dental clinics, including
direct encounters with dental providers and use of various educational
materials. The latter include (1) brochures in both English and Spanish, and (2)
the Clinically Advanced Education System (CAESY), and a DVD. The latter is
viewed on a chair side monitor and provides not only patient education but also
describes treatment options, sequencing, post-operative instructions, and
treatment alternatives.
Provider Training and Education: One Year Training and Distance-Based Curriculum
Lutheran’s dental training targets residents, not dental school students. As of
2008, five residents were enrolled in Lutheran’s Advanced Education in General
Dentistry Program (AEGD) and receiving hands-on training at the three El Rio
dental clinics. The AEGD is a one-year program with an optional second year of
training. (Training covers multiple areas in advanced general dentistry and is
not just HIV-specific for the year.) All residents become experienced in working
with HIV-infected patients. Backing up this clinical training is a
distance-based didactic curriculum, used across the nation by Lutheran, which
involves four hours of classroom instruction per week via video
teleconferencing.
Dentists on staff at El Rio who serve as clinical teachers for the residents are
appointed to Lutheran’s faculty and require training in the philosophy,
policies, and procedures of the AEGD program. Lutheran conducts periodic faculty
development workshops that include continuing education sessions on special
topics of clinical interest such as care for those who are HIV-infected.
Five residents who have completed their rotations at El Rio Health Center have
been subsequently hired there. The technique for recruiting is straightforward
as potential hires from among the residents are linked to openings when they
occur.
