Peer Advocates. Use of peer advocates to assist with
patient care delivery.
Cross-State Collaboration. Agencies in New York and
Florida worked together to make a significant change in the Federal grant to
move services given closure of the dental program at the original grantee site.
Partners
Albany Medical Center
Nova Southeastern University
Care Resource
Florida and New York
Nova Southeastern University, College of Dental Medicine
Adapting to Change to Integrate Dental Care with Medical Services
The need for change, and flexibility brought these two geographically removed sites
together—one in Florida, the other in New York State. The latter, Albany Medical
Center, faced a mini-crisis when its dental residency program closed. While
continuing to provide HIV medical care under Ryan White funding from multiple
Parts and other sources, they needed a place to locate their Ryan White-funded
dental training. An opportunity arose in, southern Florida, at Nova Southeastern
University.
Today, Ryan White supported student dental training takes place solely in
Florida, while dental services continue at both sites—in both cases, integrated
within primary care settings.
In Florida, the dental clinic is within an agency called
Care Resource, which delivers primary medical care, case management and support
services to PLWH.
At the Albany site, dental care is co-located on the
same floor as the HIV medical clinic and serves clients in the area as well as a
vast rural area of upstate New York.
Patient Education and Involvement: Consumer Advisory Board, Peer
Advocates
Multiple strategies are used in this project to involve patients in their care.
Notably in New York, a long-standing Consumer Advisory Board remains active as a
venue for garnering patients’ input on their care, from medical to dental. The
group is reflective of the patient population. Members are involved in the
design, administration, and analysis/reporting of patient satisfaction surveys.
These surveys are distributed to patients annually. The results are used for the
purposes of program design and evaluation.
Consumers are also involved in care delivery as they are hired as peer advocates
for other patients. On average, there are four peer advocates. Peer advocates
are trained to provide patient support such as knowing about what local services
are available and understanding the dynamics of the helping relationship. Their
roles include providing patient information and education, making referrals,
providing support and education about treatment adherence, and fostering
retention in care. These peers also help run patient support groups, organize
treatment updates for patients, and act as resources for medical providers.
Beyond patient involvement, Florida and New York ensure that patients are
educated about dental care. Methods include patient educational materials
available in both English and Spanish, such as: monographs on diabetes,
children’s dental health and additional information about methamphetamine use
and oral health. Oral health assessment and education is documented in dental
charts of patients so staff can ensure that this crucial task is completed as a
routine of the care they provide.
Provider Education and Training: Ample Reflective Time
Nova Southeastern University conducts weekly student rotations at a recently
constructed 2-chair dental clinic in Ft. Lauderdale. Students learn about HIV
primary care concurrently with dental care because services are co-located.
Training occurs in large part through consultations and case reviews with
seasoned dental faculty working on-site. These staffers have over 10 years
experience in treating HIV patients in multidisciplinary HIV dedicated health
centers.
Formal reflective time (i.e., time to brief, explore the learning experience and
debrief) is built into the rotations in the form of daily “lunch and learn”
sessions where the day’s cases are reviewed and analyzed. Medical, dental,
social and behavioral profiles of the patients are analyzed, giving the students
an opportunity to listen and learn from the on site behavioral scientists and
social workers. Thus, each patient’s background is explored in detail and the
discussions center not simply on their medical conditions, but also on the
social and behavioral aspects of each patient’s profile, allowing for an
improved approach to care.
A better informed clinician emerges to treat these patients by being more aware
of the body, mind and emotions that accompany each mouth that they heal. This
approach aims at eliminating prejudices and misconceptions that students carry
from their previous private experiences and sensitizes them to aspects of care
that they might otherwise have not received in their general basic dental
training, which traditionally might focus solely on oral care.
Patients not only take pleasure and pride in becoming an integral part of the
training of a new generation of dentists, but also feel the reassurance and the
comfort of the detailed attention they receive. This attention becomes obvious
to them when observing the learning interactions between students and faculty,
and the patients in turn often volunteer more information about their medical
health, their dental fears, and their own misconceptions about dentists and
dental care that they carry from their past experiences.
Ultimately the goal is to bring together patients and dental providers for more
effective health partnerships through closer communication and better
understanding. By keeping patients in the safety of their own medical care
environment and introducing dental students into this multidisciplinary team, a
level of reciprocated comfort and trust is achieved that goes far beyond that
which is more the norm in a dental school.
