Dental Hygienists Handle Routine Care. Community college
dental hygiene programs and students handle routine oral health care.
Agency Networking. Extensive networking with other Ryan
White Parts resulted in an expanded referral network.
Co-Location of Services. Co-location of medical and
dental services enhances delivery of an array of HIV services.
Partners
University of Mississippi Medical Center’s School of Dentistry
Crossroads Care Services
Northeast Mississippi Community College Hygiene Program
Pearl River Community College Hygiene Program
Delta AETC
Mississippi
University of Mississippi Medical Center, School of Dentistry
Integrating Dental/Medical Care, Expanding Care Via Hygiene Program
One way to mainstream dental care into a community setting is to co-locate
services. Under the University of Mississippi Medical Center’s School of
Dentistry project, regular dental care is provided at a multi-service AIDS
service site. University-based clinicians are there to handle the tough cases
and provide training. In addition, a school of dental hygiene helps deliver
basic care and also trains dental hygiene students in providing care to
HIV-positive clients. This single site is not the only place for HIV dental
care, however, as services are promoted with agencies and providers at other
sites across the State.
Services: Co-Location, Dental Hygienists Do Basic Care
A large volume of HIV dental care in Mississippi’s
community dental project is delivered at an AIDS service site called Crossroads
Care Services, which was established by the State health department as a
multidisciplinary HIV care clinic that serves clients enrolled in Mississippi’s
Ryan White AIDS Drug Assistance Program. As of late 2006, 1,051 HIV-infected
patients were enrolled. They get care from a well-staffed medical facility that
offers an outpatient pharmacy, HIV testing facility, phlebotomy laboratory
and—of course—dental care. Off-hours and emergency cases are handled by
residents being trained by the University, which maintains a 12-chair dental
department on-site.
Crossroads has a three-chair dental clinic and, in 2006-07,
provided services to 200 unduplicated clients, with 650 patients visits in the
past 12 month period—a 40 percent increase from 2005. The Crossroads Dental
Department provides comprehensive dental care including diagnostic, preventive,
and surgical services to name a few. Collaboration is hard to avoid when
services are next door to each other, which is the case at Crossroads. Medical
and dental departments are not only in the same office but also share a common
waiting/reception area and clerical staff. Referrals and communication between
the medical and dental clinicians is literally as easy as a walk down the hall.
An added benefit is that co-location offers patient privacy and ready access to
other services.
While Crossroads provides a large amount of HIV oral care
in Mississippi, lots of advocacy takes place to urge a network of agencies and
providers across the State, which receive over $4 million annually in Ryan White
funds, to expand their dental care to PLWH. The Dental Partnership’s clinic
director does lots of networking with private dentists, medical providers
including specialists, and does training in liaison with the local AETC. As a
result, a strong network of providers attentive to HIV dental and medical care
needs has been created. Providers network on an ongoing basis by emails and
scheduled meetings with the director.
The latest partner to be added to this network is an area
community college and their hygiene program. As of this writing another dental
hygiene program has been added as a partner. They are offering such basic
services as teeth cleanings and x-rays. Patients needing more specialized care
are referred out. This referral process happens by informing area health
department clinics, district social workers and area infectious disease clinics
about the services being provided at the local hygiene program. A referral sheet
is given to the hygiene program from the referring clinic to assist with the
initial contact of the patient.
Patient Education and Involvement: One-On-One, Satisfaction Surveys
Patient education at this Mississippi dental project takes
place informally at each dental visit and involves one-on-one (patient to
doctor/assistant) discussion of oral health in relation to total health.
Discussion, flip-charts, videos and brochures are used to cover topics like
periodontal disease, brushing and flossing. Tobacco cessation and how it can
improve oral health is also covered, with referrals made to a dedicated tobacco
cessation program housed on-site at Crossroads.
Patient satisfaction at Crossroads is measured via random
consumer satisfaction surveys and is reportedly high. There is general
satisfaction with wait times to get appointments and to get in to see dental
providers once on-site. Notably, a good number of patients displaced from
Louisiana due to Hurricane Katrina have been getting dental care in Mississippi.
Some are staying in the area, perhaps in part due to the services they are
receiving.
While this Dental Partnership does not have a formal
Consumer Advisory Board, the dentist actively involves consumers in program
activities by informing each patient of the clinic’s plans and eliciting their
suggestions during appointments. Feedback is positive and patients voice an
interest in becoming more active in the recruitment of patients and in the
developing quality improvement aspect.
Provider Education and Recruitment
Efforts to re-energize the manpower ready and able to take
on HIV dental care are undertaken through the School of Dentistry’s dental
education program curriculum. It provides second year students with HIV
education, while third and fourth year students have an opportunity to be
trained in the care of HIV-infected patients through a 6 ½ day elective rotation
at Crossroads. In 2006, two senior students took the elective rotation and two
students spent 2 weeks of training as volunteers during their vacation time.
Student surveys indicate 100 percent student satisfaction with their experience
at Crossroads while on rotation.
Results from a pre/post rotation questionnaire assessing
knowledge and confidence about treating HIV-positive individuals suggest that
most students do have a pre-conceived stereotype of HIV infection and those who
are infected (homelessness, education, illness). After rotations, students show
a tremendous improvement with their confidence and competence in regards to the
dental treatment of HIV persons, and regularly state that they learned so much
from the experience and no longer have reservations about treating patients with
HIV.
Private dentists have the opportunity to spend anywhere
from a half to a full day at the Crossroads clinic observing and treating HIV
patients. This training opportunity has been taken advantage of by 15 dentists
(those in private practice and those within the State prison system). Training
occurs under the direction of the clinic’s dental director and is co-sponsored
with the Delta AETC.
