Section 2: Dental Partnership Activities

Service and Training Strategies

While the above data outline the number of patients served and providers trained, equally compelling are the various strategies and approaches sites have developed for providing services, training providers, and managing their partnerships. They reflect different circumstances, stressors and conditions that unfold daily in clinics and universities funded under the Dental Partnership. The challenges they tackle in delivering oral health services are extensive and include: high no show rates by clients; lack of transportation; difficulty with recruitment and retention of clients; too few trained, or willing, dentists to provide dental care; and limited resources.

Grantees also had to be creative in creating opportunities for resident and student training to accommodate schedules and allow for meaningful patient time while settling organizational differences within schools and/or community agencies. Grantees also needed to maintain standards for high quality oral health care by providing regular comprehensive care and timely follow-up visits, specialized services, all while making accommodations for walk-ins and emergencies.

Service Delivery Innovations

Dental Partnerships deliver oral health care using methods that are commonly found in any dental practice. However, a number of techniques and extra steps are taken to enhance retention in care for PLWH and to otherwise make care delivery more efficient. Examples include:

• Reducing No-Show Rates Through Special Support and Reinforcement Methods. See Reducing Patient No-Show Rates for strategies being used.
• Co-Location of Medical and Dental Services. Several projects ease access to dental care by co-locating services with medical care, such as Colorado, Mississippi, and Massachusetts.
• Dental Hygiene Students to Deliver Basic Dental Care. In Mississippi, a dental hygiene school’s students deliver such basic dental services as teeth cleaning and x-rays, effectively expanding the pool of dental professionals for the community.
• Peer Advocate Support for Patients. The Nova Southeastern University Partnership, which operates in Florida and New York, uses four consumer peer advocates to perform roles such as providing information and education (especially on topics like adherence to treatments) and facilitating referrals to care. These peers also help run patient support groups, organize treatment updates for patients, and serve as resources for medical providers.

Reducing Patient No-Show Rates

Patient no-show rates vary considerably across sites and generally have fallen as projects have been implemented. Multiple Dental Partnership programs have realized remarkable improvements in no-show rates. To illustrate:

• Colorado reduced its no-show rate in one of its funded clinics from 20-25 percent to 6 percent by using a “Fast Track” program in which they changed the delivery of services by providing comprehensive oral health care in an intensified way. For example, patients received treatment plans and were scheduled every other week until the plan was complete. Patients receive hygiene treatment four times annually and are kept up to date with treatments they need. The dental staff knows the name of every patient and services are patient-centered. Recently, the team’s hygienist “remodeled” one of the operatories by creating a more patient-friendly environment.
• One of New Jersey’s many methods to enhance retention in dental care is educational trainings to support groups of people with HIV. At these sessions, staff also set up patient appointments and focus on reducing patient anxiety about coming in for dental care.
• Loma Linda gives dental patients with HIV the option of waiting in a separate and private waiting room, which many patients with HIV opt for, given privacy concerns. Louisiana’s Partnership also uses this technique.
• Illinois continues to experience high no-show rates in the range of 30-40 percent but, nonetheless, has used such methods as having dental staff regularly check for potential appointment conflicts with medical care appointments at other health care clinics. Dental appointment staff also confirm telephone numbers and addresses of patients at each visit. Referrals to specialty care at the University are tracked by a paper check-in process that includes notations in charts. Louisiana does much of the same. Their appointment support to address no-shows includes confirmation of contact information, identification of conflicting appointments with other providers, coordination by case managers, and reminder calls and mailings.