Consumer Involvement. A Consumer Advisory Board garners
patient input into clinic operations.
Dental Hygiene Student Training. Training is provided to
dental hygiene students along with dental students and residents. Each dental
hygiene student rotates through the Clinic for one or two days. One dental
hygiene school requires students to keep a journal of their experiences at the
clinic.
Partners
Oregon Health and Science University School of Dentistry
Russell Street Clinic
Cascade AIDS Project
Oregon
Oregon Health and Science University, School of Dentistry
Building on Long History of Dental Care for the Poor
Ryan White funding for oral health at the Russell Street Clinic builds on their
33-year history of providing dental services and student training to poor
clients in Portland, Oregon and seven surrounding counties. Oregon Health and
Science University established Russell Street’s dental activities decades ago in
order to provide a community learning experience for dental and dental hygiene
students. Russell Street also has a long-standing relationship with the county’s
HIV program to deliver dental care for HIV positive clients.
When HIV came along, Russell Street added PLWH to its vulnerable patient
population to provide dental care in part through what was then called Ryan
White Title III (now, Part C) funding via the county. Dental care services are
integrated but not co-located with medical services. Specialty care is also
provided at Russell, while the University handles cases requiring hospital-based
oral surgery.
Partnerships are a core success of this project, including collaboration with Part B
and Part C networks.
The Russell Street Clinic partners with multiple local
agencies, which refer clients for dental care. While many medical care providers
are aware of Russell’s services—something that Russell Street was able to make
happen through networking and outreach—their two main referral sources are
Cascades AIDS Project, the largest provider of HIV support services in Oregon,
and the health department (both agencies provide case management services to
dental clients). The networking of these partners occurs through routine email
and phone communication and an annual meeting among institutional principals.
Likewise, partnerships with the University and other
health professions schools are in place for drawing students to complete
community rotations at the clinic. Faculty and institutional appointments are in
place for individuals involved in the Ryan White dental program.
Necessary clinical information is routinely shared
between medical and dental providers including direct communication by telephone
as well as letters and consultations. Laboratory studies, medication regimens
and medical clearances are obtained as necessary from the primary care medical
provider prior to dental care. Referral mechanisms integrate oral health care,
HIV medical management, and social and support services. A key factor in the
success is that three of the Russell Street Clinic’s providers have been with
the program since virtually the inception of the HIV epidemic, while the
providers at the Part C clinic have also been extraordinarily stable, so that
the relationship between providers is very long-standing, and there is an
enormous amount of both trust and respect between organizations.
“Prevention is key,” reports the project director. “This might include fluoride
treatments to address lack of salivation in patients with HIV, so that patients
don’t get in a cycle of decay and losing teeth, at which point the dental
practice must address restoring the teeth that are there.” With prevention a key
practice, smoking cessation counseling is included as part of patient care.
Patients also get a brochure on HIV and smoking.
The broken appointment rate at Russell is approximately 25 percent for
HIV-infected patients, due in part to patient illness and homelessness.
Case managers at Cascade AIDS Project are used to identifying hard-to-reach
clientele and linking them to primary care as well as dental care, which is why
Russell works in partnership with Cascade to do patient outreach with such
groups as Latinos and the recently incarcerated. Efforts to reach the African
American community target a community faith-based organization. Otherwise,
outreach is primarily through word-of-mouth and relationships built through
agencies funded by Ryan White programs. The dental program also serves as a
resource to other health care providers in the community regarding HIV-related
oral health by making presentations at local and state dental meetings.
While no passes are available for bus transportation to clinic visits, patients
can request medical transportation and some case workers in the area
occasionally pay for taxi services for clients. Otherwise, patients arrive using
their own vehicles or request a ride from their friends or family.
Patient Education and Involvement: Consumer Board Feedback, Education During Services
The Russell Street Clinic operates a Consumer Advisory
Board for consumers to provide feedback in order to help improve health care
services being delivered. “It’s important to address patient needs as the
patient describes them,” reports the project director.”
Most patient education occurs during the delivery of dental
services. Additionally, the reception area has several mounted posters and
materials in both English and Spanish containing information on the importance
of oral health care for those with HIV, and a brochure entitled “HIV Infection
and Oral Health” has been developed that discusses the need for regular dental
care, how to perform an oral self examination, oral manifestations of HIV
infection and where to go to access dental care.
Provider Training, Recruitment, and Retention: Dentists and Dental Hygienists
The Oregon Ryan White project hosted 72 dental students, 60
dental hygiene students and six residents in 2006. They come from the
University’s dental school as well as area dental hygiene schools.
Dental students receive training regarding care of
HIV-positive patients as part of their undergraduate curriculum in oral surgery,
oral pathology and community dentistry. The dental director of Russell Street
Clinic provides a portion of the didactic information. Similar to the dental
students, residents complete an end of year evaluation of the rotation.
In turn, the training provided to dental hygiene students
is as follows:
Students receive training regarding care of HIV-positive
patients as part of their dental hygiene curriculum in classes such as oral
pathology and theory classes. Immediately prior to their second year, when the
rotation to Russell Street Clinic occurs, the program director presents two to
four hours of training on the management of HIV-positive patients. In addition,
efforts towards cultural competency are initiated through information shared by
a consumer with the various classes.
One dental hygiene school requires students to read the
AIDS Update Newsletter and take a post-test prior to their rotation.
Once the students present to the Clinic, the staff
dental hygienist provides a one-hour review of important concepts and reviews
the charts for the day, emphasizing specific details relevant for particular
patients.
Each dental hygiene student rotates through the Clinic for
a one or two day clinical experience during their second year of training. One
dental hygiene school requires students keep a journal of their experiences at
the Clinic.
