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Section 3: Profiles and Audio from the Field
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Features
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Methods facilitating the University of Illinois’ partnership with Heartland
Health Outreach include:
- Budgeting
- Community Outreach
- Regular Meetings
- Emails
- Medical and Dental Providers Share, Collaborate and Provide Clinical Information
- Memoranda of Agreement
- Scheduling
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Partners
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- University of Illinois at Chicago College of Dentistry
- Heartland Health Outreach
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Illinois
University of Illinois at Chicago, College of Dentistry
Close Partnership, Continuous Feedback
An affiliation is like dating, but a partnership is like marriage. That’s how
the dental project team at the University of Illinois sums up their Ryan White
dental partnership with Heartland Health Outreach. The point, of course, is not
about who has to cook dinner or clean the dishes. It’s about the level of effort
it takes to make things work.
This marriage involves two very substantial service agencies. The University of
Illinois at Chicago College of Dentistry is the State’s largest provider of
dental care to PLWH. Their HIV/AIDS dental practice started in 1989 with 60
patients and now has over 2,600. The community partner, Heartland Health
Outreach, is a multi-site human service agency that got its start in 1888. This
close partnership works because of joint involvement in multiple activities (see
Features).
The following methods facilitate the University of Illinois’ partnership with
Heartland Health Outreach:
- Budgeting. Each partner provides input on budget issues, aiding buy-in
to the overall project as all partners have a financial stake and obligation in
the Partnership’s ongoing success. This also helps ensure that plans that are
proposed are actually doable.
- Community Outreach. The University urges community-based preceptors to
represent the project at local and national meetings.
- Regular Meetings. Monthly meetings are held at various partner facilities
to discuss program status (especially with regard to students, patients, and
preceptors). By rotating locations and lead roles, there is a lessened perception
of one partner as the lead agency.
- Emails. Communication is ongoing via email and typically covers budgets,
student scheduling, and other issues that come up at talk-back sessions (e.g.,
how to handle needle-stick reimbursement).
- Medical and Dental Providers Share, Collaborate and Provide Clinical Information.
This is accomplished via telephone, letters, and consult requests that specify medical information needed
by the medical provider or the dentist.
- Memoranda of Agreement. This document helps clarify partners’ understanding of
the bylaws and responsibilities of each entity.
- Scheduling. Student scheduling ensures that students are scheduled when they are
needed and available (e.g., not during spring break). It also ensures that preceptors are available to
supervise students during these times (i.e. not during staff meetings).
Services: Steps Taken to Address No Shows
Three dental clinics provide care to patients with HIV in the Illinois program
(two dental clinics at the community partner site and one HIV-specific clinic at
the University). Sites can provide dental care on an emergency walk-in basis;
regular patients are seen within 24 hours.
The current broken appointment rate is quite high, 30-40 percent, at the two
community dental clinics. Typical reasons given for no-shows are weather. Steps
take in response include:
- The appointment staff regularly checks for potential
conflicts with medical care appointments at other health care clinics. This is
done by simply calling providers listed on dental patient charts to check on
appointment times. The providers at the medical agencies share the same parent
organization, and patients give consent for this cross-checking before entering
into the health-delivery system.
- Dental appointment staff members confirm telephone
numbers and addresses of patients at each visit.
- Patients with specialty care needs in periodontics,
orthodontics, endodontics and oral surgery are referred to the University dental
clinic. These referrals are tracked by a paper check-in process that includes
notations in charts.
Provider Education and Training: Rotation Time Expanded
Students used to be on-site at the Heartland community site for just one
week—not nearly enough time to gain an appreciation of community dentistry and
the rapid pace of seeing varied clients with many needs. The rotation was
expanded to 20 days to provide students with a richer learning experience and
more comfort treating PLWH. Student training includes the following:
- Students receive formal instruction and supervised
clinic experience in: (1) HIV medical risk assessment including taking records
and interpreting a medical history and physical evaluation as performed by a
physician; (2) understanding the indications of and interpretation of laboratory
studies, and (3) understanding the relationship of oral health care and HIV
disease.
- Students engage in structured reflection activities,
using a service-learning methodology. Students are asked to undertake a critical
analysis about their experience working with HIV positive patients by completing
a “Significant Moment Report” that poses three questions about an incident (of
the students’ choosing) that happened during the clerkship. The intent is to
turn conflicts into learning opportunities. (See the
TARGET Center’s TA Library for a copy of this form.)
- Students are directed to examine a key policy issue they
have identified and describe their experience in advocating for change.
- Students and residents engage in monthly “talk-back”
sessions to share feedback on experiences.
Retention and Recruitment of Clients
The University of Illinois serves as a resource to other health care providers in the
community regarding HIV related oral health. This is done via presentations to dentists
in such settings as the AIDS Education and Training Center (AETC) Dental Study Club and
the University’s UIC Extramural Site Conference. Up to eight of these presentations are
held each year and are conducted by the community clinic’s dental director, principle
investigator, and/or AETC-sponsored speakers. Additionally, University dentists are
available to community dentists for regular consults about their private patients.
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