Section 3: Profiles and Audio from the Field

Audio from the Field Grantee Overview of Features Transcript

Features

Fast Track Method to Reduce No-Shows. The no-show rate at a dental clinic decreased from 25 percent to 6 percent over 2 years as a result of intensified services and extra personalized care. New Dentist Hire. A graduate from the School of Dentistry who participated in the Dental Partnership was placed at a community-based clinic. Partnerships. Partnerships were fostered between Ryan White and Robert Wood Johnson programs to provide more comprehensive care, facilitate referrals, promote cross-training and communication between physician and dental providers, and enhance use of fiscal resources across Ryan White programs in the State.

Partners

University of Colorado, School of Dental Medicine Marillac Clinic Pueblo Community Health Center Longmont Dental Clinic Howard Dental Center

Colorado
University of Colorado Health Sciences Center, School of Dental Medicine

Reducing No Show Rate, Creating Partnerships to Serve Vast Area

There is a lot of wide open space in Colorado. The only practical way to bring oral health care to such a large area is for agencies to work together. To do it well is an altogether separate challenge, one that the University of Colorado and its four agency partners have proof that they know how to tackle. They achieved a major reduction in a dental clinic site’s no-show rate from 20-25 percent down to 6 percent over a multi-year period. What made this happen was intensified delivery of dental services, dubbed Fast Track. Its components include:

• Treatment Plans and Up Front Intensified Care. Patients receive treatment plans and are scheduled for care every other week until their dental care plan is complete.
• Regular Care. Patients get hygiene treatment four times annually and are kept up-to-date with treatments they need.
• More Personalized Care. One method is for dental staff to know and use the name of every patient (using first names if appropriate) and to greet patients courteously and with respect. Unsurprisingly, this facilitates patient-provider communication. One partner agency, the Howard Clinic, personalizes care by making the dental clinic more comfortable, which the team’s hygienist did by remodeling the operatories to create a “spa-like” environment.
• Regular Patient Feedback. Another partner, Pueblo Community Health Center, conducts quarterly patient satisfaction surveys and uses results to improve services for clients.

Services: Network Handles Regular/Specialty Care

The University of Colorado Health Sciences Center manages a Statewide consortium that delivers HIV dental care across the State via four community partner agencies. Making such a large collaboration work requires ongoing communication among the community-based partners, the AIDS Education and Training Center (AETC), and the University. Geographic distances between partners require heavy reliance on e-mail and phone communications, but members also meet face-to-face for regular meetings, topical conferences, and problem-solving sessions.

Dental services are co-located with medical care at some sites. Regardless, regular meetings occur at each site and include medical, dental and other health care disciplines to discuss patient care and collaborative efforts. In 2006, 458 unduplicated clients were seen for dental services—an increase of 16 percent from the prior year.

Each community agency has its own medical referral system, which helps decrease time needed to access specialty care. The University handles specialty dental cases. The regional AETC can act as a referral source and consultation service for any of the community-based partners.

Colorado uses multiple techniques to get patients into dental care:

• The Howard Dental Center uses word of mouth outreach, direct referral from medical providers, and direct advertising in fliers/newspapers. However, attracting patients is not a challenge as many clients are close to their clinic location. Howard also has very few no-shows, which is thought to be attributable to patient appreciation of services given the patient friendly environment they have created. On a practical level, it is widely known among patients that getting another appointment any time soon if one is missed is not easy at this popular clinic.
• At the remote Marillac Clinic, located on the western slope of the Colorado Rocky Mountains, efforts to facilitate patient scheduling and appointment keeping include transportation vouchers and even overnight accommodations for those who travel the greatest distances.

Loma Linda dental trainees are drawn from fourth year senior dental students, senior International Dentist Program students, and dental hygiene students. Dental students complete the HIV-oriented training under a broader service-oriented curriculum that requires 120 hours of service-learning during an academic career.

Provider Education and Training: Array of Techniques Used

Colorado’s School of Dental Medicine has extensive student training in place and is also part of the nationwide Robert Wood Johnson Foundation dental initiative that also provides students with a community-based learning experience as part of their goal to expand the oral health workforce for rural areas. The area’s AETC adds to the mix of training via continuing education programs to dental societies and dental study clubs.

Student training at the University takes place through month-long rotations at community dental sites. Features include:

• Exposure to how medical care is provided to PLWH via HIV specific lectures and case-based discussions and competency examinations. Students review medical histories of patients at training sites, perform head and neck examinations on patients, and receive immediate feedback (from faculty and patients) on how the examinations were performed.
• Oral Medicine and Oral Diagnosis Competencies (case presentations and case-based exercises) are required before graduation. One part requires each student to work in partnership with a patient to complete a medical consultation.
• Clinic rotations for select students take place 9-12 months per year and attempt to match students with programs at community-based centers. This frequency allows more time for rotations and rotation slots.
• Distance learning methodologies/technologies are used to simulcast Grand Rounds from the University’s main campus to community sites.
• Students can access a file cabinet of current articles from the dental and medical literature during any down-time they may have.
• Students are encouraged to prepare a short and simple slide presentation on a particular topic of interest or a patient they treated while at the Howard Clinic in downtown Denver. Part of the presentation includes feedback about their rotational experience.