concepts in dental public health ch 2

7/27/2019 Concepts in Dental Public Health Ch 2

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Concepts In Public Health

Chapter 2

Trends In Dental Public Health


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What Is An Oral Health

Disparity? When certain populations or groups

experience a higher level of oral diseases

when compared to other groups. Non-Hispanic Blacks, American Indians,

Hispanics, Alaska natives have the poorestoral health of all racial groups in U.S.

Limited knowledge and access to preventivecare contribute to disparity.


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Demographics Used Age

Sex

Race or ethnicity

Socioeconomic status

Primary language

Geography Medical or disability status

Behavior lifestyles


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Correcting The Disparities Healthy People 2000, 2010, 2020

Surgeon General National Call to Action

Improve data collection

Collect data/do research

Put data and research into action (I saidthis)


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Healthy People 2020 Oral health is a focus of this initiative

42 objectives

Oral health linked with other areas(maternal and child health, cancer,diabetes, access and infrastructure)


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National Call To Action Framework for oral health action

Strategies for collaboration to reducedisparities

Strategies to improve oral health

*Report calls for action in 5 areas.

(See next slide)


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Five Areas For Action Change perception of oral health

Overcome barriers/replicate effective

programs and proven efforts Build science base/accelerate science

transfer

Increase oral health workforce,diversity, capacity and flexibility

Increase collaboration


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Improve Data Collection Data collection methods need to be

improved

Data analysis methods need to beimproved along with methods ofcomparison


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Collect Data/Do Research State health departments

Local health departments

Dental schools

Dental hygiene schools

*Research needs to be conducted byeach of these entities in order toproduce comparable data.


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Demographic Shifts Fastest growing segment of U.S. population is

85 years and older. (Good thing or bad?)

By 2030, 20% of U.S. population will be 65 orolder.

Fewer than 5% of elderly live in nursinghomes.

About 20% of Americans have a disabilitywith 10% having a severe disability.


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Note With people living longer there is more

of a demand for oral care.

HOWEVER! Graduate dental studentswho answered a survey stated they didnot feel well prepared to work with the

elderly, disabled, or those withHIV/AIDS.


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Demographics Continued 1 in 4 Americans is Black, Hispanic, orAsian/other non-Hispanic.

1 in 10 U. S. residents is foreign born.

Number of oral health professionalsrepresenting minority groups is

disproportionate to the number ofethnic groups.


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NoteAccording to your text, the field of

dental hygiene is even less ethnically

diverse than the dental field. Relativelyfew faculty members in dental or dentalhygiene schools are ethnic minorities.

Why? What do you think?


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Think About This Do you agree with the statement:Appropriate role models/mentors are

lacking for students and graduates fromethnic minority groups who wish towork in dental public health settings?

In other words, does a rolemodel/mentor have to be ethnic if thestudent they are mentoring is ethnic?


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Access To Care Fact: More than 90% of active dentists

and hygienists work in private practice.

Fact: Many dentists do not participatein Medicaid or State Childrens HealthInsurance Program.


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Dental Health Professional

Shortage AreasWhat it is: Geographic areas, special

population groups, or facilities

designated by the government ashaving a shortage of oral healthpersonnel.

Examples: rural areas, low income orMedicaid populations, correctionalinstitutions.


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Safety Net Dental Clinics No regular source for dental care/now

this facility is chosen

Sliding fee scale/Medicaid accepted

Will not be turned away if they cannotafford treatment

Clinic is close to home

*Problem-not enough of these clinics


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Mobile and Portable ServicesAnother solution to access problem

Mobile vans, mobile trailers, portable

dental equipment

Provides services to underservedpopulations


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Teledentistry Addresses lack of dental specialty services in

rural areas

Uses electronic information andcommunications technology

Provides consultation by a specialistselectronically/saves travel time and expenses.

Uses digital radiography, computer and videoapplications


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Other Solutions Allow dental hygienists to practice without

supervision of a dentist

Change law that limits licensure to only thosepractitioners who have successfully passed astate clinical board

Change law that prevents third party payersfrom reimbursing dental hygienists directly


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Medicare1. Provides health insurance to those 65

and older, certain people with

disability, and persons with kidneyfailure

2. Does not provide coverage for oral

health services


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Medicaid Jointly funded by federal and state

Provides insurance for low income

families Includes children, seniors, blind,

disabled

Oral health services mandatory forchildren

Oral health services optional for adults


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What Do You Think? What message do you think Medicare

and Medicaid send by providing the

kinds of coverage they provide?


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SCHIP State Childrens Health Insurance Program

Jointly funded-federal and state

Health insurance for children to age 19 Incomes are generally less than 2x the

poverty level/do not qualify for Medicaid

Oral health coverage not a mandatory

component All states have opted to include some oral

health coverage


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Community Based Programs Community clinics

School-based sealant programs

Preschool fluoride supplement programs

Nursing home oral health programs


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Funding For Programs Federal/state/local governments

Corporate sponsors

Foundations/philanthropic organizations

Sliding fee schedule clinics

Private donations


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Insurance 15% of persons 18 and older have no

medical insurance

45% (approx. 85 million) have nodental insurance


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InsuranceTwo types:

1. Indemnity plans-reimbursement

plans/fee-for-service plans

2. Managed care plans


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Managed Care PlansThree Types:

Health maintenance organization

(HMO)

Preferred provider organization (PPO)

Point-of-service plans (POS)


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Health Maintenance

Organizations HMO, DMO, DHMO

Health care services are on a prepaid basis

Were designed to reduce cost of health care Dentist receives monthly fee (capitation)

Members must receive care from a network

provider Example: Aetna DMO


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Preferred Provider

Organization PPO

Patients must use a network provider

Provider agrees to discount their fees

Patients can go out of network (higherdeductibles and co-pay amounts)


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Point-Of-Service Plans POS

DMO patient can go to out of network

provider

Benefits are usually lower than ifpatient stays in network


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Capitation Provider is paid a fixed amount for each

patient enrolled in his/her office

regardless of whether or the patientactually uses the services.

Providers are paid in several ways:

capitation, fee-for-service, or can besalaried by the plan.


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Gatekeeper Function Primary care provider controls referral

to specialists

Primary care providers include:Pediatricians, family doctors, generaldentists, pediatric dentists.


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Oral Health Infrastructure Programs and people who assure the

publics oral health

Lack of personnel with oral healthexpertise-serious problem/results indecline in publics oral health

Oral Health America-issued Oral HealthReport Card for states/grade=C


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WorkforceText states:

Recruiting members of underrepresented

ethnic groups into oral health and alliedhealth professions and therefore, intodental public health positions has been

difficult.What can be done?


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What Is The Problem? Student debts

Graduates repay student loans by practicing

in Health Service Corps or Indian HealthServices leave when loan is repaid

Mean graduating debt for a dental student in2002 was $107,503

Only about 145 dentists are board certified indental public health


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Oral Health Integration Surgeon General called for integration of

oral health and general

Mouth should be thought of as integral partof the body/not separate entity

Oral health can be integrated into:Nutrition, cancer, HIV/AIDS, osteoporosis,

birth defects, diabetes, CD prevention,tobacco cessation, prenatal counseling,school readiness initiatives


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Other Ways To Integrate Teach general dentists to treat young

children and recognize other childhood healthproblems

Promote first dental visit by age one

Assure each child has a medical anddental home

Incorporate oral health screening/referral,education, and fluoride varnishes into primarycare and well child visits

Increasing inter-professional education and

communication via the Internet


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Technology Good or bad?

Information overload

Is information reliable? Consumers expect health care

professionals to know their

stuff/causes clinicians to pay highmalpractice premiums/developdefensive mind set


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Health Communication

Strategies Social marketing-technique to increase

public awareness of the relationship of

behaviors to diseases and to influencepeople to take action.

Media advocacy-use of various media

outlets and formats to increaseawareness and knowledge of issues.


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Literacy 45% of adults in U.S. read at 8th grade level

or lower

Health literacy importance:1. Learning oral health knowledge

2. Purchasing oral health care products

3. Promoting oral health to others

4. Communicating with oral health careproviders

5. Navigating the oral health care system


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Improving Health Literacy Integrate health concepts and skills into

adult education, GED programs, and

ESL classes. Plain Language Movement-documents

written in plain language help people

find what they need, understand whatthey find, and act on thatunderstanding


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Evidence Based Practice Goal-to facilitate timely translation of

research findings into clinical and communitypractices

Barriers that prevent evidence based practice:page 26 in text, box 2-3

Research shows that it takes at least 10 years

for practitioners to adopt new materials ortechniques.

Cochrane Oral Health Group

concepts in dental public health ch 2

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