Download - 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