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SPNS IHIP Oral Health Webinar Series: Dental Case Management……………….Presented by Dr. Howell Strauss and Nelson Diaz of AIDS Care Groupand Dr. Carolyn Brown and Lucy Wright of the Native American Health Center January 9, 2014
Agenda■Introduction to SPNS Integrating HIV Innovative Practices (IHIP) project
■ Sarah Cook-Raymond, Managing Director of Impact Marketing + Communications
■Presentations ■AIDS Care Group of Chester, PA
■ Dr. Howell Strauss, Executive Director & Dentist■ Nelson Orlando Diaz, Dental Case Manager &
Community Health Worker■Native American Health Center of San Francisco,
CA■ Dr. Carolyn Brown, Dental Director, Programs &
Development■ Lucy Wright, RDA, Dental Program Coordinator &
Former Patient Navigator
■Q & A
IHIP Resources onTARGET Center Website www.careacttarget.org/ihip
IHIP Oral Health Resources■Training Manual
■Curriculum
■Pocket Guide
■Webinar Series■ Healthy Mouth, Healthy Body (Held Dec. 13)■ Dental Case Management■ Clinical Aspects of Oral Health Care for
PLWHA
Recording and slides for all Webinars will be uploaded to TARGET Center Web site following the
live event: www.careacttarget.org/ihip
Other IHIP Resources■ Buprenorphine Therapy
■ Training Manual, Curriculum, Monograph, and Webinars on implementing buprenorphine in primary care settings
■ Engaging Hard-to-Reach Populations■ Training Manual, Curriculum, and Webinars on engaging
hard-to-reach populations
■ Jail Linkages■ Training Manual, Curriculum, Pocket Guide, and Webinars
on enhancing linkages to HIV care in jails settings
■ UPCOMING: Hepatitis C Treatment Expansion■ In Spring/Summer 2014, look for training materials on
increasing access to and completion of Hepatitis C treatment for PLWHA on the TARGET Center Web site.
AIDS Care GroupAIDS Care Group
Outreach and Dental Case Outreach and Dental Case ManagementManagement
Clinical servicesClinical services
MedicineMedicine DentistryDentistry Medical case managementMedical case management NutritionNutrition PsychiatryPsychiatry Psychosocial servicesPsychosocial services
Social and Medical Factors Affect Social and Medical Factors Affect Individual and Community HealthIndividual and Community Health
There is poverty, joblessness, homelessness, There is poverty, joblessness, homelessness, and despair.and despair.
Crime, substance abuse behaviors, and/or Crime, substance abuse behaviors, and/or mental health conditions affect access to mental health conditions affect access to and retention in care.and retention in care.
Dental care historically lacking in this targeted Dental care historically lacking in this targeted population.population.
Historical Review of Access to Historical Review of Access to Dental CareDental Care
1980s: Regardless of ability to pay, dental 1980s: Regardless of ability to pay, dental care was inaccessible.care was inaccessible.
Early 1990s: One of two dental schools in Early 1990s: One of two dental schools in Philadelphia accepted HIV positive patients.Philadelphia accepted HIV positive patients.
Middle 1990s: Americans with Disabilities Middle 1990s: Americans with Disabilities Act: All dental practices are offices of public Act: All dental practices are offices of public accommodation.accommodation.
History continuesHistory continues
New ways devised to deny dental care: New ways devised to deny dental care: ““This office does not accept Medicaid dental This office does not accept Medicaid dental insurance.insurance.””
Barriers to CareBarriers to Care
Fear of the dentistFear of the dentist Inability to payInability to pay Need to be asleepNeed to be asleep No way to get thereNo way to get there Other family and health issuesOther family and health issues
Newly Constructed BarriersNewly Constructed Barriers
To get care in the Ryan White setting, you To get care in the Ryan White setting, you must present your papers.must present your papers.
““Papers, please.Papers, please.””
Special ProjectsSpecial Projects
The AIDS Care Group was awarded The AIDS Care Group was awarded a Special Projects of National a Special Projects of National
Significance grant for Significance grant for ““Oral Health Care – Outreach Oral Health Care – Outreach
ProjectProject””A new clinic was established in Coatesville in October, 2006A new clinic was established in Coatesville in October, 2006
Dental Case Management
Outreach stresses the need to go where people are receiving the most basic of their needs.
It can mean meeting people in hospitals, food distribution centers, religious meeting places, or social service agencies. It can also mean meeting people in prisons and jails, drug and alcohol treatment centers, or crack-houses.
The dental case manager is the glue that keeps the program together.
Linked patients, papers, and providers.Liaison between medical and social
services providers, family members, and dental staff.
Transportation: New van logged 35,000 miles in first year of operation; exclusively for the dental outreach program.
Other enhancements: food, clothing, gas cards, chief kibbitzer.
New dental clinic established.New dental clinic established. New dentist hired.New dentist hired. Staff added from the community.Staff added from the community. Outreach provided to multiple communities.Outreach provided to multiple communities. Start-up time: 4 months.Start-up time: 4 months. Full patient schedule within 6 months.Full patient schedule within 6 months. Over 600 patients treated.Over 600 patients treated.
Program sustained to this day, using the Program sustained to this day, using the same model of outreach and removing same model of outreach and removing barriers to care.barriers to care.
2014 HRSA/SPNS IHIP Dental Case Management Webinar
Native American Health Center
Carolyn Brown, DDS Lucy Wright,RDADental Director Dental Program Coordinator
Former Patient [email protected] [email protected]
Building the Case for NAHC’s Patient Navigator (Pre-2006)
Wide range of dental services offered at NAHC– Compact dental team focusing on clinical services
Referrals for HIV+ persons from 14+ agencies to NAHC dental
Sporadic success in managing dental treatment – Sometimes resulted in incomplete appointments, missed
appointments– Confusion on the part of the patient, NAHC and referring agency– Dentist or over burdened receptionist often requesting + med info– Most treatment plan completions for patients with the least
amount of access issues– 35% no-show rate for dental appointments from HIV+ patients
referred from partner agencies1
1- Goddard G, Brown C, and Ahmad S: Oral Disease Prevalence among HIV-Positive Native American Indians in an Urban Clinic, Journal of Psychoactive Drugs, Vol 37 (3), Sept 2005. PMID: 16295015
Creating Dental Case Management
The chicken or the egg?
Option 1:
Dental staff and train for case management
Option 2:
Case manager and upgrade dental i.q.
Patient Navigator-GOALS
Increase Access– Identify barriers to care during interviews, and treatment;
customize support or ancillary services Intro the idea of a dental home
– Patient will identify with NAHC, their dentist, and dental case manager as THEIR provider, fostering understanding and motivation towards treatment plan completion
Build Team Mentality– Build cohesiveness of the dental team– Bridge resources with medical case managers– Bridge resources for referrals– Partner w. the patient, and care givers to meet their needs and
accomplish their dental goals– Identify other medical or community resources for the patient
Patient Navigator- A Day in the Life of…
9a -HIVQUAL audit prep930a- Pick up food from Food Bank10a- Accompany patient to the oral surgeon 11a- Call 10 patients for appt reminder; Remind 1 patient to bring
lab work1130a-Coordinate with oral sx’s office on patient’s f/u instructions12p- Answer patient’s email who is confused about appt time;
review incoming faxes and lab work2p- Intake 2 new patients; f/up with 1+3p- Meet with DDS to review tx plan progress4p- Review treatment plans with DDS430a- Call patient from oral surgery appt; follow-up5p- Meet with 1 patient after dental appointment
Findings from the SPNS projects
Clinical:Improvement in overall health statusMore likely to complete Phase 1 treatment plansMore likely to be retained in dental care
Patients:Availability of DCMIncrease accessKnowledgeEmpathy and offer comfortPatients credited overall health improvement to DCM
LeMay, Tobias, Umez-Eronini, Brown,McCluskey, Fox, Bednarsh and Cabral.Dental case manager encounters: the association with retention in dental care and treatment plan completion. Spec Care Dentist. 2013 Mar-Apr;33(2):70-7.
LeMay, Cashman, McDonald, Graves. A new approach to ensuring oral health care for people living with HIV/AIDS: the dental case manager. Prev Chronic Dis. 2012;9:E158.
NAHC HOPE/SPNS Study 2007- 2010 Results
DCM (n= 85) and non-DCM patients (n=205) very similar populations
DCM patients had significantly higher:– Phase 1 treatment plan completion– Low intensity preventative treatments– Higher number of dental appointments/yr– Higher likelihood of keeping appt.– Higher reported oral health quality of life
Brown C, Ponnala S, Kim J. Oral Presentation: “Maximizing Clinical and Health Outcomes: HIV+ Dental Case Management”. International Association for Dental Research, Miami, FL. April 1-4, 2009.
NAHC’s Patient Navigator Success
No show rate for HIV+ dental patients at 5% from 35% over 4 years
118 patients who have been out of care recruited and retained
88+ specialty referral appointments kept and treatment received
Close partnership with 10 medical clinics specializing in HIV+ care
Added 2nd Dental Case Manager; Ratio was 40-50 patients : 1 DCM
The State and Future of HIV
Research Goal #3: Optimizing treatment and care of the HIV-infected individual
“I never really had good teeth, but my T cells have actually gone up to 600 since I’ve been here getting my teeth fixed. My health improved so much; I’m so grateful! I never realized that I needed help in getting here. I love Lucy, my DCM.” Mike M.
Strategies for Success
NAHC SPNS Team
Sridevi Ponnala, DDS, Clinical DirectorCarolyn Brown, DDS, Dental Director
Eulalia Valerio, Director, Projects & EvaluationLucy Wright, RDA, Dental Patient Navigator
Gloryanna Valerio-Leonce, Data & Intake Manager
Next Oral Health Webinar
Clinical Aspects of Oral Health Care for PLWHAJanuary 22, 2014 at 3 PM EST
More information available at: https://careacttarget.org/library/clinical-aspects-oral-health-care-plwha
• Presenters:• Dr. David Reznik, HIVDent and Grady Health System
of Atlanta, GA• Ms. Helene Bednarsh, RDH, MPH, HIVDent and
Boston Public Health Commission of Boston, MA
Q & A
Twitter: @impactmc1| Facebook: ImpactMarCom |www.impactmc.net | 202-588-0300
Connect with UsSarah Cook-Raymond, Managing Director |Impact Marketing +
Communications
To be informed about Webinars and other upcoming IHIP resources, sign up for the IHIP listserv by emailing
IHIP Web site: www.careacttarget.org/ihip
