Integrating Oral and General Health Through Health Literacy Practices Proceedings of a Workshop (2019) / Chapter Skim
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5 Exploring Pathways to Integration
5 Exploring Pathways to Integration
Pages 43-62
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From page 43... ...
"We want to spread this ‘infection' throughout our colleagues so we can work together. It's a positive epidemic." A FEDERAL INFRASTRUCTURE The federal government has an opportunity to serve as an infrastructure for integration, said Renée Joskow, chief dental officer for the Health 1 This chapter is based on presentations by Renée Joskow, chief dental officer for the Health Resources and Services Administration; Amit Acharya, executive director of the Research Institute at the Marshfield Clinic Health System and chief dental informatics officer for the Family Health Center of Marshfield Inc.; John Snyder, executive dental director and chief executive officer of Permanente Dental Associates; and Kelly Close, early childhood oral health coordinator for the Oral Health Section of the North Carolina Division of Public Health.
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From page 44... ...
Joskow focused her remarks on two of those goals: integrating oral health and primary care, and increasing the dissemination of oral health information and improving health literacy. The report established four strategies for achieving the first goal: 1.
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5. Integrate dental, medical, and behavioral health information into electronic health records.
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All of these goals are related to integrating oral health and primary care. For example, Joskow mentioned a contract between HRSA and the American Academy of Pediatrics to develop a curriculum for learning about oral health integration in primary care practices for children.4 She also described work at the practice interface of interprofessional education, in which HRSA served as a convener and a provider of infrastructure.
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One is testing the competencies in health centers through a pilot program with the National Network for Oral Health Access, which has resulted in a user guide for implementation of the interprofessional oral health core clinical competencies (NNOHA, 2015)
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DRIVING INTEGRATION THROUGH COMBINED ELECTRONIC HEALTH RECORDS Amit Acharya, executive director of the Marshfield Clinic Research Institute at the Marshfield Clinic Health System and chief dental informatics officer for the Family Health Center of Marshfield, said that he is a clinician who has been infected by the passion to integrate medical and dental care and to use the results of research to improve clinical care. The Marshfield Clinic Health System is a large physician group practice of more than 1,000 providers that started in 1916.
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When asked what dental information medical providers would like to access in a combined electronic health record, 62 percent said oral health status, followed by treatment plan (58 percent) , dental problems list (56 percent)
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. As of the workshop, the health system had been able to provide an integrated electronic health record to more than 140,000 of its patients.
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Between 50 and 60 percent of the information in an electronic health record would be common to the records of both a dental and medical practice, answered Acharya, who had previously done a study of electronic and paper records for both dental care and medical care. He also mentioned, in response to a question from Holland, that providers in the Marshfield Clinic Health System have access to prescription histories and have been looking at retrospective data to examine past practices.
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From page 52... ...
"Our whole education is based on preventing disease, so we can be really good at it," said Snyder. At the end of 2016, PDA went live with a fully integrated electronic health records system that has interfaces to dental care, pharmacy, social workers, care managers, and other parts of the health care system.
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Patients are 110 percent more likely to receive the child flu immunization, 81 percent more likely to receive the child human papillomavirus vaccination, 114 percent more likely to receive an adult physical, and 160 percent more likely to receive a cervical cancer screening. "That's part of the cultural transformation that changes when you get adjacency and interprofessional interactions," said Snyder, "amazing results." The health care system is now testing three models of dental care that feature different combinations of people, processes, and infrastructure.
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SOURCE: As presented by John Snyder at the workshop Integrating Oral and General Health Through Health Literacy Practices on December 6, 2018. mentioned the new ability to identify people over the age of 65 who did not receive an influenza vaccine the previous year.
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When the program went statewide, it had six partners: the North Carolina Academy of Family Physicians, North Carolina Medicaid, the North Carolina Oral Health Section, the North Carolina Pediatric Society, the University of North Carolina Gillings School of Global Public Health, and the University of North Carolina School of Dentistry. Each of these six organizations had an active role and was invested in the program, said Close.
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For example, in North Carolina communities with Early Head Start programs, parents report that about 80 percent of young children received preventive oral health services by a dentist or nondental medical provider by age 3, which is a higher rate than for children on Medicaid but not enrolled in Early Head Start in those communities (Burgette et al., 2018)
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"You researchers," she said, "we need you to do some research on screening." Research has shown that parents express satisfaction with having preventive oral health services at primary care visits (Rozier et al., 2005) , experience low health literacy demands by medical providers during oral health counseling (Kranz et al., 2013)
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Close responded that she does not know what the most effective referral method is because IMB has not done research on that question. But "we do know that getting kids into the dentist early is important, even with medical providers doing preventive oral health services," because children with dental treatment needs do not receive this care from medical providers.
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"That personal touch really makes the difference," Snyder said. Referrals also work in the opposite direction, from dental providers to general health providers, and dentists are good at making these referrals, according to Acharya, because they can be very analytical in terms of closing health care gaps.
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Feedback received from dentists after the webinar was that they wanted a webinar specifically on how to incorporate behavioral health into a dental environment. For one thing, such training could help dentists cope with "dental phobics," who can be very challenging for dental care providers, said Joskow.
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• How can health literacy be used not only to inform integration but to drive it? For example, do patient portals offer a way for patients to understand the value of integrated systems and demand such systems?
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