Connecting the Head to the Body

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One of Clinica Family Health’s pediatric patients receives an oral health exam during a recent visit to the Pecos Dental Clinic.

By Krysia Gabenski
From the Fall 2016 Journal of the Colorado Dental Association

Integrating dental care with medical care offers patients a whole healthcare experience that links oral health with systemic health. As healthcare becomes increasingly more patient-centric, with a focus on overall health, this integration will provide value to both patients and healthcare providers. Across Colorado, many dental-medical integration models have been established—and each one differs from the next, offering interested oral healthcare and medical professionals a chance to tailor programs to fit their strengths and their communities’ needs.

Clinica Family Health Home Dental Clinic
At Clinica Family Health Home, a federally qualified health center system, it’s about identifying patients with higher needs for dental care—children or those who are pregnant or who have diabetes—and making sure those patients get linked to care, according to Dr. An Nguyen, vice president of dental services. In the Clinica system, physicians see about 55,000 medical patients a year. Providing dental care to all of those patients isn’t yet a reality, so the clinic focuses on those with higher needs, enabling dental professionals to treat 11,000 of those medical patients per year. Two of the five Clinica locations in Colorado have full-service dental clinics, and all five locations have hygienists embedded in the medical clinics.

Patients who seek medical treatment at any of the five clinics also see a dental hygienist who identifies those who could benefit from follow-up dental care. Medical providers also are trained to identify acute needs in patients. If the hygienist determines during a caries risk assessment that a patient needs a fluoride varnish, for example, the treatment will be completed during the same visit. If a bigger treatment is deemed necessary, the hygienist will schedule a follow-up appointment for the patient before he/she leaves the clinic that day.

The model focuses largely on education and prevention. The hygienists who are embedded into these medical clinics work in concert with physicians in the medical exam rooms, wheeling from room to room carts that are full of the supplies for exams and patient education materials. The goal is to educate patients on the importance of preventive care, which will lead to better health outcomes in the long run for those patients.

The dental home model has proven to be a great recruitment tool for healthcare professionals in the Clinica system. It allows the hygienists to exercise other parts of scope of practice, like assessment, screening, and risk-based care, than in other types of dental models. The dental-medical integration also has heightened visibility of oral health for primary care and oral health teams. In the Clinica system, it has led to a more robust dialogue, leading to a higher quality of care for patients. To be successful, Dr. Nguyen emphasizes that dental-medical integration is a two-way street. The primary care physicians involved must be as invested in oral health as the dental professionals.

Springfield Medical Clinic Dental Home
In Baca County, Colo., access to dental care was a big concern when seven years ago it became a one-dentist county. That lone dentist is Dr. Carol Morrow, who runs the Walsh Dental Clinic in Walsh, Colo.; a satellite clinic in Johnson City, Kan.; and now second satellite clinic based out of the Springfield Medical Clinic in Springfield, Colo.

The clinic saw a need for dental access in its community and reached out to Dr. Morrow to help meet that need. With the help of a passionate grant writer from the clinic, Dr. Morrow worked to establish funding for the new dental clinic. A process that began seven years ago became a reality in September. Since the dental home became operational, the patient schedule has been full—and continues to be through the end of the year.

Dr. Morrow travels one day a week to treat patients in a one-chair exam room that she equipped thanks to grants from the Colorado Department of Local Affairs, DentaQuest and others. All of the supplies come from her main clinic in Walsh, making this dental home model sustainable without the help of additional outside funding. In her exam room, Dr. Morrow is set up to provide the full spectrum of treatment options she offers in her main practice. Her focus is on providing dental care to nursing home patients who live in the home connected to the clinic, Medicaid beneficiaries and those who don’t have transportation to her main clinic in Walsh.

Working in conjunction with the Walsh Medical Clinic, next door to her main dental clinic, Dr. Morrow has realized medical professionals often would avoid talking to their patients about oral healthcare because they thought it was stepping on dentists’ toes. But she finds a dental-medical collaboration to be beneficial for patients, a concept she’s brought to the Springfield clinic. Dr. Morrow is training medical professionals to recognize signs that a patient might need an oral exam or treatment, and the doctors refer those patients Dr. Morrow either in her main practice in Walsh, if they have transportation, or to the in-house dental clinic at the Springfield clinic.

Marillac Clinic Dental Model
In Mesa County, Colo., Marillac Clinic has offered integrated dental-medical services to county residents since 2003. What once operated as two separate clinics with two registration systems was streamlined into one clinic, where patients could receive whole body healthcare.

Patients at Marillac Clinic span all ages and receive the full scope of dentistry, including preventive care, emergency, restorative, crowns, bridges and dentures. Marillac also works with at-risk populations and agencies serving at-risk populations, such as HIV/AIDS patients, migrant school children and Hilltop’s Before Babies Program for low income pregnant women.

Marillac recently expanded its services to private medical practices in the Western Colorado region, thanks to a Medical-Dental Integration Project grant awarded by the Delta Dental of Colorado Foundation in 2015. With the grant, Marillac was able to hire a full-time dental hygienist, Patrick Andrews, R.D.H., in October 2015 to develop the program. Andrews divides his time by working with the medical clinic at Marillac, the pediatrician at Marillac and a private practice pediatric office in Grand Junction, Colo. Since then, Marillac has hired a second full-time dental hygienist, who will work at the county medical/dental clinic at the Mesa County Health Department.

The goal is for each dental hygienist to see seven patients a day. Each dental hygienist provides oral health education, a dental screening, application of fluoride varnish and coordination of care back to the dental clinic, especially for those without an established dental home.

Kristy Schmidt, community and donor relations director, emphasizes how important it is for the oral healthcare team to develop a strong relationship with the medical team. Physicians are becoming more aware of and committed to oral health and the importance of early intervention for overall good health.

The Head Is Indeed Connected to the Body
As different as each of these dental home models are, one similarity stands out: For a dental-medical integrated healthcare model to succeed, it takes commitment of both the oral healthcare professional and the medical professional. What used to be two siloed professions is slowly integrating into a whole body healthcare team across the state.