1. "An Alternative Approach To Oral Health Disparities In
Medical Facilities Using A Non-dental Interdisciplinary Clinical Workforce"
1- Delvin R. Champagne, COTA/L, MSHE(c); Roberta Hollander, PhD, MPH, MS; Thanos Zavras, DMD, DrMS; Brian Swann, DDS, MPH
ABSTRACT
The 2000 Surgeon General’s report: “Oral Health in America” called oral health a “silent epidemic affecting poor children, the elderly, and many members of racial and minority groups.” In 2003 Dr. Richard Carmona published “National Call to Action to Promote Oral Health, an open invitation to all public health professionals to take an active role in the fight for oral health promotion. Oral hygiene is often a neglected activity of daily living (ADL) that has a major overall impact on general physical health. Research published by the American Dental Association, American Heart Association & the American Diabetes Association shows a direct correlation between periodontal disease, diabetes & heart disease. Adults over the age 55 are most likely to be affected by oral health disparities, especially in acute hospitals, skilled nursing and long term care facilities. Medicare was not designed to cover routine dental services, therefore oral healthcare must be provided by a "non-dental” interdisciplinary clinical workforce that is currently set up to receive Medicare reimbursement.
CLINICAL INTERVENTION: Take a SIP
The proposed Oral S.I.P. Training Curriculum, leading to the
Certified Oral Health Advocate (COHA) Credential:
DEFINE SIP: (S.ystemic I.nfected P.eriodontal)
(Seniors In-need of Providers)
(S.taff I.nterdisciplinary=P.revention)
(S.creen I.ntervention P.lan)
Formal 2 day didactic & clinical oral health training provided by
Dentist & Dental Hygienists specifically for professionals from the
targeted disciplines who are currently certified & state licensed.
Earn Professional Development CEU’s toward licensure
Medicare Oral Enhancement Rehabilitation Act of 2008
AOTA is currently working with the American Association of Oral and Maxillofacial Surgeons and the American Dental Association on legislation Allowing Dental Referrals to Occupational Therapy Introduced Representatives Bill Pascrell (D-NJ) and Eric Cantor (R-VA) recently introduced legislation that would permit occupational therapy services to be furnished under the Medicare program to individuals under the care of a doctor of dental surgery or of dental medicine. Currently, only physicians, podiatrist and optometrist can refer individuals under their care for occupational therapy services. The Medicare Oral Health Rehabilitative Enhancement Act of 2008 (H.R. 5590) would add dentist to the list of those providers under Medicare.
METHODS/PROCEDURE
SAMPLE:
50 professionals from each of the 4 “Primary” target disciplines,
n=200, via national association membership databases.
OT-American Occupational Therapy Association
SLP-National Speech Language & Hearing Association
RRT-National Association of Respiratory Care
Nursing- Association of Professionals in Infection Control and Epidemiology
VARIABLES:
-Knowledge of the oral-systemic connection
-Attitude toward providing routine oral health services
-Interest in completing the Oral SIP training program
SURVEY:
20 Q Likert Scale
Surveymonkey.com /Zoomerang.com and US Mail
ANTICPATED RESULTS
Lack of knowledge regarding the oral-systemic connection
No significant +/- attitude toward providing oral health services
Significant interest in the Oral SIP training program
LEARNING OBJECTIVES
By the end of the presentation participants will be able to:
1.) Communicate increased knowledge of health disparities & chronic diseases related to the Oral-Systemic connection
2.) Discuss the rationale for a “non-dental” interdisciplinary oral health workforce in medical facilities…i.e., OT, SLP, RRT and CIC Nursing
3.) Describe the efficacy of the proposed ORAL SIP training program leading to the Certified Oral Health Advocate (COHA) credential
ORAL SYSTEMIC HEALTH DISPARITIES
Diabetes: Healing Process, Dry Mouth
Heart Disease: Periodontal & Endocarditis
Pneumonia: Non-ambulatory, VAP, HAP, Artificial Airway, Mechanical Vents, Aspiration of oral bacteria/pathogens
Oral Cancer: Screening for early detection
Dental Caries: #1 Chronic Disease in Children, 8 times more prevalent than asthma ( Deamonte Driver Story)
ACCESS:
REFERENCES
Healthy People 2010, March Oral Health-Goal # 21, Rockville, MD htm#_Toc
U.S. Department of Health and Human Services (HHS). Oral Health in America: A Report of the Surgeon General. Rockville, MD: HHS, National Institutes of Health, National Institute of Dental and Craniofacial Research, 2000.
National Center for Health Statistics (NCHS). National Health and Nutrition Examination Survey III, 1988–1994. Hyattsville, MD: Centers for Disease Control and Prevention (CDC), unpublished data.
Scannapieco, F. Pneumonia in nonambulatory patients: The role of oral bacteria an oral hygiene. JADA 2006; Vol 137, No suppl_2, 21S-25S.
STATEMENT OF THE PROBLEM
Poor oral health in the geriatric population has tremendous systemic affects on major chronic diseases such as: Diabetes; Heart Disease and Pneumonia. There is also a tremendous need for early diagnosis of oral cancer.
Centers for Medicare & Medicaid Services (CMS) estimates $80 billion in healthcare waste over the last 10 years, and more than 10,000 deaths annually in adults over the age 55, all caused by oral-systemic associated infections.
RATIONALE FOR RESEARCH STUDY
Medicare does NOT cover routine dental care in medical facilities, therefore oral health services must be provided by a “non-dental” interdisciplinary clinical workforce that receives Medicare reimbursement for existing services. The targeted disciplines are: Occupational Therapy, Speech Language Pathology, Respiratory Therapy, Infection Control & Prevention Nursing