Session
The Case for Medical-Dental Integration to Improve Oral and Overall Health
APHA 2022 Annual Meeting and Expo
Abstract
Integration of Oral Health into Primary Care: Patients’ Perceptions and Attitudes
APHA 2022 Annual Meeting and Expo
Background: MORE Care (Medical Oral Expanded Care) is an initiative of CareQuest Institute for Oral Health. Its goals are to integrate oral health competencies into primary medical care settings. In collaboration with Oral Health Ohio, this program is a pilot that operationalizes the establishment of medical-dental integration (MDI), alternative payment models (APMs), and medical-dental networking. Data surrounding this information is critical to the adoption of and sustainability of such a program.
Methods: The MORE Care Ohio pilot will launch in August 2022 and will involve primary care clinics in Ohio. Patient surveys will include items on demographics and social determinants of health (SDOH). Clinical metrics will be captured regarding the number of patients with documented oral health assessments, discussions of oral health self-management goals, fluoride varnish applications, and referral to a dental provider when appropriate.
Results: Descriptive analyses will characterize the patient population of MORE Care Ohio in terms of demographic variables and presence of chronic health conditions through ICD-10 codes (e.g., diabetes, asthma, developmental disabilities). SDOH will be assessed using ICD-10 Z55-65 codes (e.g., problems related to housing and economic circumstances). Regression analyses will determine predictors of clinical metrics that will be used to further tailor MDI programs.
Conclusions: Prior research by CareQuest Institute has shown that consumers and providers are both interested in increased interprofessional practice. Results from this study will present data on the operationalization of an MDI program and patient acceptance of such a program.
Abstract
Consumers’ Experiences with and Attitudes toward Receiving Health Screenings at Dental Visits
APHA 2022 Annual Meeting and Expo
Background: Integrating overall health screenings into dental visits ensures individuals receive both necessary dental care and important medical screenings, both which benefit patients and the overall health care system. This study examined consumers’ experiences with and attitudes toward receiving health screenings from dental providers.
Methods: CareQuest Institute for Oral Health collaborated with NORC at the University of Chicago to conduct the nationally representative State of Oral Health Equity in America (SOHEA) survey in January-February 2022. Adults were asked about their experiences with and attitudes toward receiving routine health screenings in a dental office.
Results: Adults (N=5,682; mean age=48.0 (sd=17.4), range=18-95, 51% female) participated in the survey. While fewer than one-third of adults reported a dental provider screened them for health conditions (from a high of 37.1% for blood pressure to a low of 11.1% for diabetes), more than two-thirds said they feel comfortable with a dental provider doing such screenings (from a high of 82% for oral cancer to 57% for BMI). Only 35.2% of respondents indicated their oral health provider “always or “often asks about their overall health. Further, 38% of respondents who had not had a medical visit in the prior year had seen a dentist, emphasizing the importance of dental providers doing health screenings.
Conclusions: Health screenings are not commonly done during dental visits, although most adults are comfortable with dental providers doing such screenings. Integrating health screenings into dental visits is an important and infrequently used opportunity that can benefit patients and the overall healthcare system.
Abstract
US Adults' Perceptions about HPV, HPV Vaccine and Dental Providers' Role in HPV Vaccination
APHA 2022 Annual Meeting and Expo
Background: Human Papillomavirus (HPV) is one of the most common sexually transmitted infections. Oropharyngeal cancers (OPC) are the most common cancers of all HPV cancers and can be prevented using HPV vaccines. However, HPV vaccine rates are far from Healthy People 2020 or 2030 goals. This study examined adults’ HPV vaccine knowledge and perceptions in the context of oral health.
Methods: CareQuest Institute for Oral Health collaborated with NORC at the University of Chicago to conduct the nationally representative State of Oral Health Equity in America (SOHEA) survey in January-February 2022. Participants were asked about their knowledge of HPV and oral health and whether their oral health care provider ever recommended the HPV vaccine.
Results: Adults (N=5,682; mean age=48.0 (sd=17.4), range=18-95, 51% female) participated in the survey. Nearly one-third (31.4%) say HPV vaccines are “very important, and nearly half (46.0%) say they are “somewhat important in preventing OPC. More than half (54.1%) agree dental providers are qualified to provide HPV vaccine education. Using ordered logistic regression, we found HPV knowledge (OR= 2.28, 95% CI: 1.83, 2.84) and receipt of HPV vaccine recommendation (OR= 3.12, 95% CI: 2.15,4.53) were positively associated with perceptions of the HPV vaccine being “very important in preventing OPC.
Conclusions: Adults are knowledgeable about the role of HPV vaccines in preventing OPC and felt confident receiving recommendations about HPV vaccines from dental providers. Integrating effective communication strategies with oral health providers can build patient awareness of the importance of the HPV vaccine for the prevention of OPC and other cancers.
Abstract
Screening for Diabetes in the Oral Health Care Setting: Developing a Predictive Algorithm to Identify High-Risk Patients
APHA 2022 Annual Meeting and Expo
Background: Approximately 2.5% of individuals with diabetes mellitus (DM) are undiagnosed. DM and periodontal disease (PD) have a suggested bidirectional relationship; those with PD have an increased risk of DM and vice versa. The goal of this study was to develop and test a predictive algorithm to identify adults at risk for DM and test their A1C levels in the dental setting.
Methods: We developed a predictive algorithm using demographics, medical and dental history to identify patients at high risk of, but not previously diagnosed with DM. Across five health centers, patients were approached to have their A1C levels tested (finger stick) during their dental appointment, primarily by dental hygienists. Patients with prediabetes (A1C = 5.7% - 6.4%) or DM (A1C > 6.5%) were referred for follow-up medical care. Patients also completed surveys about their screening experience.
Results: Patients (N=410) were screened for DM; 17% (n=70) were determined to have prediabetes, while 6% (n=26) had DM. Nearly two thirds (62%) of survey respondents (N=320) said they had not been screened for DM before, and 98% said they were “comfortable/very comfortable being screened at their dental office. Nearly all (94%) said they planned to follow up with a medical provider regarding their screening results.
Conclusions: The predictive model was able to identify 6% of patients with previously undiagnosed DM, more than twice the estimate of undiagnosed DM in the general population. Screening for DM in a dental setting has the promise to identify those at high risk who may not otherwise receive A1C testing.