Dental Surgeon Work Experience Format by goq40676

VIEWS: 72 PAGES: 32

More Info
									Reaching the Healthy People 2010
  Objectives for Rural Children:
   Facilitators and Barriers for
 Reaching Healthy People 2010
              Goals.


Elaine Jurkowski, MSW, PhD1
Sandra Nagel Beebe, RDH, PhD2
Charla J. Lautar, RDH, PhD2
School of Social Work1
Department of Health Care Professions2
Southern Illinois University Carbondale2
Problem

 In rural, southern Illinois, despite the
 perception that oral health services are
 available through public services, low income
 or Medicaid children still DO NOT access
 services.
Healthy People 2010

Healthy People 2010 outlines a series of
 benchmarks for children and their oral health
 status. Included in these benchmarks are the
 following:

   21-1. Reduce the proportion of children
    and adolescents who have dental caries
    experience in their primary or
    permanent teeth.
Healthy People 2010 (cont.)

   21-2a & b. Reduce the proportion of young
    children and adolescents with untreated dental
    decay in their primary teeth.

   21-8. Increase the proportion of children who
    have received dental sealants on their molar
    teeth.

   - 21.10 Increase the proportion of children and
    older adults who use the oral health system each
    year.
Healthy People 2010 (cont.)

   21-12. Increase the proportion of low-
    income children and adolescents who
    received any preventive dental service during
    the past year.
Limited Access

   Miles for Smiles
   School-based Sealant Program
   Medicaid Dental Clinic (limited hours)
   FQHC
   No dentist accepts Medicaid patients
   Counties without a dentist
   Specialists are within an hour or more
   No method for referrals (i.e., Head Start)
Perceived needs for care

   Oral health education
   Services and resources for people that do
    not have access
   Education for parents and providers working
    in care facilities
   Transportation
   Reduced materials in Spanish
   Target parental attitudes
Methods for investigation

   Chart review from FQHC, University
    Teaching and Medicaid clinics targeting
    children >18 years of age.
   100% sample from the University
    Teaching Clinic
   100% sample from the Medicaid Clinic
   20% sample from the Federally Qualified
    Health Center.
Methods

 Chart reviews for patients seen in 1998 and
  2002 from FQHC clinic and University
  Teaching Clinic (UTC).
Sample was as follows:
 N=88 UTC; N=166 Heartland; 100% sample –
  2002.
 N= 144 UTC; 100% sample; N= 205 FQHC; 20%
  sample – 1998.
Methods (continued)

   Variables collected included zip
    code, age, race, payer source,
    reason for exam, brush/floss
    frequency, year of first visit,
    number of decayed, missing &
    filled teeth, and number of
    existing sealants.
Findings
Year patients were first seen…

  100                                        100
                           78.4
  80
                                                   1994
  60                                               1995
                                                   1999
  40                                               2000
                                                   2001
  20    3.4         11.4
                                                   2002
              1.1 1.1   3.4
   0
                  UTC             Medicaid
Age breakdown of patients seen
(1998 vs 2002)

   50

   40

   30

   20

   10

   0
        FQHC98      Medicaid02       UTC98         UTC02

        <3   3-6 yrs.   7-11 yrs.   12-15 yrs.   16-18 yrs.
Racial breakdown of patients seen
(1998 vs 2002)

    100
     80
     60
     40
     20
      0
          White       Pacific       Asian
                     Islander

          FQHC98   Medicaid02   UTC98   UTC02
Reasons for visit
(1998 vs 2002)

         100
           80
           60
           40
           20
            0
                tio   n          m           cy          ion
            ven              Exa       ergen      u ltat
        Pre                          Em       Cons

        FQHC98            Medicaid02      UTC98     UTC02
Percent of kids with no sealants by age
group (1998 vs 2002)

   100

   80

   60

   40

   20

    0
         <3   3-6 yrs.   7-11 yrs. 12-15 yrs. 16-18 yrs.

         FQHC98   Medicaid02     UTC98    UTC02
Percent of kids with sealants by age
group (1998 vs 2002)

   100

   80

   60

   40

   20

    0
         <3   3-6 yrs.   7-11 yrs. 12-15 yrs. 16-18 yrs.

         FQHC98   Medicaid02     UTC98    UTC02
Findings (cont.)

   There is a significant difference in the age of
    children seen in 1998 UTC (Mean=12.43
    years) as compared to 2002 UTC (Mean
    =9.7 years) t=2.92, df=61.65, p=.005.
   There is a significant difference between the
    number of caries in the primary teeth with
    more seen in 1998 (t=4.375, df=170.983,
    p=.000)
Findings (cont.)

   Findings reflect the disparities of the Surgeon
    General’s report and other data/literature.

   There was a significant difference in the
    number of filled teeth for primary and
    permanent dentitions, with higher mean
    values in 1998 (t=4.568. df=168.919, p=.000;
    t=2.436, df=168.354, p=.016).
Conclusions

   The majority of patients seen in public clinics in
    2002 were new referrals, which suggests either
    follow-up does not exist, or intervention efforts at
    recruitment were successful.

   Although a sealant program exists, it is likely that
    the patients who were utilizing the sealant
    program are not the same children seen in the
    public clinics.

   Although resources may exist, there is some
    work needed to direct services to reach those
    most in need of services.
Conclusions (cont.)

   The nature of the public clinics does not
    promote long term relationships with clients
    who may be low income or under insured.
    This has an impact on the efficacy of
    targeted intervention efforts, and requires
    address.
Discussion

   Are outreach efforts with Head Start and WIC
    really working? How can we better serve or
    address the needs of those who have problems?

   The data found suggest that those who are
    utilizing public resources for oral health care are
    not seeking care consistently or returning to the
    clinics for follow up.
What are the barriers that exist?

     Transportation and realities of living
      conditions for community based rural
      children and their families.

     Lack of follow-up from pilot projects or
      demonstration projects to improve access to
      services.

     Medicaid and health insurance are not readily
      accepted by dentists in rural communities.
What facilitators can be used by
providers to reach the
uninsured?


   Teach the importance of oral health care to school
    health personnel and school social workers in an effort
    to translate information to the target population.

   Integrate patient education to children and their parents
    in waiting rooms of clinics.

   Follow-up is necessary within the public clinics to
    insure that patients return for care and services.
What facilitators can be used by
providers to reach the uninsured?

   Implement a referral system so that when
    case managers within either the school or
    DCFS systems detect a problem, they have
    resources available for referral.

   Integrate the role of oral health and oral
    health assessment into the role of total
    health assessments through screening or
    “trigger” questions.
What are some specific steps that can
be undertaken to eliminate barriers?

   Continue to integrate dental hygiene
    students with WIC program case
    managers, Head Start, and oral health
    school curriculum for education and
    intervention.
   Work with providers to identify
    strategies and respectable practices
    which will encourage follow through
    with target group.
   Strengthen and expand indigent care
    options with current providers.
What are some specific steps that can
be undertaken to eliminate barriers?

   Develop health promotion messages which
    can be integrated through brief motivational
    counseling methods.
   Continue to foster volunteer dentists’
    participation.
   Advocate for a shift in Medicaid policy which
    requires provider numbers on all claims
    versus dental provider (i.e., Medicaid clinic
    vs. actual dentist)
Contact information:

   Charla J. Lautar, RDH, PhD
   cjlautar@siu.edu
   Interim Chair, Dept. of Health Care
    Professions, SIUC
   M/C 6615
   College of Applied Sciences and Arts
   Southern Illinois University Carbondale
   (618) 453-7211
Contact information (cont.)

   Elaine T. Jurkowski, MSW, PhD
   etjurkow@siu.edu
   Director, Center on Gero-Enrichment for
    Social Work Education, SIUC
   M/C 4329, Quigley 4
   School of Social Work
   Southern Illinois University Carbondale
   (618) 453-1200
Contact information

   Sandra N. Beebe, RDH, PhD
   M/C 6615
   Dental Hygiene Program
   College of Applied Sciences and Arts
   Southern Illinois University Carbondale
   (618) 453-7202
Special thanks to….

   Preetesh Mahendra, Doctoral Student,
    (SIUC) for his help with chart reviews and
    data collection.
Notes…..



								
To top