Oral Health Access and Issues in Rural Areas. Diane Brunson, RDH, MPH Director, Public Health University of Colorado Denver School of Dental Medicine

Transcription

1 Oral Health Access and Issues in Rural Areas Diane Brunson, RDH, MPH Director, Public Health University of Colorado Denver School of Dental Medicine

2 What is Rural?

3

4

5

6 What is Rural? You probably live in a rural area if you dial the wrong number and you still know the person who answers. It s s a rural area if the skyscrapers are all white and have COOP written on them.

7 What is Rural? You know all the news before it s published and just buy the hometown paper to see if the editor gets it right! You still need to order the Sears- Roebuck Catalog.

8 What are the unique challenges? u Many counties without a dentist OR primary care physician u Not enough population to support a full- time practice u Varying degrees of income levels Ranching vs farming Resort vs service industry u Lack of providers accepting third-party reimbursement/lack of large employers

9 Access to Medicaid Dental Services

10 Medicaid Dental Access Percentage Urban Large Rural Resort Isolated Rural 5 0 County Status Source: CO Dept of Health Care Policy and Financing

11 Workforce Solutions u Dental Loan Repayment recruitment u Rural Track in Dental Education u Community Development - retention u Scopes of Practice Review u Mobile Dental Clinics u Medical/Dental Home Initiatives u Alternative providers

12 Dental Loan Repayment u Health Professional Shortage Area designation not a requirement u Underserved populations receive care, even in urban areas u Recruitment strategy not necessarily retention u Funded by tobacco settlement dollars u 8-10 new providers each year u Dentists and Dental Hygienists

13 Retention Grew up Isolated (N=54) Small rural (N=141) Large rural (N=118) Overall (N=313) Rural 52.2% 54.0% 55.1% 54.1% Suburba n 35.0% 33.1% 32.4% 33.2% Urban 12.8% 12.9% 12.5% 12.7% Area where grew up (Q4) by rural strata of practice area (Q9) Colorado Health Institute Rural Dentist Survey

14 Interdisciplinary Rural Track u Dental, Medical, Pharmacy u Grand Rounds, seminars, rotations u Leadership skills u Scholarly activity u Pipeline concept u Clinical focus challenge

15 Colorado STRIDES u Sustainable Towns: Rural Innovation, Development, Expansion, and Success u To enhance the ability of communities in rural Colorado both to recruit and to retain quality healthcare providers through locally driven community, economic, and leadership development efforts u Sponsored by AHEC and Office of Rural Health

16 CO Workforce Collaborative u.establish a strategic public policy framework for Colorado that will advance health professions workforce priorities within an improved health care system. Scopes of Care Provider Incentives Health Education Funding Clinical Placements and Preceptors State Workforce Plan u Yearly summits

17 Scopes of Care/Practice u Governor Executive Order Evidence-based Review It is clear from health manpower studies that we do not have sufficient numbers of providers, especially physicians and dentists, to meet current health needs..especially acute in rural and other underserved areas. u Advanced Nurse Practitioner (ANP) u Dental Hygienists (RDH)

18

19

20 Mobile/Portable Practices u Not a system of care, expensive, but essential

21 Medical/Dental Home u Cavity Free at Three Caries risk assessment Fluoride varnish Self management goal setting u Medical Home Initiative: includes oral and behavioral health, incentives u Frontier Center Interdisciplinary education Students and health professionals

22

23 Frontier Center - Delta Dental Foundation - Virtual Center Hard/soft tissue exam Brush biopsy Fluoride varnish 23

24 Conclusions u Pipeline: exposure of rural K-12 K students to health professions u Rural Track in dental school: specific focus on dental admissions u Rural rotation exposure mobile, CHC s u Alternative providers u Provider incentives dental loan repayment, medical/dental home u Rural community development