AETC PROGRAM ORAL HEALTH COLLABORATIVE: NEXT STEPS. April 30, 2014
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1 AETC PROGRAM ORAL HEALTH COLLABORATIVE: NEXT STEPS April 30, 2014
2 Historical Federal Responses to HIV June 5, 1981 first reporting of AIDS (5 young men from CA with PCP, CMV, oral candidiasis) - MMWR September 2, 1983 first MMWR with health-care provider precautions to take regarding occupational exposure (regarding HTLV-III ) September 13, 1985 Hairy Leukoplakia identified as correlate to AIDS in MMWR November 15, 1985 first MMWR occupational transmission report April 18, 1986 MMWR Recommended Infection-Control Practices for Dentistry ; updated in 1993; 2003 August 18, Ryan White Comprehensive AIDS Resources Emergency (CARE) Act passed August 16, 1991 MMWR releases Recommendations for Preventing Transmission of HIV/HBV to Patients During Exposure-Prone Invasive Procedures (6 patients in U.S. identified as possibly having been HIV-infected through dental procedure) American Academy of Oral Medicine published Dental Management of the HIV-Infected Patient, Journal of the American Dental Association Collaborations with HRSA/SPNS for HIV oral health resource development
3 Past AETC Program Oral Health Professional Member Activities Research identifies significant increase in routine use of gloves and masks by MA dentists (Bednarsh & Connolly, 1990) Dental Alliance for AIDS Care established 1997 HIV Dental Alliance (HIVdent.org established) Numerous national and regional AETC-sponsored conferences Regional Dental Directors met regularly with Medical Directors AETC technical assistance for HIV care management (including rapid HIV testing) in dental facilities/curriculum (i.e., private practitioners, dental schools, dental hygiene schools) Regional oral health resource development
4 Previously Identified AETC Program Oral Health Issues to be Addressed Identification of model programs (clinical care and academic programs) Best-practice strategies for the linkage, engagement, and retention of hard-to-reach populations (ADA; CDC; AETC NRC Toolkit) Promotion of oral health professional involvement in the care of vulnerable populations in non-traditional settings (incarcerated, homeless, immigrant, migrant, mentally ill) reducing institutional barriers
5 Previously Identified AETC Program Oral Health Issues to be Addressed Point of care HIV and HCV screening in oral health clinics (policy, procedure, reimbursement, training) Oral Health specific Needs Assessment Tool to be utilized by oral health teams across the U.S. (for increasing data from same instrument, comparison across regions)
6 Previously Identified AETC Program Oral Health Issues to be Addressed Federal funding for workforce development of oral health professionals with clinical training in HIV care Standards in Dental Care for PLWHA (HRSA Quality Indicators; ADA guidelines??) Train the Trainer program development Continuing Education of: oral health professionals without HIV/ID expertise & MD, DO, NP, PA, RN, SW, and other non-dental clinical staff on oral health issues and HIV
7 Previously Identified AETC Program Oral Health Issues to be Addressed Collaborations with insurance companies to identify dental providers interested in support/education related to caring for PLWHA and at-risk persons (incorporate HIV/HCV screening) Oral Health Professionals ARE health care professionals - promote the involvement of physicians, nurses, NPs/PAs in oral health issues and oral health profession collaborations
8 Previously Identified AETC Program Oral Health Issues to be Addressed Promote the role ( core responsibilities ) of each oral health profession team member in the care of PLWHA and educate primary care and other providers on these roles (including health prevention roles) Inclusion of oral health professionals in multidisciplinary conferences and meetings of HIV clinical care providers State licensing boards no standardized HIV/ID course curriculum for licensure (state-to-state differences)
9 Newly Identified Issues to Address Feelings of isolation or working in a silo among many oral health professionals providing care to PLWHA - ongoing collaboration among oral health professionals Changing workforce needs (aging provider population doing HIV work since the 1980 s; changes in oral health care provider practices) "Centers of Excellence" in terms of training oral health professionals (dentists, oral surgeons, dental hygienists) as well as
10 Newly Identified Issues to Address providing HIV oral care in specialty and general dental care practices; pre- and post- graduate training; training of trainers/faculty/post-grad professionals as well as students Funding sources related to "full spectrum" oral health screening opportunities: possible funding sources include state DOHs, CDC, insurance reimbursement (Medicaid); may
11 Newly Identified Issues to Address have funding for screening "start-up" or for limited # of persons, but maintaining the testing and making it available on an ongoing basis is difficult without adequate reimbursement and ongoing support. Reimbursement issues: need for ADA to provide coding if medical coding not acceptable for billing (i.e. HIV, HCV testing); new codes
12 Newly Identified Issues to Address Oral Health Professional HIV/HCV Screening: training needed for oral health practitioners as well as a user friendly (like pocket-guide) reference resource for oral health provider reimbursement/screening tips Oral Health Professional membership in Infectious Virology/CDC/HRSA/NIH Round Tables, Committees and Task Forces
13 Newly Identified Issues to Address Need for in-person networking, training, collaborating of oral health professional experts in HIV care Discriminatory and infection control issues/media reports with regard to PLWHA and dental clinics or HCV/HIV/HBV transmission concerns
14 Current Oral Health Educational Resources* * Resources from the AETC Program and/or HRSA, HAB within the past 5 years 5 webinars ( Oral Health Screening in the Primary Medical Care Setting ; The Vital Role of Oral Health Care in Overall Well-being for PLWHA ; Dental Case Management ; Clinical Aspects of Oral Health Care for PLWHA ; Introduction to Oral Health: Oral Screening and Dental Management ) 3 videos ( Identification of Oral Anatomical Structures Often Misdiagnosed as Pathology ; Head & Neck Exam for Healthcare Professionals ; HIV Testing in Dental Clinics ) 2 online trainings ( Web Study ; Modeling Risk Assessment: Conversations between Dentists and HIV+ Patients )
15 Current Oral Health Educational Resources 2 slide sets ( Oral Health: The Role of the Primary Care Team ; Meth Mouth: Dental Issues in Methamphetamine Abusers ) 1 pocket guide ( Oral Health Care for the HIV+ Patient ) 1 chart/poster ( Oral Manifestations Associated with HIV/AIDS ) 1 self-study module ( Oral Lesions and Treatment Recommendations for the HIV+ Patient ) 1 fact sheet ( Oral Health and HIV ) 1 curriculum ( Integrating Oral Health Care in HIV Primary Care Settings: A Guide to Oral Health Care for People Living with HIV/AIDS )
16 NEXT STEPS...
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