Integrating Oral Health Into Primary Care: Development and Use of PCOAT (Primary Care Oral Assessment Tool)

Transcription

1 Integrating Oral Health Into Primary Care: Development and Use of PCOAT (Primary Care Oral Assessment Tool) Alicia Grady, DDS Christine Cogil, FNP-BC, DNP(c)

2 Objectives Objective 1: Describe strategies in development of an interprofessional collaborative practice that innovates methods to integrate oral health knowledge effectively into a primary care environment. Objective 2 Discuss the difference between CAMBRA and the primary care oral assessment tool, evolution of the tool by primary care professional and staff trial use, and sporadic early adopter use. Objective 3 Employ a primary care oral assessment tool (PCOAT) as the keystone to assure and sustain implementation of oral assessment in clinical practice change and offer integrated medical/dental services.

3 EPIC El Pueblo Inter-professional Collaborative HRSA NEPQR: Innovation in Primary Care Oral Health: Interprofessional Collaborative Practice UD7HP

4 EPIC: El Pueblo Inter-professional Collaborative UNM CON Family Health Partnerships UNM Dental Services El Pueblo Health Services

5 Goals of the EPIC Project 1. Develop an inter-professional collaborative in primary care 2. Improve the oral health of patients 3. Sustain and diffuse an inter-professional primary care oral health delivery model

6 Barriers to Oral Health Care

7 Access to Oral Care Issues Lack of dentists in rural areas Transportation Dental acceptance of Medicaid Cannot afford out of pocket expense Dental phobia Work release issues Lack of child care resources Limited knowledge of the importance of dental care

8 Primary Care Oral Assessment Tool

9 Why PCOAT? Introduce oral health assessment to PCPs Learn dental/medical terminology Risk based assessment familiar to primary care such as: Depression screening Alcohol/drug use Cancer risk: breast/prostate/colon

10 Development of PCOAT CAMBRA (CAries Management By Risk Assessment) Search for similar tool in primary care Developed PCOAT (Primary Care Oral Assessment Tool) PCOAT addresses oral health conditions

11 Other CAMBRA Tools

12 PCOAT for Primary Dentition

13 Provider Protocol

14 PCOAT for Permanent Dentition

15 Provider Management Protocols Protocols associated with patient level of risk Guidance for provider about oral interventions Recommendations appropriate for primary care PCOAT scanned into the patient electronic record

16 Self-Management Tool for Children

17 Self-Management Tool for Adults

18 Implementation

19 Implementation of PCOAT Introduced to Providers Use at new OB exams, yearly physicals, well-child checks Feedback after 3 months of use Time consuming Difficult to add into routine Some PCOAT questions unclear Wanted more training on oral assessment

20 Four L s for Oral Screening Exam Lift/Lower Lips Look at Teeth Lasso the Tongue Lap with finger around gumline

21 Revisions in the Process A work in progress Include MAs in team meetings Offer inter-professional education sessions Ongoing evaluation after usage Multiple revisions from feedback Providers and staff involved

22 Outcomes

23 Learnings Provider and staff buy-in Challenge of changing practice habits Evolution from prevention to management Utilization for target populations Patients with diabetes

24 Outcomes PCOAT is keystone for the oral health project Dental referral network developed Inter-professional medical/nursing/dental relationship building Inclusion of all clinic staff for successful practice change

25 Thank You!

26 References American Academy of Pediatrics (2003). Oral Risk Assessment Tool. Retrieved from: American Academy of Pediatrics (2003). Self Management Goal Tool. Retrieved from: American Dental Association (2010). Caries Risk Assessment Form. Retrieved from: dental-education/continuingeducation/ce387/ce387.aspx?modulename=coursecontent&partid=3&secti onid=-1 Health Action New Mexico (2014). New Mexico Population to Dentist Ratio by County. Retrieved from: