UCSD Student-Run Free Clinic Project and Fellowship in Underserved Health Care A Trans-Disciplinary Model. Ellen Beck, MD ADEA 2011

Transcription

1 UCSD Student-Run Free Clinic Project and Fellowship in Underserved Health Care A Trans-Disciplinary Model Ellen Beck, MD ADEA 2011

2 Goals Need Programs Learnings and Next Steps

3 Need for adult restorative dental care with the underserved 53 million need medical care 108 million without dental care ( 2002 Surgeon General Report) Now, many, many more. Health Reform Bill: Doesn t address adult dental care California and other states: Denti-Cal eliminated

4 Need for transdisciplinary training Medical Training: Medical Students at UCSD receive 2 hours of oral health training thoughout four years and one of those hours is elective. E.g. do not consider dental infections when a person has diabetes that is out of control

5 History UCSD Student-Run Free Clinic Project 1997-First site Now Four Sites 2 churches, 2 inner city elementary schools Community partners, passionate students, faculty leadership Provide free high quality access to health care for uninsured people who fall through the giant holes in San Diego s very limited safety net Started as medical clinic, after several years, we realized that 40% of patients had stated unmet oral health needs 2002 started Dental Clinic, students, community partners, volunteer dentists and an orthodontist

6 UCSD Student-Run Free Clinic Project

7 UCSD Student-Run Free Clinic Project We are committed to providing free high quality health care to underserved communities of San Diego OUR MISSION The UCSD Student-Run Free Clinic Project, in partnership with the community, provides accessible, quality healthcare for the underserved in a respectful environment in which students, health professionals, patients, and community members learn from one another.

8 Dental Director Dr. Irvin Silverstein Dr Silverstein and the students have won numerous awards for humanitarian service and educational programs including the ADA Golden Apple Award

9 Core Philosophy Empowerment Humanistic Community as Teacher Trans-disciplinary

10 Disciplines involved at the Free Clinic Project Medical Dental Pharmacy Social Work Law Acupuncture Health Promotion Mental Health

11 Pre-dental Society San Diego doesn t currently have a school of dentistry Clinic is staffed administratively by trained pre-dental students and care is provided by Volunteer Dentists and Fellows in Underserved Dentistry, all of whom are appointed as Community Faculty in the School of Medicine

12 Dental Services 3 sites, Pacific Beach (church), Downtown( church), Southeast San Diego( inner-city elementary school,serving the community) 7 clinical half-day or evening sessions a week Restorative Dentistry: Not poverty dentistry Services include: Primary Care Dentistry Specialty Dentistry Supplies and Labs are donated or purchased by us at low cost through donations we receive Equipment is acquired through fund-raising and donations

13 Pacific Beach United Methodist Church basement- First site of the free dental clinic project

14 Patient Population 2000 patients in all 1000 medical patients Over 85% have a chronic illness, including hypertension, diabetes, hyperlipidemia, asthma, and depression Do not qualify for access to care in San Diego s very limited safety net programs 51% Latino, 30% Caucasian, 19% African American, 7% Asian 51% female 25% street homeless One of our Clinical Goals: Refer all medical patients for a onsite dental visit, especially diabetics

15 Medical student education re oral health UCSD Student-Run Free Clinic Project 105 of 120 First Year medical students take a one quarter elective to work at the free clinic project. This includes: a session on oral health and diagnosis Weekly Reflection On-site weekly reminders of the importance of dental health, role of dental health in diabetes, and working in the same setting as the dental team

16 Fourth Year Medical Students 80 of 120 Fourth year medical students take a four week block clerkship They receive the same as above and a session on fluoride varnish They learn to be clinical coaches of the junior students All care is directly supervised by faculty from the school or community.

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18 Student Need Students arrive with passion, compassion, and a desire to make a difference

19 Medical Students at PB Site

20 Pre-Dental Students Work at a single site, taking on a variety of roles Train in Dental Assisting, Xray, and Professionalism Assist volunteer dentist faculty and dental fellows/faculty who provide the care Attend sessions with Dental Deans from around the country to learn about different dental schools and professions and meet role models

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22 Dental Clinic Project Statistics (Between ) Have provided over $3.2 million worth of free restorative dental care Students volunteered over 49,000 hours in the clinics Dentists volunteered over 6,400 hours Our clinics had over 9,300 patient visits Have seen over 1,500 new patients

23 Fellowship in Underserved Dentistry Started with Fellowship in Underserved Medicine Expanded to Underserved Health Care, specifically Underserved Dentistry 9 fellows, of whom 2 have been in dentistry 1-2 years Half to full time- clinical work, teaching, administrative, help to run the free clinic project All 9 working with underserved communities

24 Dental Fellows/Faculty Dr. Sussi Yamaguchi Dr. Randall Taylor

25 National Faculty Training Addressing Health Needs of the Underserved 135 Medical School Faculty From all stages of career from young faculty, deans, residency directors, department chairs: 27% from underrepresented minorities in the health professions, 30 states 3 weeks over a year with followup Goals: Community Partnerships, faculty development, professional renewal Outcomes: pre-post changes in all 35 parameters, including being able to design curricula addressing issues of culture and race, write grants, develop promotora programs, etc Outcomes after First 53 participants-10 new free clinics, 20 new residency curricula/rotations in underserved/community medicine, etc.

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27 Other dental programs through the Pre- Dental Society Dental Students: Relationship with other dental schools so that dental students do rotations with us, special programs Global Health: Mercy and Comfort Missions, Navy Dental Health Ambassadors: Teaching healthy behaviors in elementary schools

28 Lessons learned and next steps Our professions need to work more closely together and train more closely together for the benefit of the patient Effective mechanisms include: Transdisciplinary training in student-run free clinic projects and other community projects Clerkships Residency, Fellowships in Underserved Healthcare Faculty Development-Discipline and Collaborative

29 Philosophy that is integrated throughout training: Humanistic, empowerment, community as teacher, patientcentered Societal issues: Access to Care, Barriers to Access, Social Determinants of Health, Toothlessness leads to joblessness Policy and health reform: Access to adult dental care Orthodontics included in SCHIP/Healthy Families programs Restorative, not Poverty Dentistry Transdisciplinary training Diabetes, heart disease, oral cancers, importance of hygiene, communication skills, depression, self-worth, value of cotraining

30 Conclusion: Programs such as Student-Run Free Clinic Projects, Pre-Dental Society, and Fellowships in Underserved Dentistry Offer opportunities for students, residents, fellows, clinicians: To have a sense of ownership in the health care of their patients To experience satisfaction of making a difference To recognize issues of access to care in the nation To help create and become part of the solutions to the problems of lack of access to restorative oral health care for underserved communities To become healers and teachers To keep the passion for service alive throughout their training and career ( Pipeline)

31 Websites and contact information IRVINE AWARD VIDEO ABOUT THE FREE CLINIC PROJECT meded.ucsd.edu/freeclinic/ FREE CLINIC WEBSITE DENTAL FREE CLINIC AND PRE-DENTAL SOCIETY WEBSITE

32 Q and A, Discussion THANK YOU!