The need to integrate preventative oral health practice into primary care in rural communities is difficult since a variety of barriers to oral care exist particularly for underserved populations. For example, rural areas are more likely than urban areas to be located within dental health professional shortage areas that have higher rates of poverty with fewer dental providers accepting Medicaid.
Rural primary care providers need to play a pivotal role in the oral health of their patients. In order to do this, the providers must receive medical education training on oral health competencies and then work with a sustainable systemic model to be able to collaborate with dental providers.
MORE Care www.dentaquestinstitute.org connects Rural Health Clinics (RHC) with dental care partners and provides for Inter-Professional Oral Health Networks (IPOHN) to provide patient-centered oral care. The initiative began in South Carolina and is being replicated in other states such as Colorado.
MORE Care an initiative of the DentaQuest Institute (DQI), provides primary and secondary preventive oral health services in primary care medical offices to underserved populations as well as test optimal patient-centered referral systems between primary care and dental care teams.
DQI is partnering with State Offices of Rural Health to test strategies to overcome the barriers. Phase 1 of the project involved conducting a pilot study with the state of South Carolina. DQI partnered with the South Carolina Office of Rural Health http://scorh.net and the Medical University of South Carolina (MUSC) www.musc.edu.
The goal was to pilot test models to integrate oral health into primary care and to build dental care referral networks. Seven rural primary care practices participated in the twelve month learning collaborative and were able to test strategies that would optimize systems in their practices.
Teams are also working to develop and track effective referrals to dental providers for dental disease treatment if needed. DQI and MUSC are also identifying and developing relationship agreements with local dental providers to ensure that patients from primary care offices that are in need of dental treatment have sufficient access.
In addition, MORE Care in Phase 1 is working with participating rural clinics in Colorado to successfully adopt chronic disease management strategies to provide primary and secondary preventive oral health services to patients up to age 19. This is being achieved through conducting clinical trainings, creating collaborative care models, and developing referral networks between medical and dental providers.
In Colorado, efforts to improve health IT among rural partners and the Colorado Rural Health Center http://coruralhealth.org enabled changes to be made to the Quality Health Indicators (QHI) informatics system. This system traditionally used for hospital system metrics and quality improvement, but now also collects oral health data.
This system change allows MORE Care clinics to integrate oral health into their current measurement system so that oral health is integrated into the established system rather than appearing as an extra stand-alone effort.
Phase 2 of the pilot has enabled MORE Care to expand into additional states. This phase of the pilot will involve a multi-state learning collaborative for at least five to seven rural primary care practices from each participating state with support from their State Office of Rural Health. The goal of Phase 2 will be to further test oral health integration strategies and develop further dental referral networks.