Instead of debating how to increase access to healthcare, particularly for underserved people, we should focus on the evidence-based, community solutions connecting patients to the right care at the right time – right now.
Whichever side of the aisle you sit on, to change the status quo and create sustainable healthcare programs we need to start by looking at the real barriers underserved people face: low income, lack of awareness of available public health resources, low health literacy, and transportation and childcare challenges so adults who do make doctor appointments are able to keep them. Addressing these barriers can help ensure we are making policy and program decisions that are based on evidence and proven outcomes. This is particularly true when it comes to dental care.
Why does dental care matter so much? Consider these facts:
- 2.2 million people visit hospital emergency departments each year for dental pain, according to the American Dental Association's Health Policy Institute.
- 91% of adults aged 20-64 have caries, the disease that causes tooth decay and cavities, and nearly a third (27%) go untreated, per the Centers for Disease Control and Prevention (CDC).
- Almost half (47%) of people over age 30 have some form of gum disease.
These are sobering statistics when you think of the effect unchecked dental diseases have on the body. Infection from severe tooth decay may develop bacteria-filled abscesses with potential to spread to other parts of the body. Severe gum disease has been associated with increased risk of several other chronic diseases such as diabetes and heart disease.
In dentistry, we have seen success with programs that address barriers head-on in a multidisciplinary way. One program that is particularly effective is the Community Dental Health Coordinator (CDHC), a trained member of the dental team with community health worker skills who receives a comprehensive mix of dental and community health worker education that can be adapted across community settings, including public health clinics, traditional dental offices, schools, social service agencies and more.
There are many stories of CDHCs serving as connectors between underserved people and the dental care they need. For example, a CDHC working in a single-dentist practice in a remote, rural location in Arizona, in one year doubled the clinic's patient base in 2011. In Wisconsin, a CDHC reduced the broken appointment rate from 20% to 8%, and a CDHC working in 30 schools provided 1,200 screenings, 1,300 cleanings, and more than 2,000 sealants for children. Just one CDHC in New Mexico provided services to 114 patients in a rural tribal community health center's diabetes clinic. The missed appointment rate for diabetes patients dropped to zero, compared with a clinic-wide rate of 18 percent.
This solution does not require public funding or resources to license a new dental provider and solves the true challenge of connecting people with available dentists who can provide the care they need now and help prevent dental disease in the future. CDHCs also provide oral health education about the importance of good oral hygiene and a healthy diet which leads to healthier behaviors that can prevent dental disease from the start.
Hospital Emergency Department Referral Programs are similarly effective. More than 2 million patients visit the emergency department for dental pain—that's one patient every 14 seconds—yet hospitals are rarely staffed or equipped to provide dental care. A staggering $1.9 billion was spent on hospital emergency departments visits for dental conditions in 2014 alone.
Dentists across the country are collaborating with hospitals in unique ways to refer emergency room patients to dental offices and public health clinics where they can get the dental care they need in the right setting while greatly improving healthcare costs.
There are various Emergency Department referral models that are effective. The Pay it Forward model refers patients from the ER to volunteer dentists who provide care and patients “pay” for their treatment through community service to non-profits. In Michigan, the usage of the emergency room for dental visits dropped by 72% over a six-year period in one county. Hospital in Florida and Alaska are now piloting the Pay it Forward referral model.
The Voucher Emergency Department model enables a patient to be immediately referred for necessary dental care, without a waiting period and is currently in operation in Illinois, South Carolina and Missouri. Pilot Voucher programs are being considered in other states including Alabama.
To solve these complex challenges, there is no silver bullet, but there are community-based solutions that can help eliminate the barriers patients face and connect them to the dental care they need. Provider administrators, physicians and policy makers can consider these and other similarly established multidisciplinary approaches that can help patients now, and be a model for healthcare beyond dentistry.
