1 The TeleDentistry ProjectIncreasing Access to Dental Services for Georgia’s Children through Public Health Suleima Salgado, MBA Director of Telehealth & Telemedicine Office of the Chief of Staff Georgia Department of Public Health March 28, 2017
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3 Some of Georgia’s DPH Telemedicine InitiativesHigh Risk OB Clinic Children’s Medical Services Centering Pregnancy Ultrasound / Colposcopy Consult w/ Maternal Fetal Medicine Specialist Developmental & Genetics Endocrinology Nephrology Neurosurgery Pulmonology Sickle Cell WIC Nutrition Infectious Disease (HIV/AIDS) Breastfeeding Support Nutrition Education Staff Training/Development Patients at local clinics see DPH Infectious Disease specialist Mobile presentations from home or community setting
4 Oral Health Tooth decay is one of the most preventable childhood chronic disease among children It accounts for persistent pain, trouble eating and sleeping, missed school days, and expensive emergency room visits for preventable dental problems yet oral health care remains the most prevalent unmet health care need for children, especially low income children Early diagnosis and treatment are emphasized due to the progressive, destructive nature of caries and periodontal diseases
5 Oral Health Yet, much of the reason dental disease persists comes down to the fact that underserved children and other vulnerable populations in Georgia lack access to routine dental care Unfortunately, the traditional office-based dental care delivery system does not reach a large segment of Georgia’s population. Because of the lack of providers, rural areas have additional barriers to dental care when compared to other locations. The targeted counties are designated Health Professional Shortage Areas (HPSA) and dental HPSAs by the Health Resources and Services Administration (HRSA).
6 Oral Health Routine use of Oral Health services is driven by a variety of “access to care” issues including: Dental Health Insurance One dental practice in each county Limited number of Medicaid/PeachCare patients seen in two of the practices, none in the third Limited pediatric specialty services Socio-economic Status Workforce Issues Oral Health Literacy Individual and Cultural Health Behaviors Geography
7 Why Dental Services in Schools?DPH polled school nurses from four southeast Georgia counties, including Brantley and Charlton, and nurses reported back to us that dental related complaints surpassed asthma as the leading reason given for seeking school nurse services.
8 GEORGIA’S (2) TELEDENTISTRY INITIATIVESThe Teledentistry Project is a partnership between the Southeast Health District, Georgia Regents University School of Dentistry and a private practice dentist in the target area, Dr. Jon Drawdy, DMD. The mission of the network is to provide a system of care to meet the oral health needs of individuals living in South Georgia. GEORGIA’S (2) TELEDENTISTRY INITIATIVES
9 Teledentistry InitiativeMission for DPH: Provide dental screenings, preventive services, and oral health education for students who may not have access to dental care in rural, South Georgia.
11 Innovative Partners
12 TeleDentistry Process FlowCaregivers provide prior consent. Student is called out of class and seen during school hours. A thorough medical/dental history is captured Hygienists provide cleaning, fluoride, x-rays and dental education Hygienist collects initial information about students oral health, uploads and submits X-rays to dentist for review Dentist, from his or her office, makes a diagnosis and connects with dental hygienist to discuss findings with student and develops a treatment and follow up plan, if needed. For more advanced treatment needs, case management begins and referrals can be made. All results mailed to caregiver 1- Treating the patient during school hours is fast and efficient minimizing missed class time. 2- Connection via teleconferencing is made at the beginning of each clinic day and lasts the duration of the clinic. Basic preventive services are performed including a prophy(cleaning), bite-wing x-rays, intra-oral images, fluoride varninsh & home care instructions and dental education. 3- The reviewing dentist is able to view the clinic procedures in real time. A diagnosis, treatment plan & referral is made as each patient is treated. The dental software allows the hygienist to store forward in the event a treating dentist requests patient records & x-rays. These patient records are kept in the software for future reference & follow up information. 4- Case management begins immediately after each referral is recommended. A letter of referral and list of local dental providers is mailed home for the care provider to seek further dental treatment for the patient. Follow up is done on a regular basis and involves the teledentistry staff, school nurses, counselors, teachers and administration. New questions, responses, and updates
13 Patient Satisfaction District has been providing care to high-risk children for nine years through this program. Overwhelmingly positive results Routine Customer Satisfaction Surveys conducted Parents/Teachers express a high degree of satisfaction with the program, in large part because this program is designed in a way that makes accessing dental care easy and convenient for students. Teachers and Administrators have made this a standard practice and recommend kids for referrals routinely
14 Health Outcomes Children receive services they may not have gotten otherwise Children learn how to care for teeth for lifetime Children come to school ready to learn & experience less dental pain School reduce absenteeism rates for dental related illnesses and appointments Parents save w/ transportation costs, lost wages, & preventative care Children are connected w/a dental home for future services Dental providers receive information from screening and have payor source intact It has been proven both successful and cost effective in demonstration projects throughout South Georgia and can contribute to the solution of getting dental care to those who need it most.
15 2010 -2011 2011 -2012 2014 -2015 2015 -2016 Teledentistry Project Children Seen 164 914 355 616 First Dental Visit 26 380 52 42 Refer to General Dentist 47 293 144 192 Refer to Pediatric Dentist 66 287 129 260 No Further Referral Needed 51 334 124 163 Private Insurance 30 162 24 60 Medicaid/PeachCare 57 348 202 389 Uninsured 77 404 132
16 Barriers: Follow-up challenges Pediatric providers TransportationMedicaid/PeachCare providers Acceptance by local dental Scope of practice regulations for Dental Hygienists Payment for services/sustainability
17 TeleDentistry Initiative (2)South Central Health District: Increase scope of network and the resources available to other health districts (Dublin, GA) EX series desktop video conferencing system provided and access to all DPH provider sites. Hygienist takes laptop into CHDs to serve young WIC clients with screenings and preventative oral health services DMD oversees operations remotely from office using technology Outfitted local mobile dental trailer to provide services in field Community Elementary Schools to provide dental services
18 Next Steps: Expansion of Service into Dental Office and Mobile Clinic in South Central Health District Implementing mobile trailer (Early April, begin use next school year) Continued Pursuit of Medicaid Reimbursement for Teledental Services to Improve Sustainability New state law carve out from DCH for hygienist to practice outside of direct dentist supervision, which would allow us to bill for our teledental hygiene visits (Pending final legislative approval). Recruitment of Part or Full-time Dentist to Expand Capacity of Treatment Hire a new dentist. We continue to pursue increased client treatment capacity through the use of contracted services
19 Next Steps: Further Development of Teledentistry Protocol for Adoption by the Georgia DPH Work with state office of Oral Health Implement University (GRU) Student Rotation of Teledentistry Services Difficult process. Little interest from our partner dentist to act as preceptor for the program. In lieu of this, we've decided to push for more community outreach in the form of continuing education classes to community providers, and using the forum to assist with educating the members about our program.
20 Peebles, Heather G. "A Cost-Effectiveness Analysis of the Southeast Health District's Teledentistry Program." Thesis. Emory University, Print.
21 Georgia Department of Public Health Southeast Health DistrictContact Information Suleima Salgado, MBA Director of Telehealth & Telemedicine Office of the Chief of Staff Office: Georgia Department of Public Health Southeast Health District Office: