Supporting HIV care through education and innovation

Module 10: Taking the First Steps — Building Organizational Capacity for Oral Health Care

Module 10: Taking the First Steps — Building Organizational Capacity for Oral Health Care

November 2013
Author:
IHIP
HRSA HIV/AIDS Bureau

45 minutes

Materials Needed:

  • Computer and compatible  LCD  projector to play  the  PowerPoint presentation
  • Whiteboard,  large  paper and easel, or other means of taking notes
  • Colorful markers.

POWERPOINT PRESENTATION

SLIDES 1–3: Refresher — Overview of Pros, Cons, and Important Considerations for the Six Organizationa l Models

Briefly review the pros and cons of the 6 organizational models that were first discussed in module 3.

Overview of the Six SPNS Organizational Models Studied

ModelGranteeProsCons/Caveats
Increasing
services at their
existing clinics
  • Harbor Health
  • Most expedient model
  • Does not necessarily enable clinic to expand oral health care access to
    new geographic areas or populations
Building satellite
clinics
  • AIDS Care Group
  • AIDS Resource Center
    Wisconsin
  • Special Health Resources for
    Texas
  • Community Health Center, Inc
  • Tenderloin Health Center
  • Reduces travel time for some patients, often reducing a huge
    barrier to care
  • Enables greater patient enrollment
  • Improves likelihood of program
    sustainability
  • Can be costly
  • Can take a lot of time to establish,
    including navigation of regulations
    and completion of construction
Collaborating
with clinics in
dental hygiene
schools or
community
colleges
  • HIV Alliance*
  • High-quality oral health care for PLWHA in a mixed clinic setting
  • Improved training in care of PLWHA
    and reduced perception of HIV
    stigma on part of students
  • Enhanced clinical space and
    equipment
  • Faculty supervision and training
  • Requires careful coordination and flexibility
  • Ensure that expectations for
    participating organizations in
    partnership are clearly and formally
    spelled out and agreed upon prior to
    beginning collaboration
Fee-for-service
dental
reimbursement
with contracted
providers
  • AIDS Resource Center Wisconsin
  • Reduced travel time for patients
  • More cost-effective than establishing
    a formal satellite clinic
  • Important to ensure that dentists recruited are culturally and clinically
    competent to serve PLWHA
  • Funding options for fee-for-service
    varies by State and may be more or
    less attractive to providers as a result
Leasing space at
existing private
offices/clinics
  • Center for Comprehensive Care
  • Increased access to care for patients
  • Less resource-intensive than building
    a satellite clinic
  • Provision of care in private clinics that
    are non-HIV-affiliated may reduce risk
    of stigma for patients
  • Leased office locations may not qualify as Medicaid-certified
    providers, limiting ability to bill for
    dental services in some States
  • Important to ensure that patient
    caseload is manageable so that
    patients can be seen at regular
    intervals for follow-up care to improve
    retention and clinical outcomes
Purchasing
mobile dental
units
  • Sandhills Medical Center
  • University of Miami
  • Louisiana State University
  • Montefiore Medical Center
  • Enables provision of care to patients isolated by geography or with
    challenges traveling to dental services
  • Ability to serve a high volume of
    patients
  • Expensive to purchase**
  • Expensive and time-intensive to
    maintain both the dental equipment
    and the unit itself***
  • Cannot be used anywhere—need
    open, flat area; proper parking
    permits; access to electricity to
    operate van and equipment; etc.
  • Requires research into unique
    State regulations, infection control
    procedures, town and county parking
    ordinances, medical record access
    and storage, and scheduling and
    staffing
  • Requires referral of clients to other
    nonmobile clinics for many dental
    services, including most x-rays
  • Patient confidentiality may be a
    concern when using electronic
    medical records through wireless
    system
  • Difficult to navigate roads with
    sensitive dental equipment on
    board because measures used to
    hold equipment stable were often
    insufficient

*While HIV Alliance was the only grantee to use relationship with dental program as their program model, several other grantees established formal or informal relationships with dental professional schools.

**Mobile dental units used by grantees ranged from $144,000 for a one-chair unit to $330,000 for two-chair unit.

***All grantees who employed a mobile dental unit experienced frequent mechanical, electrical, and vacuum system problems.

SLIDE 4: Finding Solutions to Common Barriers to Organizational Growth

  • Which of the model(s) of care would be the best fit for our organization and the populations we serve?
  • What will be the biggest barriers to care in implementing this/ these model(s) of care in our organization from:

    – A systematic/regulatory standpoint?

    – A financial standpoint?

    – A human resources/staffing standpoint?

    – A patient standpoint?

  • What strategies or resources are needed to overcome these barriers?
  • Do existing staff roles and responsibilities need to be redefined? How?

GROUP ACTIVITY

  • Divide the class into 2 or 3 groups and provide each group with a large sheet of paper, markers, and an easel or tape to affix the paper to the wall.
  • For 20 minutes, have each group address the questions listed in the PowerPoint slide, assigning one person in each group to take notes.
  • Once the groups have finished taking notes, go through each question with the class, giving one person from each group the chance to share their group’s response to each question.
  • At the end of the discussion, have the group vote on the top 3 to 5 initiatives or issues that the organization should undertake. Identify the key action items needed to occur to address these initiatives/issues and assign individuals to lead research into and implementation of the initiatives.
  • Designate someone to schedule a followup meeting within the next 1 to 2 months to touch base on progress toward the stated initiatives.

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