Care Training: National Survey and Interview Results Evaluating - - PowerPoint PPT Presentation

Assessment of Oral Health Education in Primary Care Training: National Survey and Interview Results Evaluating Multidisciplinary Education

Judith A. Savageau, MPH Kate Sullivan, BA Hugh Silk, MD, MPH Gail Sawosik, MBA

University of Massachusetts Medical School Department of Family Medicine and Community Health American Public Health Association Annual Meeting; November, 2018

Disclosure

• I, and all project team members, have no relationships to

disclose.

Objectives

• Describe the current landscape of oral health teaching in

primary care disciplines’ training programs

• Identify the specific elements that influence curriculum

development

• Identify the barriers and factors related to a program director’s

satisfaction with oral health competence among their learners

Christine Riedy, PhD, MPH (Lead PI); Russ Phillips, MD; Hugh Silk, MD, MPH (Co-PIs) HRSA Cooperative Agreement: UH1HP29962

CIPCOH serves as a national resource for systems-level research on oral health integration into primary care training with special emphasis on training enhancements that will train primary care providers to deliver high quality, cost-effective, patient- centered care that promotes oral health, addresses oral health disparities, and meets the unique needs of all communities. CIPCOH’s Objectives:

• Conduct Systems-Level Research on Primary Care Training
• Disseminate Current Research, Evidence-Based or Best Practices, and Evaluation

Tools

• Develop a Community of Practice

UMMS CIPCOH Projects to Date

Year 1 Project

• Evaluate the integration of oral health into primary care curricula

using a national survey of 13 primary care disciplines Year 2 Project

• Qualitatively evaluate the impact of oral health integration on

training outcomes among non-dental program/school champions Year 3 Project

• Convene a Delphi group to create an evaluation tool to assess the
• ral health curriculum in health schools and primary care residencies

Year 1 - Methodology

• 13 nationwide surveys were distributed electronically across

multiple disciplines

• Univariate statistics/frequencies were used to describe all

survey items

• Sub-analyses assessed influences of OH in the curriculum such

as having a faculty oral health champion, program demographics, formal dental faculty teaching, etc.

• Analyses were conducted with programs that had at least a

40% response rate (10 of 13 programs)

For most disciplines, less than 1 in 4 program directors were satisfied with the OH competence of their trainees at the time of graduation.

OH Analysis of Relationships within Programs of Having an OH Champion and: Satisfaction with OH Competence of Graduates, # of Hours of OH in Curriculum, and Existence

• f Relationship between Program and Dental School, Residency or Hygiene Program

DO Schools (N=22) (52%) Peds/ Med-Peds (N=110) (40%) Fam Med (N=195) (40%) Geriatrics (N=75) (51%) Physician Assistant (N=102) (42%) Midwifery (N=33) (85%) Adult Geri NP (N=74) (56%) Pedi NP (N=50) (68%) FNP (N=106) (41%) MAXIMUM # OF POSSIBLE POINTS INPUTS Champion/etc. Department support 6 10 1 4 7 2 2 9 1 10 INPUTS Documents 1 1 1 1 1 1 PROCESS Hours/Day 2 3 3 2 3 2 2 3 2 3 PROCESS Topics: Risk Assessment Oral Health Education 2 2 4 4 2 4 4 4 Topics: Prevention/intervention Communication Interprofessional Collab Other 4 6 2 1 7 3 2 7 7 7 SFL 1 1 1 1 OUTPUTS Evaluation 2 1 2 2 1 2 1 2 Perceived Competence 3 3 6 6 6 TOTAL SCORE 20 25 6 7 31 14 10 33 16 34

Total Quality Score for Each Discipline

Year 1 – Lessons Learned

• Champions are important for # of hours, satisfaction with OH

competence of trainees, and creating relationships

• Time and lack of faculty expertise are major barriers
• Physician Assistants and Nurse Practitioners are leading the

way; Family Medicine and Geriatrics need more effort/support

Year 2 - Methodology

• Development of a structured interview guide
• 31 primary care training programs that had self-identified as

“best practice” OH programs participated in a 1-hour interview (all 13 disciplines interviewed)

• Qualitative analysis of the 31 interview transcripts,

development of a coding schema

• 7 major themes and sub-themes were identified

Mean (SD) Number of Years OH in Curriculum (interview data) Range 1.5 years to 50 years Range 1.5 years to 21 years (excluding outlier of 50 years) 8.2 (9.5) 6.7 (5.4)

Year 2 – Demographics

N (%) In what region of the country is your program located? Northeast Midwest South West 9 (29) 7 (23) 9 (29) 6 (19) For how many years has your program been training learners? 1-5 6-10 11-15 16+ 4 (13) 1 (3) 3 (10) 23 (74) What is the approximate number of learners enrolled in your program per year? (N=29) 1-10 11-20 21-30 >30 7 (24) 7 (24) 4 (14) 11 (38) How many hours of oral health are in your curriculum? 1-3 4-6 7-9 10+ 6 (19) 7 (23) 4 (13) 14 (45)

N (%) It is important for primary care providers to address their patients’ basic oral healthcare issues (e.g., caries prevention, dental referrals). Strongly Agree Agree Neutral Disagree Strongly Disagree 27 (87) 2 (6) 0 (0) 0 (0) 2 (6) I am satisfied with the current level of competence that our graduates achieve in oral health. Strongly Agree Agree Neutral Disagree Strongly Disagree 6 (19) 4 (13) 13 (42) 8 (26) 0 (0)

Major Themes Sub-Themes

• 1. Driving Force / Impetus / Motivation

a. Experience: personal, practice or community-based b. Passion/interest c. New/Existing funding d. New/Existing relationship with dental partners e. Social justice/lack of access/population considerations f. Important topic

• 2. Topics / Competencies / Objectives Rationale

a. External Influences: borrowed from existing curriculum, heard at a conference, read in the literature b. Internal Influences: local faculty expertise, local dental partners c. Patient population / geographic considerations / epidemiologic data d. Academic Requirements: board exam prep, accreditation / certification requirements, tied to competencies / objectives and/or EPAs e. Tied to funding / insurance reimbursements (fluoride)

• 3. Best Aspect / Curriculum Structure

a. Knowledge-based didactics b. Skills-based experiences (e.g., OH exam, counseling, varnish) c. Clinical experiences / rotations / OH electives d. Integration of OH into existing curriculum e. Partnering with other faculty, IPE partnerships, dental collaborations

• 4. Barriers / Challenges

a. Lack of time / curriculum restraints b. Lack of buy in (faculty, department, institution level) c. Lack of faculty knowledge / expertise / interest d. Lack of access to care for patients e. Lack of dental (and non-dental) partner(s) / relationship(s) f. Lack of champion (problems with champion sustainability) g. Lack of funding availability / Loss of funding h. Lack of medical / dental integration

Major Themes Sub-Themes

• 5. Dental Relationships / IPE

a. Collaboration with dental school or residency or hygiene program b. Non-dental expert OH teaching c. Faculty appointments d. Dental resources (e.g., handouts, supplies, referral lists)

• 6. Evaluation Strategies / Styles

a. Quiz / Test questions (e.g., SFL) b. Clinical observation/assessment/feedback c. Attitudinal-based (e.g., toward other professions) d. OSCE / Simulation experiences

• 7. Lessons Learned / Advice / Recommendations

a. Borrow (i.e., don’t reinvent the wheel) b. Pilot curriculum c. Obtain / Sustain a champion d. Obtain buy-in (faculty, department, institution level) e. Obtain / Sustain funding f. Devote time / make time in the curriculum g. Relationships: establish / reinforce relationship with dental partners and non-dental OH experts h. Include / Improve evaluation component(s) i. Make OH part of what you already do/teach j. Include / Improve IPE component k. Include / Improve OH Elective l. Pt education (e.g., insurance, referral lists, resources, etc.)

Year 2 – Quotes

• Motivation for teaching oral health: “As a nurse practitioner, I worked on

the border of (state deleted) and (state deleted). One of the things that I saw, that was a desperate need, and where I knew I wasn’t trained, was

• ral health. Everybody came to me because they had no access to dental

care.” – Family Nurse Practitioner

• On borrowing material for others: “There is no sense in reinventing the

wheel when the wheel is like a Cadillac.” (referring to the SFL curriculum) – PA Assistant Program Director

• Integrating oral health into existing curricula: “Incorporating that

knowledge of oral health into the regular physical exam I think has enhanced our ability to really pick up some potential problems that may turn into medical problems later on.” – Osteopathic Medical School Dean

Year 2 - Lessons Learned

• Oral health champions are vital for starting and sustaining

curricula

• Make OH education a part of the overall curriculum (and not

an ‘add-on’)

• Maximize local resources by working with local dental

professionals and organizations

• Learners do well with skill-based sessions, whether that

means a procedure workshop or actual clinical experiences

Discussion

• Year 1 and 2 results help unpack why some disciplines are lagging

behind and others are flourishing.

• Majority of those surveyed/interviewed feel oral health is a vital health

topic not to be glossed over.

• Best practice programs maximize local resources by working with

academic or community-based local dental professionals; working clinically with dental professionals leads to sharing new approaches and skills.

• Programs should be encouraged that it does not take long to achieve

success; oral health curricula can be accomplished with limited or no funding, and local dental partners need not be teaching experts.

References

• Kane, S. F. (2017). The effects of oral health on systemic health. Gen Dent, 65(6), 30-34.
• Dye, B. A., Thornton-Evans, G., Li, X., & Iafolla, T. J. (2015). Dental caries and sealant prevalence in children and adolescents in the United States, 2011-2012. NCHS Data Brief

(191), 1-8.

• Long, S. S. (2012). Children’s dental health affects school performance and psychosocial development. The Journal of Pediatrics, 161(6), A3.

doi:https://doi.org/10.1016/j.jpeds.2012.10.029

• Puertas, A., Magan-Fernandez, A., Blanc, V., Revelles, L., O'Valle, F., Pozo, E., . . . Mesa, F. (2018). Association of periodontitis with preterm birth and low birth weight: a

comprehensive review. J Matern Fetal Neonatal Med, 31(5), 597-602. doi:10.1080/14767058.2017.1293023

• Gil-Montoya, J. A., Ferreira de Mello, A. L., Barrios, R., Gonzalez-Moles, M. A., & Bravo, M. (2015). Oral health in the elderly patient and its impact on general well-being: a

nonsystematic review. Clinical Interventions in Aging, 10, 461-467. doi:10.2147/CIA.S54630

• U.S. Department of Health and Human Services. Oral health in America: A report of the surgeon general. Rockville, MD: U.S. Department of Health and Human Services,

National Institutes of Health, National Institute of Dental and Craniofacial Research, 2000. NIH publication 00-4713. Available from: URL: http://www.nidcr.nih.gov/sgr/oralhealth.asp

• U.S. Department of Health and Human Services. National Call to Action to Promote Oral Health. Rockville, MD: U.S. Department of Health and Human Services, Public Health

Service, National Institutes of Health, National Institute of Dental and Craniofacial Research. NIH Publication No. 03-5303, Spring 2003.

• IOM (Institute of Medicine). 2011. Advancing Oral Health in America. Washington, DC: The National Academies Press.
• U.S. Department of Health and Human Services Oral Health Strategic Framework, 2014-2017. (2016). Public Health Rep, 131(2), 242-257.
• Healthy People 2020. Washington, DC: U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion [cited May 1, 2018. Available from:

https://www.healthypeople.gov/2020/topics-objectives/topic/oral-health

• Vujicic, M., & Nasseh, K. (2014). A decade in dental care utilization among adults and children (2001-2010). Health Serv Res, 49(2), 460-480. doi:10.1111/1475-6773.12130
• Hale, K. J. (2003). Oral health risk assessment timing and establishment of the dental home. Pediatrics, 111(5 Pt 1), 1113-1116.
• Douglass, A. B., Gonsalves, W., Maier, R., Silk, H., Stevens, N., Tysinger, J., & Wrightson, A. S. (2007). Smiles for Life: A National Oral Health Curriculum for Family Medicine. A

model for curriculum development by STFM groups. Fam Med, 39(2), 88-90.

• Institute of Medicine and National Research Council. 2011. Improving Access to Oral Health Care for Vulnerable and Underserved Populations. Washington, DC: The National

Academies Press. https://doi.org/10.17226/13116.

• Dolce, M. C., Haber, J., & Shelley, D. (2012). Oral health nursing education and practice program. Nurs Res Pract, 2012, 149673. doi:10.1155/2012/149673
• National Organization of Nurse Practitioner Faculties, NP Core Competencies Content Work Group. (2017). Nurse practitioner core competencies content. Retrieved from

http://c.ymcdn.com/sites/www.nonpf.org/resource/resmgr/competencies/2017_NPCoreComps_with_Curric.pdf

• Oral Health Care During Pregnancy Expert Workgroup. (2012). Oral Health Care During Pregnancy: A National Consensus Statement. Washington, DC: National Maternal and

Child Oral Health Resource Center. Retrieved from https://www.mchoralhealth.org/PDFs/OralHealthPregnancyConsensus.pdf

Thank You!

Contact: Judith A. Savageau, MPH; judith.savageau@umassmed.edu; 774.442.6535

N (%)

Medical and Osteopathic (DO) Schools Residency Program Directors (Family Medicine, Pediatrics, Med/Peds, Internal Medicine, and OB/Gyn) Geriatric Fellowship Directors Nurse Practitioner Program Directors (AGPCNP, FNP, PNP) Midwifery Program Directors Physician Assistant Program Directors 4 (13) 11 (35) 1 (3) 9 (29) 3 (10) 3 (10)

Disciplines Interviewed

33/39 50/74 74/133 22/42 75/148 29/68 102/244 106/259 195/482 110/272 22/132 40/256 12/171

Response rates ranged from 7% - 85%; 10 cohorts had acceptable response rates (i.e., ≥ 40%) to warrant further analyses.

Response Rate

UMMS CIPCOH Year 3 Project (in process)

• Delphi group – structured communication technique, relying on an expert

panel come to a consensus on the development of a tool to evaluate academic oral health

• Identified champions of integrating oral health in primary care training

(some previous interview participants, some not)

• Specialties include: Family Medicine, Pediatrics and OB/Gyn residencies,

Geriatric fellowships, NP/Midwifery programs, Medical/Osteopathic schools, and PA schools across the country; group will serve as an advisory group for creating and refining a tool to evaluate a program’s oral health curricula

• Will meet virtually three times between November 2018 and March 2019,

providing materials to review before each meeting