Transcript The OHS Journey – Year 1

The OHS Journey – Year 1
Where we’ve been
Lit.
Submit
OHS
Team
Meet
FG’s
Serving Seniors:
Challenges for Oral Health
• By 2041, the senior population will be 23% (1995
only 12%) - 80,000,000 more teeth to care for!
• Literature indicates many barriers to care:
– Financial, access, attitudes & beliefs, institutional,
education, physiological
• Oral health is marginalized from publicly funded
health care
• Oral health impacts overall health
and quality of life
Purpose
To determine the key components of a health
services model, based on continuity of care,
which will help improve access to oral
health services for seniors.
What’s needed?
• A collaborative, integrated team
approach
• Data
• Increased awareness of the issue
• Links to other research and
initiatives
Nova Scotia:
Our Project’s Playground
• High proportion of seniors: 128,333 seniors
(65+) in NS; 13.6% of total population
• Many seniors living in rural communities, at
home and with poor socio-economic
conditions
• Currently, outside of our project, there is no
information on the oral health services, barriers
and facilitators
• No publicly funded dental services for seniors
Objectives – Year 1
(Data Collection/Planning)
 Develop a survey for seniors and DCP
 Develop 4 focus group guides
 Develop a research logic framework for the Best
Practices
 Identify resources and experts to consult
 Develop a recruitment strategy and materials
 Begin organizing the Forum
 Develop a communication plan
Objectives – Year 2
(Analysis/Model Dev./ Dissem.)
 Synthesize, design and prepare a final report and
executive summary for the Focus Group findings and Best
Practices Scan
 Design Forum process, recruitment strategy, funding, and
develop materials/presentations
 Host Forum
 Assist with the development of proposals for future
projects/initiatives
 Develop a oral health services model for Nova Scotia
 Disseminate project findings
Products/Wins
 Intersectoral team, 20+ working group meetings
 A comprehensive evaluation framework
 Communication Plan - 30 opportunities
 Facilitator training workshop
 Recruitment process and materials
 2 surveys and 4 focus groups guides
 Survey and Focus Groups findings
 Framework for Best Practices Scan
 Over 266 literature references
 Detailed tracking of project progress
It takes a village to build a model
Seniors
Education
Government
Researchers
LTC facilities
Insurance
Researchers
Dentistry societies
Celebrating our Work
Today’s Agenda
9:30am
Welcome & Project Update (Mary & Liz)
10:00am
Seniors’ Oral Health Services Evaluation:
An Overview & Discussion of the Findings (Pam & Liz)
12:00pm
Lunch
12:45pm
Best Practices Scan:
An Overview of Preliminary Findings (Pam)
2:30pm
Building a Model:
A Discussion to Plan Year 2 (Renée)
3:15pm
Closing Remarks (Mary)
Please take a few minutes to complete the evaluation – thank you!
Challenge Today
• To receive an update of the OHS project’s
Year 1 activities
• To share and discuss the research results we
have to date
• Prepare recommendations and a plan for
Year 2 activities including the Forum and
model development
Research Objectives
Goal: To determine the key components of a health
services model, based on continuity of care, which will
improve the oral health status of seniors?
1) Seniors’ Oral Health Services Evaluation
•
Survey, Focus Group Sessions, Key Informant Interviews
2) Best Practices Scan
•
Review of literature, program scan, policy scan, professional
training scan, insurance scan, promotion & prevention scan
3) Oral Health Policy Forum
•
Review OHS project findings, develop strategies, clarify
sector roles
Seniors’ Oral Health
Services Evaluation
Senior Focus Groups
 7 focus groups
 Average # attending: 10
 Range: 2-15
Margaree Forks
Canso
Bridgetown
Bear River
First Nations
Saulnierville
Northwoodcare Inc. - Halifax
Dartmouth
Dentists, Dental Hygienists and Nurses
Focus Groups
 6 concurrent focus group
sessions (18 in total)
 Average # attending:
 DDS & DH = 7
 Nurses = 4
 Range:
 DDS & DH = 6-9
Kentville
 Nurses = 2-5
Sydney
Antigonish
Truro
Halifax
Yarmouth
Survey Findings
Profile of the Senior Participants
• 67 senior participants
• Most:
–
–
–
–
Female
Living 21+ years in their community
Perceived oral health and general health to be good
Partial or full dentures, only 73% had all their own teeth
• All but 3 of the seniors were able to care for their own
teeth and/or dentures
• Slightly over half of the seniors visited a dentist, dental
hygienist, or denturist in the last year
• Only 68% of the seniors have private dental insurance
Profile of Dentist and Dental
Hygienist Participants
•
•
•
•
•
•
•
41 dentists and 44 dental hygienists participants
Most:
– 41+ years of age
– 11+ years in practice
19 DDS and 22 DH had some form of geriatric training - either as a
component of their degree or CE courses
Seniors comprised less than 30% of their patient base
Like the seniors, most of the care providers perceived their senior patients’
oral health and general health to be good
All but 10% indicated that their dental offices were wheelchair accessible
26 DDS and 9 DH provide dental services to seniors outside of the
traditional dental office:
– 16 DDS and 5 DH in nursing homes
– 7 DDS in the hospital
– 4 DDS and 2 DH serve homebound seniors
Focus Group Findings
Profile of Nurse Participants
• 21 nurses participated in the focus
groups
• There were both general nurses
and nurse supervisors and working
in homecare, long-term care and hospitals.
• Majority indicated no existing dental care
policies or procedures in work place.
• No formal or informal geriatric dental care
training either during nursing training or through
their place of employment
Key Findings - Services
Question #1: What are the existing dental
services for seniors?
T ype of S ervice
D entists
D ental O ffice
D entist/D ental H ygienist
S pecialist/H ospital
N ursing H om es
MD





D ental
H ygienists





N urses
S eniors










Note: Lack of services in rural areas
Key Findings - Barriers
Question #2: What hinders seniors from
accessing dental care (the barriers)?
– Financial (Rural)
– Lack of continuity –LTCF
– Attitudes Beliefs, & Practices (Rural/Communication)
Key Findings - Enablers
Question #3: What helps seniors access dental care
(the enablers)?
– Supportive Measures
– Transportation
– Education/Awareness
– Initiatives Outside N.S.
Key Findings - Ideas
Question #4:What do you feel is needed to create a
system of oral health care for seniors living in Nova
Scotia?
– Universal dental coverage
– Mobile clinics/equipment
– Policies/standards
– Geriatric education/awareness
– Dental Coordinator
Think Big and
Dream Big!
The following is an
example of storytelling
An Overview of the Seniors’ Oral
Health Services Evaluation
Welcome to Smileyville
Introduction
Gotta Research
Played by: Pam Magee
Our Representatives
Shirley A. Senior
Ima Caregiver
Played by: Liz Tait
Played by: Crystal Holly
Unida Scale
Played by: Jennifer Le
Dr. Phil Yourtooth
Played by: Steve Creaser
Profile of the Senior Participants
•
•
•
•
Shirley A. Senior (Liz
Tait) will be travelling to
Smileyville to speak on
behalf of the senior
patricipants-
•
67 senior participants, 7 focus groups
Most:
– Female
– Living 21+ years in their community
– Perceived oral health and general health to be good
– Partial or full dentures, only 73% had all their own
teeth
All but 3 of the seniors were able to care for their own
teeth and/or dentures
Slightly over half of the seniors visited a dentist, dental
hygienist, or denturist in the last year
Only 68% of the seniors have private dental insurance
Profile of DDS and DH Participants
Dr. Phil Yourtooth
(Steve Creaser)
and Ms.Unida
Scale (Jen Le) will
be travelling to
Smileyville to
speak on behalf of
the participants of
their sector
• 41 DDS and 44 DH participants
• Most: - 41+ years of age
- 11+ years in practice
• 19 DDS and 22 DH - some form of geriatric
training (component of degree or CE courses)
• Seniors comprised < 30% of patient base
• Most care providers perceived senior oral
health and general health as good
• All but 10% indicated that their dental offices
were wheelchair accessible
• 26 DDS and 9 DH provide services to seniors
outside dental office:
– 16 DDS and 5 DH in nursing homes
– 7 DDS in the hospital
– 4 DDS and 2 DH serve homebound
Profile of Nurse Participants
Ms. Ima Caregiver
(Crystal Holly) will be
travelling to Smileyville to
speak on behalf of the
nurse patricipants
• 21 nurse participants in the
focus groups, 6 focus groups
• Nurse supervisors and general
nurses; working in homecare,
long-term care and hospitals.
• Majority indicated no existing
dental care policies or
procedures
in work place
• No formal or informal
geriatric dental care training
either during nursing training
or through their place of
employment
The Round Table Begins…
Question 1.
What are the existing dental
services for seniors?
Key Point Recap – Question #1
T ype of S ervice
D entists
D ental O ffice
D entist/D ental H ygienist
S pecialist/H ospital
N ursing H om es
MD





D ental
H ygienists





N urses
S eniors










Note: Lack of services in rural areas
Question 2.
What hinders seniors from
accessing dental care (the
barriers)?
Key Point Recap – Question #2
– Financial (Rural)
– Lack of continuity –LTCF
– Attitudes Beliefs, & Practices
(Rural/Communication)
Question 3.
What helps seniors access dental
care (the enablers)?
Key Point Recap – Question #3
– Supportive Measures
– Transportation
– Education/Awareness
– Initiatives Outside N.S.
Question 4.
What do you feel is needed to create
a system of oral health care for
seniors living in Nova Scotia?
Key Point Recap – Question #4
– Universal dental coverage
– Mobile clinics/equipment
– Policies/standards
– Geriatric education/awareness
– Dental Coordinator
Discussion Questions
1) What key findings or issues stand out?
What are the highlights?
2) Do you feel that story-telling would be a
useful tool for dissemination of these
findings at the Forum? Ideas for
improvement?
Recap of Focus Group Findings
• Services: All / rural
• Barriers: Financial, LTC facilities, attitudes,
beliefs and practices
• Enablers: Supportive measures,
transportation, education / awareness
• Think Big: Universal dental coverage,
mobile units / equipment, policies /
standards, geriatric education / awareness,
dental coordinator
Best Practices Scan
BP Scan
Literature
Review
Policy
Scan
Prevention
& Promotion
Scan
Program
Scan
Professional
Training
Scan
Insurance
Scan
Best Practices Analysis
Scan of barriers and facilitators in oral health services for
seniors’. Critical analysis of experiences and lessons learned
in Canada and elsewhere.
Objectives:
Conduct a review of the
literature relating to the Oral
Health Care of Seniors’.
Conduct a scan for programs &
services at 3 levels:
• Seniors’ dental programs
• Geriatric dental training
programs
Conduct a scan of existing
policies that address seniors’
access to oral health care:
• gov’t, insurance
• national, international
• Seniors’ oral health
promotion/prevention services
Progress:
Comprehensive search of
existing literature completed
•Seniors’ oral health program
scan: completed
• Geriatric dental training scan:
completed
Oral Health Policy Scan –
initial stages of search, ongoing
• Promotion / prevention scan
on-going
Next Steps:
Literature Review
Key Findings
• 266 articles that address seniors’ oral health issues:
–
–
–
–
–
–
Disparities in Oral Health Care and Access
Seniors’ Oral Health Status
Oral Health and Quality of Life
Oral Health and Medical Status
Oral Health and Nutrition
Barriers to Accessing Oral Health Care
• Seniors’ Barriers
• Care Providers’ Barriers
• System Barriers
–
–
–
–
–
Long-term Care Facilities and OralAttitudes,
Health beliefs and practices
Oral Health Prevention/Promotion
Geriatric Oral Health Education/Training
Policy and Seniors’ Oral Health
Recommendations and Future Directions
Policy Scan
What is a Policy?
A policy is “a broad
direction or course of
action that has been
endorsed by a body
with authority to both
implement it and
resource it.”
HEAL Policy and Initiatives Scan, 2003
Types of Policies
• Care/Access- Those which state the level of care
one must receive, and also the level of access to
which one is entitled
• Coverage- The policies which outline the coverage
of dental care and treatment to which individuals
are entitled
• Advocacy- The policies of authoritative bodies
which advocate for better or changed Oral Health
Policies
Canada: 7
3 Coverage
4 Care/Access
Profile of Policies (total = 18)
US: 4
2 Advocacy
2 Care/Access
International: 7
1 Advocacy
6 Coverage
Canadian Policies (total = 7)
NWT/ Nunavut: 1
1 Coverage
Federal: 2
2 Coverage
Yukon: 1
1 Coverage
BC: 1
1 Care/ Access
Ontario: 2
2 Care/ Access
Policy- Canada
Policy
Level
Addressing
Veterans Health Care Regulation
Federal
Coverage
Non Insured Health Benefits
Federal
Coverage
Community Care Facility Act
Provincial
Care/Access
Extended Health Benefits for Seniors
Provincial
Coverage
Ontario Nursing Homes Act
Provincial
Care/Access
Long Term Care Facility Oral and
Dental Care Program (Halton)
Regional
Care/Access
Health Care Insurance Plan Act
Provincial
Care/Access
Policy- International
Policy
Location
Level
Addressing
Policy of Gov't of Australia
Australia
Federal
Coverage
Securite sociale & couverture maladie
universelle
France
Federal
Coverage
Social Security
Germany
Federal
Coverage
Irish Legislation
Ireland
Federal
Coverage
Medicare and Medicaid: State
operations manual
US
Federal
Care/Access
North Carolina Senior Tar Heel
Legislature
US
State
Advocacy
Policy of American Public Health
Association
US
Federal
Advocacy
United States Medicaid and Medicare
US
Federal
Care/Access
Key Findings
• Policies can be classified as governing care/access,
coverage or advocacy
• There are relatively few policies directly
mandating the Oral Health of Seniors
• There is also a lack of research or assessments of
the few existing policies
Program Scan
What is a Program?
• Division of programs (better and promising)
Profile of Programs (total = 58)
Canada: 32
US: 18
International: 8
How did we select ‘Better Programs’
Based upon:
1. Theoretical and best practices literature findings
from:
– health prevention/promotion literature
– community development and capacity building
literature
2. Discussions with senior oral health program
directors (e.g. Apple Tree, Baycrest Geriatric
Dental Program and Golden Care)
Key Indicators
Literature and Program findings used to help determine ‘better seniors’
oral health programs’ using accessibility and sustainability as the
assessment markers
Sustainability
Public/Private
Partnerships
Duration
Accessibility
Funding
OH initiatives
Geriatric Education
Expansion
Awareness
On-going evaluation
Awareness
Delivery
Location
Transportation
Open to seniors
Key findings
•
•
•
•
•
Halton Dental Program (Ontario)
Golden Care Dental Services (Ontario)
Baycrest Centre for Geriatric Care (Ontario)
Apple Tree Dental (US)
Geriatric Dental Clinic, Yad Sarah (Isreal)
Insurance Scan
What is a Dental Insurance Plan?
• An agreement that guarantees the financial
coverage of costs (partial or full) incurred as
a result of receiving dental treatment
• Two kinds:
– Private
– Public
Private Insurance
Company
Liberty
Dental Packages for Seniors
Evaluation
Individual
Program
Group
Needs Assess.
N/A
Green Shield
Canada

Standard Life
N/A
Imperial
N/A
Sun Life
N/A
 (none offered in NS)
No

Maritime Life

No
No
No
Great West Life

 (retiree packages)
No
No
Manulife

No

No

No
Canada Life
Atlantic Blue Cross
Not willing to participate

Public Insurance
Plan
Coverage
Population
NWT Extended Benefits Dental Plan
Comprehensive
$1000 max
All seniors 60 and over
Yukon
Comprehensive
$1400 2 years max
All seniors 65+
Veteran Affairs Dental Plan
Comprehensive
$600 max
All veterans 60 and older
NIHB Dental Plan
Comprehensive
All Status First Nations &
Metis
Denmark Public Health Dental Plan
Comprehensive
All residents
Finland Public Health Dental Plan
Comprehensive
70% Coverage
All residents
Norway Public Health Dental Plan
Comprehensive
Seniors (homebound and
LTC) and children
Sweden National Dental Plan
Comprehensive
Seniors (homebound and
LTC), partial for others
Germany National Dental Plan
Partial coverage
All residents
Key Findings
• Private: If seniors come forward and ask for
private insurance – the insurance companies will
develop a dental plan
• Public: Not good enough just to have a system in
place (e.g. NFLD children’s)
• Explore why not working: attitude and beliefs of
seniors, caregivers perception of need, dental
community not raising awareness about the system
Prevention & Promotion
Scan
Prevention and Promotion Scan:
• This scan is ongoing
• The three components of this scan are:
• Basic Informational Resources
• Educational Tools
– Workshops
– Tool Kits
– Other educational aids
• Assessment tools developed
Professional Training
Scan
(DDS and DH)
DDS and DH Programs in North
America
DDS Programs (Cdn)
DH Programs (Cdn)
Undergraduate = 10
Diploma = 20 (1 private)
Degree = 4 (2 pending)
DDS Programs (US)
DH Programs (US)
Undergraduate = 53
Diploma = 115
Degree = 60
Key Findings
DDS Programs
 Geriatric dental education is not universal in Canadian and
US schools
 Need to develop universal geriatric educational standards
 Curriculums not changing to meet the needs of the
population; no major changes over the last decade
 Major barrier to inclusion/expansion of geriatric didactic
and clinical components in curriculum, over crowded
curriculum
 Lack of faculty members with an interest in or training in
geriatrics
Geriatric Component in DDS
Undergraduate Programs
C anada
N = 10
US
N = 53
10
2
53
44
C lin ical
1. In tegrated as part of clin ical train in g
2. S pecified/defin ed co m pon en t of clin ical train in g
8
2
25
28
C om p reh en sive G eriatric T rain in g
G eriatric train in g/residen cy program
2
9
D id actic
1. R equ ires som e geriatric com pon en t in cu rricu lu m
2. S pecific cou rse or series of cou rses in geriatric
den tistry
Key Lessons: Iowa University
Geriatric Dental Program
 Geriatrics:
 multidisciplinary
 should be integrated into clinical departments
 Seniors require specific OH treatment
 Senior faculty member as director of geriatric courses
 Students should only provide care when equipped with the
knowledge and skills
 Students need to gain clinical experience working with
seniors
 Faculty need CE in geriatric dental care
Key Findings
DH Programs
 Lack of standardized geriatric accreditation standards
 Differences between geriatric components offered in
Diploma and Degree programs
 Lack of faculty trained in geriatric dentistry
 Overcrowded curriculum cited as the key barrier to the
growth of geriatric curriculum within programs
 No major changes in geriatric components in curriculum
over last decade
Geriatric component in DH
curriculum
Curriculum requires:
Geriatric Component
Canada and USA
N = 210
187
Clinical Component
113
Specific Course
40
Average time allotted for geriatric
didactic and clinical components
in dental hygiene programs
D iplom a
P rogra m s
D egree
P rogra m s
T im e devoted to geriatric didactic
com ponents:
A vera ge :
R ange :
10 hrs
1 to 45 hrs
A vera ge :
R ange :
C om parison: G eriatric didactic com ponents
C om parison: G eriatric clinical com ponents
22 hrs
0 to 130 hrs
T im e devoted to geriatric clinical
C om ponents:
9 hrs
26 hrs
13 hrs
11 hrs
Time Allotted to Geriatric
Clinical Components: Dental
Hygiene Programs
1. L on g-ter m care
2. A cu te care
3. O ral E xa m in ation s
4. E d u cation for care givers
5. A verage am ou n t of tim e spen t pr ovid in g geriatric
oral h ealth care
D iplom a
P rogram s
16 hrs
3 hrs
5 hrs
4 hrs
D egree
P rogram s
6 hrs
1 hr
5 hrs
4 hrs
29 h rs
17 h rs
Key Findings
DDS and DH Programs
 Similar barriers identified to lack of enhancement of
geriatric dentistry components in curriculum
 Overcrowded curriculum
 Lack of faculty trained in geriatric
 Financial considerations
 Lack of standardized accreditation standards
 No major changes in geriatric components offered over last
ten years
Lack of
seniors’ oral
health
delivery
programs
Lack of care
providers
Lack of
standardized
accreditation
assessment
tool
Lack of
policies/standards
Lack of
insurance
coverage
Lack geriatric
education/awa
reness
Lack of
standardized
geriatric
accreditation
standards
Lack of
training for
care
providers
Lack of
communication
between health
sectors
Lack of
availability of
services
(transportation,
facilities,
equipment)
Building a Model
Research Training
Education
Funding
?
Policy
Services
Discussion Questions
1) How can these findings be used in the
development of a model?
2) What is necessary to build the model:
a) During the Forum
b) After the Forum
3) Do we need new team members to help with
strategic planning and model development?
Closing Remarks - Workplan
 Synthesize, design and prepare a final report and
executive summary for the Focus Group findings
 Synthesize, design and prepare a final report and
executive summary for the Best Practices Scan
 Design Forum process, recruitment strategy, funding,
develop materials/presentations
 Host Forum
 Assist with the development of proposals for future
projects/initiatives
 Develop a oral health services model for Nova Scotia
 Disseminate project findings