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IPE: HOW YOU CAN MAKE IT HAPPEN

Presented by:Jacquelyn L. Fried, RDH, MS

Associate Professor and Director,Interprofessional Initiatives,

University of Maryland, School of Dentistryjfried@umaryland.edu

Thank you for the opportunity to be here with you today.  

1. Realize the relevance of IPE in curriculum development and health care outcomes.

2. Assess their institution’s capabilities for implementing IPE.

Behavioral Objectives

Through course participation, attendees will:

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3. Suggest options for interprofessionaldidactic, clinical and community learning experiences that could be implemented at their respective institutions.

4. Propose a concrete programmatic, departmental and/or campus action that they will take related to IPE.

Behavioral Objectives

What is Interprofessional Education?

IPE: “When students from two or more

professions learn about, from and with each

other to enable effective collaboration and

improve health outcomes” (WHO, 2010)

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What is Interprofessional Education?

Students from health care, legal and social welfare professions addressing patient and family needs in a team based environment

With the ultimategoal of improved

overall patient health

Developingrespect and

common ethics, values and language

between andamong the healthcare professions

What is Interprofessional Collaborative Practice?

Interprofessional collaborative practice:

“When multiple health workers from different professional backgrounds work togetherwith patients, families, careers [sic], and

communities to deliver the highest quality of care” (WHO, 2010)

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IPE IPC

So Why Now?Why All of the Fuss?

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Precipitating

Factors 

Economic, political, educational, socio‐cultural  

Hallmark reports, IPEC, current care delivery 

Demographics, Morbidity/Mortality

IPC

IPE

Socio-economic/Economic

disparities/burden among poor and minorities

costs of care

salaries commanded by HCPs/inadequate workforce

oral health literacy among deliverers and receivers

professional literacy among deliverers and receivers

Political/Legislative

• Affordable Care Act

• Legislature wake-up calls

• State practice acts

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Death of 12-year-old

Deamonte Driver

from untreated tooth infection

Trying tofix what

is broken

NEED for IPE and IPC

Institute of Medicine (IOM) ReportsLancet ReportCore Competencies Document

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IOM Report - 1995

Oral health is an integral part of total health, and oral health care is an integral part of comprehensive health care, including primary care.

IOM Report

Dental education and dentistry (including “allied dental professionals) are made vulnerable by their relative isolation from the broader university.

Lancet Report: Landmark Document

Frenk J, Chen L, Bhutta Z A, Cohen J, Crisp N, et al.

Health professionals for a new century: transforming

education to strengthen health systems in an

interdependent world.

• Lancet 2010; 376: 1923–58.

• Published Online

• November 29, 2010

• DOI:10.1016/S0140-6736(10)61854-5

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Lancet Report - 2010

A SLOW-BURNING CRISIS IS EMERGING

Condition: mismatch of professional competencies to patient and population priorities

Cause: fragmented, outdated, and static curricula producing ill-equipped graduates

Lancet Report: Instructional Reform

LANCET, 2010

Replace Professional Tribalism with Professional Literacy

X

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www.thelancet.com Vol 376 December 4, 2010. accessed October 8, 2012

Core Competencies for InterprofessionalCollaborative Practice: 2011

Interprofessional Education Collaborative (IPEC)American Association of Colleges of NursingAmerican Association of Colleges of Osteopathic MedicineAmerican Association of Colleges of PharmacyAmerican Dental Education Association Association of American Medical CollegesAssociation of Schools of Public Health

http://www.aacn.nche.edu/education‐resources/IPECReport.pdf

I DID WHAT?

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Teamwork

Communication  Practices

Roles &  Responsibilities  

Values& Ethics

IPEC:Inter‐professionalPractice Domains

CROSS DISCIPLINARYTHEMES

SHARED GOALS

IPCIPE

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Cross-disciplinary Themes

• Health Promotion

• Disease Prevention

• Holism

• Assessment

• Treatment Plan

• Triage

Themes

•Educational

Interventions

•Public Health

Shared Goals

• Effectiveness• Efficiency• Communication• Teamwork• Ethics• Values• Roles and responsibilities

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Shared Goals

• Accessibility• Continuity • Comprehensiveness• Affordability• Quality care

Why Oral Health Care Professionals?

1 in 4 adults, 60 and over

• completely edentulous • 50% of adults have periodontal disease • higher prevalence among lower income

adults.

Beltran-Aguilar CDC

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Courtesy of Dr. Karen Garber

NSTEP

* photos: Smiles for Life Curriculum

Caries: still most common childhood disease

Interest of other professionals

• Pediatricians

• Nursing professionals

• Recognition of oral systemic link

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IPE and IPC Promote Oral Health Literacy

Among Care Deliverers and Recipients

Ineffective Approaches/Practices not informed by Research

*Limited Sharing or Dissemination of Information

*Lack of Coordination between Sectors

Oral Health Disparities

Courtesy of Lisa Bress, UMSOD

MAKING IT HAPPEN…….

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Where, when, how to start?What will it look like?

•   Develop IPE Event (quarterly/annually)?

•   Create new IPE course? content areas?

• Integrate IPE competencies within an existing course?

• Share learning and clinical experiences? capstone projects?

Building an IPE Program

Woodrow Wilson – “It is easier to move a cemetery than to affect a change in curriculum.”

Creating Change Can Be Hard Work

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Institutional Variables

• Administrative support

• Faculty support

• Environmental opportunities

• Team players

• Resources: classroom, faculty

• Curricular flexibility

Assessment of Infrastructure

• Any stakeholders?

• Campus buy-in?

• School buy-in?

• Existing initiatives?

committees?

activities?

discussion?

• Interested parties? (on or off campus?)

Discussion Question 1

What characteristics of your institution bode well for interprofessional education and collaborations?

Why?

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Foundation

• Are any pre-existing successful models in place? How can they be augmented?

• What relationships do you have with faculty across campus? How can they grow?

• What chance encounters could create opportunity?

• What institutional resources and structural support is available?

Elements of Success

• Strategic plan• Money! • Student and faculty professional development• Reward for IPE innovations• Centralized effort• “Publicizing” new and existing IPE efforts

Sell It!

• Innovation

• Campus renaissance

• Challenge

• Student, staff and faculty excitement, learning, inventiveness

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THE MARYLAND EXPERIENCE

Actualizing IPE:

Creating Infrastructure

Action at Micro and Macro Levels

Implementing Ideas

1. Campus philosophy & strategic plan –stress IPE

2. Administrative buy-in at institutional and programmatic levels

3. Faculty and administrative advocates, change agents and leaders

4. Instructor and curricular malleability

UM, The Founding Campus:

Elements of Success

Campus

Administration

School

(Deans) Faculty

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Facilitators

• Underserved environments in close proximity

• Potential and current sites

• Accessible patient populations within hospital facilities

• Preexisting IPE models

• Administrative focus/buy-in

• Committee Structure

• Faculty excitement and perspective

Environment

Accessible Patient Populations

UMMS – hospital, out-patient programs

President’s Clinic: Pediatric Population

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President’s Clinic

• Pre-existing campus IPE model

• Students from all campus schools engage in patient care

Discussion Question 2

How would you describe current collaborative models on your campus?

If non-existent…..why?

If existent, why?

Presidential Buy-In

• Non-issue

• Wholehearted endorsement

• Hence, the President’s Clinic

• IPE/IPC: Key features of UM Strategic Plan

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Campus Higher Administration

• Major Initiative• Strategic Plan – IPE Implementation Team• Standing Committee: Task Force on IPE• IPEC Training Session• Director of IPE

Infra-structure: Campus Committees

1. Strategic Plan Implementation Committee

2. Task Force on IPE

Strategic Plan IPE Implementation Team

• Co-chaired by SON, SOP Deans

• Included high level university administrators

• Represented all campus professional schools

• Charge: develop implementation plan

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Goal 1

Excel at interprofessional education, clinical care and practice, and public service that informs the development of knowledge, public policy, and human service.

64

Goal 1 Tactic 165

Tactic 1: Priority StartFiscal Impact

Status

Identify, assess, and enhance existing interprofessional education programs to enlighten the University on ideal approaches and methods.

P1/P2 FY 2012Minimal

Underway

• Leveraging the previous work of the IPE Taskforce we are currently compiling a current list of all courses considered IP in nature across all schools

• Once complete, we will make appropriate recommendations for existing IP courses that are good candidates for expansion

Implementation Team Members

Education/Clinical Care & Practice Subgroup

Heather Congdon, PharmDAssistant Dean, Shady GroveSchool of Pharmacy

Gary D. Plotnick, MDProfessorSchool of Medicine

Jacquelyn Fried, RDH, MSAssociate Professor and DirectorInterprofessional ActivitiesSchool of Dentistry

Deborah Weimer, JD, LLMProfessorCarey School of Law

Structural/Fundamental SubgroupEdward Pecukonis, PhD, MSWAssociate Professor and DirectorMaternal and Child Health TrainingSchool of Social Work

Susan Wozenski, JD, MPHAssistant Professor and Vice ChairDepartment of Family and Community Health School of Nursing

Paula Raimondo, MLS, AHIPHead, Outreach/Liaison ServicesHealth and Human Services Library

Public Service SubgroupIan ClarkStudent, Carey School of Law

Flavius Lilly, PhD, MPHAssistant Vice PresidentAcademic and Student Affairs

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Sub-Committee on Education

Campus-wide curriculum assessment

• evaluated all schools’ existing curricula• identified common themes• identified duplication• identified courses amenable to IPE• identified course directors

Campus-wide IPE assessment

• Apply findings to curriculum planning

• May need to be assumed by each school’s Academic Dean, Course Directors

• School-specific facilitators and challenges

Infra-structure: Campus Committees

1. Strategic Plan Implementation Committee

2. Task Force on IPE

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IPE Task Force

Charge: implement finalized strategic planning committee’s metrics/milestones

Composition: Academic Deans from all Schools on campus, administrators

IPE Task Force

Standing Committee

• Meet regularly

• Plan campus-wide IPE events

• Conduct curriculum assessment

• Search for campus common denominators

Goals

Create Blueprint for IPE Center

• Develop physical structure• Establish campus-wide data base• Help define IPE activities• Train faculty • Serve as resource center• Become centralized clearinghouse

•

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Curriculum Assessment: Issues

• Schedules –coordination among schools, clinics

• Tuition sharing

• Flexibility/finding “free” days

• Dove-tailing IPE with coursework

• Developing new learning experiences

• Addressing IPE competencies

• Common calendar?

Curriculum Issue

Accreditation:

more focus on IPE activities

less focus on completed clinical experiences

Two Campus-wide Events

• IPE Day

• Faculty Development Workshop

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This event is organized by the President’s Interprofessional Education Task Force For more Information and to register: http://guides.hshsl.umaryland.edu/IPE

According to an expert panel representing the American Association of Colleges of Nursing, American Association of Colleges of Osteopathic Medicine, American Association of Colleges of Pharmacy, American Dental Education Association, Association of American Medical Colleges, and Association of Schools of Public Health, core competencies for interprofessional collaborative practice include four domains: Values/Ethics for Interprofessional Practice Roles/Responsibilities Interprofessional Communication Teams and Teamwork

President Jay Perman and the campus’ strategic plan enthusiastically advocate for interprofessional education, clinical care and practice, and public service. The Inaugural Interprofessional Education Day on April 10 seeks to educate the campus community by showcasing existing IPE activities and raising awareness of the local, national and international interest in IPE. Readings to be completed before attending the March 6 Scenarios Faculty Training Program:

April 10, 2013 ‐ Interprofessional Education Day Program

8:30 ‐ 8:40 am  Greetings from UMB President Jay PermanSchool of Nursing Auditorium, Room 1308:40 ‐ 9:00 am “Care Suffers When Communication Fails”—Lisa Rowen, DNSc, RN, FAAN, Senior Vice President of Patient Care Services & Chief Nursing Officer, UMMCSchool of Nursing Auditorium, Room 1309:15 ‐ 11:00 am Attendees report to locations for scenario‐based learning sessions 11:15 ‐ Noon  Debriefing and assessment of scenarios by attendeesReturn to School of Nursing Auditorium, Room 130Noon ‐ 1:00 pm  Lunch for Faculty Scenario CollaboratorsSchool of Pharmacy, Gallery N1041:00 ‐ 1:30 pm  Panel Discussion with UMB Deans, moderated by President Jay PermanSchool of Pharmacy, Room N1111:30 ‐ 3:00 pm Debriefing and Analysis led by Faculty Scenario CollaboratorsSchool of Pharmacy, Room N1113:00 ‐ 3:30 pm Wrap‐Up, Dr. Jane Kirschling, Dean UMB School of Nursing and Director of Interprofessional Education, School of Pharmacy, Room N111

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Activity & Collaboration Leader Participating faculty Enrollment & Location

1. Could Improved Dental Care Take a 

Bite out of Cardiovascular Disease?

Collaboration led by: 

Harlan Shiau, Dentistry

Richard Boldt, Law

Carroll Ann Trotman, Dentistry

Rebecca Wiseman, Nursing

Ed Pecukonis, Social Work

Max Enrollment: 35

School of Dentistry

Room G310

2. Growing Pains – Can a Team Based 

Approach Revolutionize Pain 

Management? 

Collaboration led by: 

Mary Lynn McPherson, Pharmacy

Sharon Gordon and Rich Traub, Dentistry

Doug Ross, Medicine

Deborah McGuire, Nursing

Karen Kaiser, Clin Prac Coord, UMMS

John Cagle, Social Work

Kat Walker, Pharmacy

Wendy Klein‐Schwartz, Pharmacy

Max Enrollment: 100

School of Pharmacy

Room N203

3. Navigation of a Simulation. Are 

Multiple Minds Better Than One?

Collaboration led by: 

Mary Fey, Nursing

Nick Fusco, Pharmacy

Katy Pincus, Pharmacy

Debbie Gioa, Social Work

Max Enrollment: 15

School of Nursing

Room 340

4. The Case of the Medically 

Compromised Geriatric Couple: legal, 

medical and social issues.

Collaboration led by:

Reba Cornman, Graduate School

Jackie Fried, Dentistry

Brock Beamer and David Loreck, Medicine

Vincent Conroy, Physical Therapy

Linda Horn, Physical Therapy

Elizabeth Galik, Nursing

Chanel Agness & Nicole Brandt, Pharmacy

Kelley Macmillan, Social Work

Max Enrollment: 50

Allied Health Building

(100 Penn St)

Rooms 146 and 152

Scenario-based Learning Sessions: Locations/Faculty

IPE Faculty Development

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March 6, 2013 - Scenarios Faculty Training Program3:00-3:15 pm Welcome! (J.Fried)Purpose of today’s training program, Purpose of April 10th IPE Day (E. Pecukonis)General background and objectives IPE competencies of Teamwork, Roles/Responsibilities, Communication, Values/Ethics3:15-3:45 pm Mock Case simulation, break-out groups, discussion

(V.Rowthorn, E.Pecukonis)3:45-4:30 pm Scenarios: Introduction of leaders (J.Fried) and descriptions of

casesEach case leader describes their scenario, IPE objectives and teaching methodology4:30-4:55 pm Discussion of 4/10 Logistics, Question/AnswerUntil April 1, promote registration among faculty and students in your school. By April 5, you will receive a list of the students and faculty who have signed up for your scenario, including their email and school affiliation. Email them to encourage attendance at the 8:30am keynote, and remind them of the location for your case scenario.When planning your case scenario, build in time at the end for debriefing. At 9:00am on April 10, groups will depart the keynote session by scenario number. You and/or your faculty collaborators should be in attendance to escort attendees to your building and room. Ensure that proper signage is in place at your guard’s desk so wayward attendees will know where to go.Urge your case faculty and attendees to return to the SON for the 11:15 am debriefing, and for all faculty to participate in the 1:00 pm faculty development session.4:55-5:00 pm Wrap-up (J.Fried)

Activity 1 (Collaboration led by School of Dentistry ‐ Harlan Shiau)Could Improved Dental Care Take a Bite out of Cardiovascular Disease?It is increasingly apparent that there is an association between chronic periodontitis and chronic inflammatory diseases, such as cardiovascular disease and diabetes. These conditions are managed by a range of health care professionals and the clinical science is emerging in several fields. Students will explore social, legal and health implications related to the question, “When does clinical scientific discovery become an expectation for best practices?” 

Activity 2 (Collaboration led by School of Pharmacy – Lynn McPherson)Growing Pains – Can a Team Based Approach Revolutionize Pain Management? MJ is an older, slightly built Caucasian woman who presents to her community dentist complaining of a loose tooth and oral discomfort, but is ultimately found to have breast cancer with metastases to the brain. The case will illustrate how a patient‐specific therapeutic goal and monitoring plan can be developed, and how a team‐based approach necessitates effective communication with patients, families/caregivers, health care practitioners, payers, administrators and others. 

Activity 3 (Collaboration led by School of Nursing – Mary Fey)Navigation of a Simulation: Are Multiple Minds Better Than One? Patients are complex and approaching them for the first time can be daunting. Several schools on campus utilize actors playing simulated patient (SP’s) so students can hone their skills. Using a series of acute care cases, students will join a charge nurse and nursing student managing a patient, thereby forming a team who will become familiar with the main points of each case and bringing their unique perspectives to optimize a management plan. 

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School Buy-in

• Trickledown theory

• IPE Task Force Members: SOD Academic Dean and JF

• School-specific facilitators and debilitators

School Level

• Dean, SOD

• Created new position (Director of Inter-professional Initiatives)

• Recommendation: speak to Dean, SON

• Dean, SON

• Mentorship

• Germination of SON/DHYG collaboration

• DHYG – pilot, 2012-13; dental students this year

Why Nursing and Dental Hygiene

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Discussion Question 3

• Identify a visible or potential ally.

• Discuss how you could initiate conversation with this individual.

1. what could be your common theme?

2. what shared goals might you have?

What Clicked?

• Nascent interest in oral health; more evidence re oral/systemic link

• Power leaders in both disciplines

• Power leaders ignited interest in others

• Willingness as collaborators and mentors

• Willingness to be change agents/risk-takers

Brainstorming

• Themes without boundaries

• Learning environments

• Perceived barriers

• Curriculum issues

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Themes

• Health Promotion

• Disease Prevention 

• Holism

• Patient Education

• Public Health

Shared content areas

• Anatomy

• Patient assessment

• Oral/systemic connection

• Population pathophysiology and wellness

Shared roles• Assessment

• Triage

• Prevention

• Health care through the life cycles

• Patient education

• Community‐based health 

Unique Challenges

•Specialty vs. generalist role

•Size of student body

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• Nursing/Dental Hygiene

• Oral/Systemic Link

• Identification of commonalities

The Collaborative Process

• Interprofessional Initiatives

• Corporate Sponsorship

• Launching Meeting

• Conference

Launching Meeting

• Purpose 

• Agenda

• Attendees

• Discussion

• Outcomes

• Next Steps

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Outcomes: Survey Results

Attitudes regarding Nursing/Dental Hygiene Interprofessional Education

N=29

QuestionsStronglyAgree

Agree Neutral Disagree StronglyDisagree

1. “envision ….collaborations between nurses and dental hygienists.”

72.4%(n=21)

20.7%(n=6)

3.4%(n=1)

3.4%(n=1)

0

2. “ student benefit…shared learning experiences…”

65.5%(n=19)

24.1%(n= 7)

10.3%(n=3)

0 0

3.  “Dental hygiene and nursing share a preventive approach to care.”

65.5%(n=19)

20.7%(n=6)

13.8%(n=4)

0 0

4.  “…campus obstacles interfere with IPE….”

37.9%(n=11)

51.7%(n=15)

10.3%(n=3)

0 0

5. “…..small pilot projects….implemented soon….”

37.9 %(n=11)

44.8%(n=13)

17.2%N=5)

0 0

Questions

StronglyAgree

Agree Neutral Disagree StronglyDisagree

6. IPE is critical to developing effective health care providers.

55.2%(n=16)

41.4%(n=12)

3.4%(n=1)

0 0

7. “ intend to work with dental hygiene/nursing faculty… to integrate students..”

44.8%(n=13)

48.3%(n=14)

3.4%(n=1)

0 3.4%(n=1)

8. “..potential for IPE in research arenas….”

58.3%(n=17)

41.4%(n=12)

0 0 0

9. “.. potential for IPE in community outreach and service learning…”

58.6%(n=17)

37.9%(n=11)

3.4%(n=1)

0 0

10.  “…potential in didactic settings…”

51.7%(n=15)

41.4%(n=12)

6.9%(n=2)

0 0

11.  “…potential in clinical settings…”

51.7%(n=15)

44.8%(n=13)

3.4%(n=1)

0 0

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Where Does One Start?

• Which program? Entry-level, NP, DNP?

• Which content areas?

• What learning environments?

• What faculty?

• Educating faculty?

• When do we start?

Curriculum Issues

• Schedules –coordination among schools, clinics, faculty

• Flexibility/finding “free” days

• Dove-tailing IPE with pre-existing coursework

Curriculum Overload

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• Corporate Sponsorship

• Launching Meeting

• Conference

Monday, October 29, 2012

The Oral Systemic Link: Creating Collaborative Initiatives

Monday, October 29, 2012

Register and learn more at: http://nursing.umaryland.edu/oral‐systemic

Join us for the first national conference highlighting dental hygiene and nursing collaborations!

Oral Systemic Link

Medications

Poor Oral Hygiene

Nutrition/

ObesityDiabetes

Speculative Linkages: CVD

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Caries

Tooth loss

Low self‐esteem

Depression

Iatrogenic medication

Xerostomia*

Periodontal Disease

Tooth loss

1.

Lowered self‐esteem

2.

Depression

3.

Iatrogenic medications

4.

Diabetes

Periodontal Disease

Esthetics

MorbidityMortality

HalitosisBleeding Gums

Missing Teeth

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Shared Learning Environments

• Simulation

• Classrooms• UMB

• Shady Grove

• Clinical Practice• Clinics

• Community sites

• Well-mobile

• Hospital ER

Undergraduate Health Assessment

Nursing students will be able to:

• 1) Describe the dental hygiene profession

• 2) Discuss importance of oral health

• 3) Conduct a cursory yet accurate IOE on a colleague

Undergraduate Health Assessment

Dental hygiene students will :

• 1) Demonstrate comprehensive intra-oral exams

• 2) Show structures of relevance to the learner

• 3) Dialogue with health professionals from another discipline on shared concerns regarding systemic/oral health.

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Student Quotes

• “nice to interact with other health care providers”

• “good to see their excitement ..and for us to provide them with information that could be life-saving”

• “my biggest concern….most…said they never receive oral cancer screenings at dental visits….”

2012, October 18th

IPE Day

• Navigating Transitions Along the CareContinuum for Frail Older Adults: An Interdisciplinary and Interactive Case Discussion

• Involves all campus disciplines

NAVIGATING TRANSITIONS ALONG THE CARE CONTINUUM FOR FRAIL OLDER ADULTS: AN INTERDISCPLINARY AND INTERACTIVE CASE DISCUSSION Thursday, October 18, 2012

Faculty Participating in the Program

School of Dentistry: Janet Yellowitz, DMD, MPH, Jacquelyn L. Fried, RDH, MSSchool of Law: Virginia Rowthorn, JDSchool of Medicine: Brock Beamer, MD; Jacob Blumenthal, MD; David Loreck, MDSchool of Nursing: Elizabeth Galik, PhD, CRNP and Nancy Lerner, DNPSchool of Pharmacy: Nicole Brandt, PharmD, BCPP, CGPDept. of Physical Therapy and Rehabilitation Science: Vincent Conroy, PT, DScPT.School of Social Work: Kelley Macmillan, PhDUniversity of Maryland Medical Center: Sara M. Eltaki, PharmD, BCPS

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Student Quotes

• “…learned about broader patient concerns...person as a whole…”

• “…importance of referral….”

• “One stop shopping! We got to interact with everyone!”

Clinical Practice

• University of Maryland Emergency Department

• University of Maryland Diabetes and Endocrinology Center

• Keswick Senior Multi-care Center

Evening Activity

• Case-based

• Xerostomia session with pharmacy, nursing, dental, dental hygiene

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• Campus HIV Initiative

• Interprofessional discussion groups, 2012

• June, 2013 – City Uprising

• Elective Course in Fall

Begun and in the works….

U of M SOD‐PV

Health Dept

Judy Center

Office of Oral Health

Union Hospital

School System

WIC & Head start

IPC: RDH, DDS Students working with multiple health and social care professionals

• Nurses • Physicians

Hospital Emergency Department

• Nurses• Caseworkers

Critical care

• Nurses• Nutritionists

Obstetrics & Pediatrics

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•ED blocks for DDS, RDH, NPs, Social work students: data collection phase

•Outreach: long term care facilities – NPs and RDH students

•Nursing students at UM rural site

• Nurse Practitioners in SOD clinics

IN THE WORKS….

Moving Your Agenda Forward…….

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Look for your institutional, school-based, programmatic strengths

Look at conditions where oral health is relevant and mandatory……

Poor Oral Hygiene

Nosocomial pneumonia

DialysisCancer Patients

Joint Replacements

Rheumatoid arthritis

HIV

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Bulimia

Tooth Erosion

Tooth Sensitivity

Caries

Compromised Nutrition

Weakness, Depression

Low Self‐esteem

Look for populations with needs and conditions that cross boundaries

Geriatrics

Women

Pediatrics

Geriatrics

Xerostomia, OHI:

Dental Hygienist,

Pharmacist

Arthritis: PT

Depression: Psychologist

Diabetes: NP

CVD: NP

Nutritional Counseling: NP, Dietician, 

RDH

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Medications

XerostomiaAnti‐depressants; HBP meds;

Anti‐histamines

Tooth decay; periodontal disease; tooth loss; compromised nutrition, depression

Xerostomia Team

TEAM

NPs

Psychologist

Pharmacist

DHyg

Periodontal  Disease/Diabetes Team

TEAM

Dentist Dental Hygienist

Nursing Professional

Dietician

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Pregnancy and Oral Health

Pregnant PatientECC prevention

Fluoride therapy

Management of

pregnancy gingivitis

Diet counseling

Tobacco prevention

and cessation

Nursing professional

Dental Hygienist

OB-GYN?Dietician

Osteoporosis

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Pediatrics

1. Nutritional counselingObesity preventionCaries control

2. Oral Hygiene Instruction3. Tooth Eruption Information4. Height and weight 

measurement5. Vaccinations

Sites for Collaborative Models

• Emergency Departments (ED’s)

• Hospitals (the OSU) – in-patient

• Community Health Centers

• Out-patient clinics

• FQHCs

• Pediatricians’ offices?

Variables: Collaborative Models

• Environment: rural/urban

• Politics progressive/limited

• Populations in need

• Levels of need

• Residences of populations in need

• Availability of technology: teledentistry

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CollaborativePractice.–Arkansas(CollaborativePracticePermit)–Alaska–Minnesota•AdvancedDentalTherapist(duallicensureasaRDHandDT)–

NewMexico–SouthDakota

Collaborative Practices

1. Arkansas (Collaborative Practice Permit)

2. Alaska

3. Minnesota –Advanced Dental Therapist

4. New Mexico

5. South Dakota

Variations of Collaborative Practice

Arizona(Affiliated Practice)Iowa (P. H. Dental Hygienist)Kansas (Extended Care Permit)Massachusetts(P.H. Dental Hygienist)Michigan (PA161)Ohio (Oral Health Access Supervision

Permit Program)TennesseeVermont (General Supervision AgreementVirginia (Remote Supervision)Washington Pilot Program–(Off-site

Supervision) for nursing homesWest Virginia (P. H. Dental Hygienist)

Future…..

• Challenges

• More IPE, IPC

• Forward Movement Legislatively

• Professional Recognition

• Benefits to the Public

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The Dental School by Night

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