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Oral Health: Putting Teeth Into the Health Care System

Aug 22, 2012, 9:00 AM

Last week, the Robert Wood Johnson Foundation (RWJF) and The Alliance for Health Reform sponsored a briefing to discuss oral health care in the United States, particularly for children and other vulnerable populations.

The discussion was co-moderated by David Krol, MD, MPH, FAAP, RWJF Human Capital Portfolio team director and senior program officer. “Oral health is an integral part of overall health,” he said. It faces the same challenges as overall health care, including “racial, ethnic, geographic disparities in disease and access to care, financing challenges, issues of determining and maintaining quality of care, and workforce controversies.” Krol said he would like to see “all conversations on health and health care… naturally include oral health.”

In 2009, preventable dental conditions accounted for more than 830,000 emergency department visits nationwide, Julie Stitzel, MA, of the Pew Center on the States’ Children’s Dental Campaign told the audience. Children were the patients for 50,000 of those visits. “There’s a real opportunity for states to save money because these visits, again, are totally preventable,” she said. “We know that getting treated in an emergency room is much more costly than the care delivered in a dental office, and states are bearing a significant share of these expenses through Medicaid and other public programs.”

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Making Oral Health Care Accessible

Apr 10, 2012, 1:05 PM

Former Health & Human Services Secretary Louis Sullivan, MD, penned an op-ed in yesterday’s New York Times making the case for devising more effective ways to deliver dental care to poor or rural communities across the nation.

The Secretary notes that, in 2009, 83,000 emergency room visits resulted from preventable dental problems. “In my state of Georgia,” he writes, “visits to the ER for oral health problems cost more than $23 million in 2007. According to more recent data from Florida, the bill exceeded $88 million. And dental disease is the No. 1 chronic childhood disease, sending more children in search of medical treatment than asthma. In a nation obsessed with high-tech medicine, people are not getting preventive care for something as simple as tooth decay.”

He goes on to list several reasons: 50 million of us live in poor or rural areas without a dentist; most dentists do not accept Medicaid; and we have a dentist shortage that will only be exacerbated when 5.3 million children are added to Medicaid and the Children’s Health Insurance Program by way of the Affordable Care Act.

Sullivan argues that the federal government should put programs in place to train more dentists. But more than that, he argues for training dental therapists “who can provide preventive care and routine procedures like sealants, fillings and simple extractions outside the confines of a traditional dentist’s office.” He says such an approach has been particularly effective in Alaska, where the state has recruited and trained dental therapists to serve many of that state’s most remote communities, including many that are accessible only by plane, dogsled or snowmobile.

A recently announced effort by the Robert Wood Johnson Foundation (RWJF) takes aim at the very same problem. The Oral Health Workforce initiative is designed to improve access to oral health care by identifying and studying replicable models that make the best use of the health and health care workforce to provide preventive oral health services.

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Program Repays Student Loans for Primary Care Physicians Working in Underserved Areas

Feb 29, 2012, 1:11 PM

The Department of Health & Human Services (HHS) has awarded $9.1 million to medical students participating in the National Health Service Corps’ Students to Service Loan Repayment Program. In exchange for funds to repay their medical school debts, the 77 students in the pilot program commit to provide primary care services in communities with shortages of health professionals and limited access to care.

After their residencies, participants will spend three years full-time, or six years half-time, working in clinical practice in underserved or rural communities. They can receive annual student loan repayment funds of up to $30,000 while in the program.

The pilot program, created by the Affordable Care Act—the health reform law—aims to help alleviate a shortage of primary care professionals. “This new program is an innovative approach to encouraging more medical students to work as primary care doctors," HHS Secretary Kathleen Sebelius said in a statement.

Read more about the shortage of primary care providers and efforts to recruit primary care physicians in underserved areas.

This commentary originally appeared on the RWJF Human Capital Blog. The views and opinions expressed here are those of the authors.

Fourth in a Series: "Nothing Has More Strength than Dire Necessity"

Jun 29, 2011, 1:45 PM, Posted by Elizabeth Kostas-Polston

The AARP Solutions Forum: “Advancing Health in Rural America: Maximizing Nursing’s Impact,” was held on June 13. This post is the fourth in a series in which Robert Wood Johnson Foundation (RWJF) Nurse Faculty Scholars share their thoughts on the ideas presented. The author, Elizabeth A. Kostas-Polston, Ph.D., A.P.R.N., W.H.N.P.-B.C., is an assistant professor at Saint Louis University School of Nursing. Find out more about the forum or view the archived webcast.

Nearly one in four Americans—70 million people—live in rural America. On average, they are older, poorer, more likely to be uninsured, and suffer from higher rates of chronic health conditions.1

For the past 15 years, I have lived in south central Missouri, in a small town—population ~12,000 rural Americans. I am a nationally, board certified Women’s Health Nurse Practitioner and Colposcopist. In this role I participate by providing primary and specialty health care to rural, underserved and uninsured women who are often the target of Healthy People 2020 indicators. What’s more, the women I care for are not just faces in the crowd. They are my children’s teachers, colleagues’ wives and daughters, the lady who waits on me at the post office, the woman who rings up my groceries, my children’s friends, and my friends’ daughters—all of whom make up our community. It is no surprise, then, that the primary aim of my practice is to improve the health of women and their families. Improving the health of women and their families, in turn, positively impacts the health of our community.

As I listened to nurses such as the Honorable Mary Wakefield and Gail Finley share their thoughts regarding the challenges and opportunities that simultaneously exist as Nursing purposely and strategically moves to make its mark on the improvement of health care in rural America, I could not help but reflect on the numerous barriers which continue to interfere with my ability to practice to the full extent of my education, training, and competence.

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First in a Series: Necessity is the Mother of Invention and Innovation

Jun 16, 2011, 1:55 PM, Posted by Tami Thomas

The AARP Solutions Forum: “Advancing Health in Rural America: Maximizing Nursing’s Impact,” was held on June 13. This post is the first in a series in which Robert Wood Johnson Foundation (RWJF) Nurse Faculty Scholars, who viewed the forum live, share their thoughts on the ideas presented. The author, Tami L. Thomas, Ph.D., C.P.N.P., R.N.C., works with rural populations in Georgia. 

When does an invention or innovation occur? According to Dr. Mary Wakefield it occurs with regularity when the best of nursing and best of rural health care merge with the support of national health policy.

The current challenges of rural health care were discussed Monday morning in Washington, D.C., as policy experts, leaders and key stakeholders met to examine how to improve health care in rural America. Growing up in rural America, my childhood memories include long car drives to see physicians or dentists. Access to care for my father’s family on a rural farm was punctuated by the death of his two-year-old sister, my Aunt Marilyn.

The access to health care problems facing my parents and grandparents are not unlike the problems facing the families I work with in my health promotion research in rural areas.

So I was excited and eager to listen to panelists discuss solutions and innovations like cutting-edge rural health models that could make a difference for the families in rural America.

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Mark Your Calendar! Forum/Webcast on Advancing Health in Rural America Next Monday

Jun 6, 2011, 3:51 PM, Posted by mtomlinson

Have you registered for the June 13 AARP Solutions Forum on Advancing Health in Rural America: Maximizing Nursing’s Impact? There’s still time! The forum will be held in Washington, D.C., and a live webcast will be offered on the Center to Champion Nursing in America’s website.

The forum will convene policy experts, thought leaders and key stakeholders to examine how to improve health care in rural America, where a shortage of providers limits access to primary and preventive services, reduces consumer choice and can raise costs.

Learn more about the forum. Register to attend in-person or via the live webcast.

This commentary originally appeared on the RWJF Human Capital Blog. The views and opinions expressed here are those of the authors.