Collaboration Between Dental and Medical Providers Improves Treatment for Elderly

Abstract

Older adults often suffer from complex medical issues that are exacerbated by dental conditions. Recent data from researchers in Nashville, TN, and teams in Boston and Chicago show that coordination and collaboration between physicians and dentists helps improve care and produce better outcomes for patients. “The collaborative models that involve patient-centered as well as community-based preventive interventions have the ability to increase access to care, improve health outcomes, and reduce the burden of disease and the cost of care for those living with chronic disease,” said lead researcher Janet Southerland, DDS, MPH, PhD, from Meharry Medical College in Nashville. “Understanding of this relationship and development of interprofessional models that will accommodate oral health outcomes as a measure of improvement in management of chronic disease will be important to improved overall health outcomes in this group of patients.” Dr. Southerland and colleagues looked at collaborative models for a range of conditions including diabetes, heart disease, heart failure, and substance abuse. For oral health, they explored the Medical and Dental Home Model, which incorporates oral health into collaborative interdisciplinary practice (Dent Clin N Am 2016;60:789–809). Organizations including the American Academy of Pediatrics, the World Health Organization, and the W.A. MacColl Institute for Healthcare Innovation at the Center for Health Studies developed this medical/health home model. The model was later revised to put more emphasis on adults with chronic conditions. Groups such as the American College of Physicians and the American Osteopathic Association have added principles to refine their vision of a patient-centered medical home. The model recommends: •A physician-directed medical practice•A personal doctor for every patient•The capacity to coordinate high-quality, accessible care•Payments that recognize the medical home’s added value for patients The Patient-Centered Medical-Dental Home (PCM-DH), an extension of the primary care medical home that includes oral care, is one alternative model. The PCM-DH seeks to ensure that patients have a personal physician or dentist who leads a team of health care providers who collectively take responsibility for delivering comprehensive care that addresses both health care and dental needs. In a recent issue of the journal Dental Clinics of North America (2016;60:879–90), Laura B. Kaufman, DMD, and her colleagues at Boston University, Harvard University, and the University of Illinois presented case studies illustrating the benefits that can come from collaboration between dentists and physicians. In one case, a homebound, legally blind 84-year-old man with a medical history of chronic kidney disease, hypertension, hyperlipidemia, chronic obstructive pulmonary disease, depression, and recent weight loss was referred to geriatric dental medicine for a comprehensive oral evaluation. The care team included a geriatric dentist, a primary care physician, and two fourth-year dental students. The students worked with the patient throughout the denture fabrication process, including the preliminary impressions and postinsertion adjustment visits. The dental team took the opportunity to manage the expectations of the patient and his perception of the new dentures. The students took pains to develop a rapport with the patient. For instance, after learning the patient was a retired choir director, the students promised to play piano and sing for him when treatment was finished. “After that seminal moment and until treatment was completed, the patient would anxiously await the arrival of the dental team,” the researchers said. “Six months after completion of the case after a follow-up by the [primary care physician], the patient’s PCP reported that the patient had gained weight and was now actively engaging in social situations, a far cry from the man they met about 7 months earlier. “Creating a culture of collaboration between separate health care providers and the patient’s social support systems will help ensure better patient-centered care with consistent outcomes for all patients,” they wrote. “Oral health care providers need to forge relationships with other professions to expand their knowledge and skills to meet the needs of geriatric patients.” Jason Harris is a freelance writer in Philadelphia.