Social Medicine and Health Care Organization as a science

Historical Development

• Dental Hygiene as Forerunner to the Prevention Movement

• Dr. Alfred Fones• Founder of Dental

Hygiene School and First Author of Dental Hygiene College Textbook

Historical Development Continued

Preventive Modalities

Dental Care Delivery

F E D E R A LD ep artm en ts o f th e

F ed era l G overn m en t

N O N G O V E R N M E N TP riva te P rac tice

In s titu t ion s , S ch oo lsIn su ran c e-B ased M od e ls

S TA TED ep artm en ts o f S ta te

S ta te P rison sC om m u n ity C lin ic s , S c h oo ls

V eh ic les o f D en ta l C arein th e U n ited S ta tes

Dental Public Health

Factors Affecting Dental Health

• Access to Care– Restriction of dental

hygiene services

– Shortage of Medicaid providers

– Financial Situations• Insurance

• Medicaid

– Transportation

Factors Affecting Dental Health, Continued

• SES Relation to Dental Health

• Dental Hygiene Sciences

• Increase in the Geriatric Populations

• Malpractice• Insurance Changes

Federal InfluenceExecutive Branch System

Legislation Senate and House ofRepresentatives

Executive President andCabinet

Judicial Federal Court

Department of Health and Human Services

• Public Health Service Operating Division

• Human Services Operating Division

Public Health Service Operating Division

• National Institutes of Health

• Food and Drug Administration

• Centers for Disease Control and Prevention

• Agency for Toxic Substances and Disease Registry

• Indian Health Services

• Health Resources and Services Administration

• Agency for Health Care Policy and Research

• Substance Abuse and Mental Health Services Administration

Human Services Operating Division

• Centers for Medicaid and Medicare – Medicaid

– Medicare

• Administration for Children and Families

• Administration on Aging

Public Health Service

• PHS works toward improving and advancing the health of our nation.

• U.S. Surgeon General• Dental Hygienists work

as Public Health Officers.

Other Federal DepartmentsInfluencing Dental Care

• Agriculture• Defense• Education• Justice

• Labor• State• Treasury• Veteran’s Affairs• United States Peace

Corps (which is an executive branch agency)

Individual State Influence

• State Dental Divisions• Medicaid• S-CHIPS• Prisons• Tribal Clinics• Institutions• Community Clinics

Dental Health Care Personnel

• Need• Demand• Utilization• Supply• Dental Hygiene

Shortages• Dental Hygienist

to Dentist Employment Ratio = 1:2

Dental Finance

Public and Private

Funding of Dental Care

Historical Funding of Dental Care

Payment Methods

Fee-for-Service• A dental practice sets a

fee, and a patient and/or third party pays for the fee.

• UCR: usual, customary and reasonable fee

• Indemnity plans pay fee-for-service.

• Discounted coverage available and sliding scales for certain patients in certain clinics

Capitation Method

Encounter and Barter

• Encounters are for an arrangement paid for each visit.

• Barter system is used when the dental provider negotiates payment by exchanging goods and services.

Insurance Plans

Dental Billing

• Claim Form• ADA CDT• Payment Plans• Dental Credit Cards• Explanation of Benefits

Government Role

Government’s Role

• U.S. PHS• Federal Block Grants• State Governments• Local Governments

Medicaid

Dental Care Delivery

Around the World

International Dental Health Care

• Dental Diseases

• Historical Perspective

• Demographics and the Dental Hygienist

• Global Education of the Dental Hygienist

• The Role of the Dental Hygienist

• Access to Care in Other Countries

International Dental Health Care, Continued

• Dental Public Health Programs and Campaigns

• Oral Health Policies

• Lobbying Groups

• International Dental Organizations

International Overview

• Related Dental Professionals

• Regulation of Dental Hygienists

• Independent Practice

• Portability of Licensure

• Future of Dental Hygiene

Legislative Initiatives Affecting Dental Hygiene Practice

In the United States

Issues in the United States

State Governments

• Legislative

• Executive

• Judicial

Major Bodies of LawMajor Bodies of Law

• Common LawCommon Law• Statutory LawStatutory Law• Constitutional LawConstitutional Law• Administrative LawAdministrative Law

Laws Pertaining to Dental Hygiene

• State Dental Hygiene Practice Act, sometimes referred to as the statute

• Supervision Status

State Dental Board

Supervision Types• Unsupervised• Independent Practice• Collaborative Practice

• General Supervision• Indirect Supervision• Direct Supervision

International Overview

• Related Dental Professionals

• Regulation of Dental Hygienists

• Independent Practice

• Portability of Licensure

• Future of Dental Hygiene

Dental Health

Education and Promotion

Health Education Principles

Dental Health Education

• Goal: to prevent dental diseases utilizing appropriate dental health interventions

Health Education Principles

Goals of Dental Health Education

Stages of Learning

• Unawareness • Awareness • Self-Interest • Involvement • Action • Habit

Transtheoretical Model• Precontemplation• Contemplation• Preparation• Maintenance • Action

Theory of Reasoned Action

Social Cognitive Theory

Empowerment Models

Motivation

Maslow’s Heirarchy of Needs

Behavioral Conditioning

Lesson Plan

Development

Assessment Phase

Dental Hygiene Diagnosis

• Formulate Findings from Assessment into a Diagnosis.

• Prioritize Goals.

Planning

• Broad Goal Formulation• Specific Objectives• Select Teaching

Methods.

Implementation

• Be Prepared.

• Effective Teacher Characteristics

Evaluation

Target Populations

For the Practicing Hygienist

Target Populations

A group of individuals with similarities of some sort whether it be

age, race, educational background, life situations, and/or health

conditions

Specific Target PopulationsSpecific Target Populations• Family CaregiversFamily Caregivers

• Health Care WorkersHealth Care Workers

• Hospice WorkersHospice Workers

• Persons with Persons with Medical Conditions/Medical Conditions/DiseasesDiseases

• Developmentally Developmentally DisabledDisabled

• Hearing ImpairedHearing Impaired

• Visual Visual ImpairmentsImpairments

• School TeachersSchool Teachers• Social WorkersSocial Workers• AgesAges

– PrenatalPrenatal– InfancyInfancy– ChildrenChildren– AdultsAdults– Older AdultsOlder Adults

Cultural Diversity

The social, ethnic, and cultural elements that compose a person.

Barriers to Dental Hygiene and Dental Care

Age Language Habit

Culture No Finances Lack of Faith

Education Misunderstanding Fear

Transportation Values Safety

Illiteracy Attitudes Denial of Disease

No providers Invulnerability Convenience

Social Issues Education Levels Provider Conflicts

Program Planning

For the Dental Hygienist

What is a dental public health program?

Educational, clinical, and referral services to a target population

Preventive Programs

Dental Public Health Programs

Dental Hygiene Program Planning Paradigm

Dental Hygiene Program Planning Paradigm, Continued

Dental Hygiene Program Planning Paradigm, Continued

Program Evaluation

Dental Public Health

Program Evaluation

Evaluation Techniques

Government’s Evaluation

• Healthy People 2010 Objectives and Evaluation Mechanisms

• NOHSS• Call to Action

Oral Epidemiology

Oral Epidemiology Reports

Epidemiology of Oral Diseases

Research

In Dental Hygiene

Significance of Research to Dental Hygiene

Dental public health is based upon programs that have demonstrated

effectiveness in achieving health for the population.

Types of Research• Historical

• Descriptive– Survey

– Observational

– Case Studies

– Correlational

• Epidemiological– Longitudinal

– Cross-sectional

• Retroactive

• Experimental (Prospective)

• Quasi-experimental

Beginning Research

Research Design

• Formulating a hypothesis

• Review of the literature

• Methods and materials

• Statistical evaluation

Experimental Approaches

Sampling Techniques

• Randomization

• Systematic

• Convenience

• Stratifying

Informed Consent

• Informed Consent is part of examining the ethics of the research project as a whole.

Dental Research

Biostatistics

Categorizing Data

• Discrete or Continuous– Nominal– Ordinal– Interval– Ratio

Descriptive Statistics

The Normal Distribution

Graphing Data

• Frequency Distribution Table

• Grouped Frequency Table

• Bar Graph• Histogram• Polygon 0

10

20

30

40

50

60

70

80

90

1st Qtr 2nd Qtr 3rd Qtr 4th Qtr

East

West

North

Correlation

• Correlation Coefficients

• Positive Correlation

• Negative Correlation

• Strong Correlation

Correlation

Statistical Decision Making

Inferential Statistics

Interpretation of Data

• Statistical Significance• Clinical Significance

Research Results

Evaluation of

Scientific Literature and Dental Products

Regulation of Dental Care Products

• Food and Drug Administration

• American Dental Association Seal of Acceptance

Dental Hygienist’s Role

• Critical consumer• Patient education• Awareness of

advertising techniques

Evaluation of Scientific Literature

Careers in

Dental Public Health

Positions for the RDH

• U.S. PHS• VA Hospitals• Federal Prisons• Military Base Clinics• Other Agencies

United States RDH Positions

• Commissioned Officer Positions

• Civil Service Positions• National Health Service

Corps

Other Options

Strategies for Creating Dental Hygiene Positions

In Dental Public Health Settings

Populations

Proposed Plan for Action

Practice Management Issues

• Patient tracking

• Appointment scheduling

• Practice promotion

• Collection of fees

Proposal Development and Presentation

• Introduction • Significance of Position• Blueprint of the

Operational Program• Conclusion• Contracts• Teaching Strategies

Dental Public Health

Review

Community Health/Research Principles

Thank you!Thank you!