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Social Medicine and Health Care Organization as a science
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!
