Bulletin of Dental Education

Academic Partnership Brings Chairside, Nurse-Led Primary Care to the Dental Clinic

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Recently, a distinguished group of scholars and community providers gathered at the Harvard School of Dental Medicine (HSDM) to celebrate the launch of a partnership between HSDM and Northeastern University’s (NEU) School of Nursing. Beginning in February, the two schools will be bringing chairside primary care into the dental clinic and educating nurse practitioner (NP) and dental students on how to work together as a team.

“Harvard Northeastern
Photo courtesy of Northeastern University
Bouvé College of Health Sciences School of Nursing.

The Nurse Practitioner-Dentist Model for Primary Care (NPD Model) is designed to improve the overall health of underserved patients at the Teaching Practices Clinic at the Harvard Dental Center in Boston. Approximately 60% of the clinic’s patients, many of whom are elderly, say they lack a primary care provider.

Working side by side with their dental student peers, NP students will take blood pressure readings, test blood sugar levels, ask patients about their chronic conditions and work with the dental students to educate patients on how to improve their oral and overall health.

Patients over the age of 65 will also be offered an annual wellness visit that will evaluate them for such risks as falls, cognitive impairment and depression; offer counseling on weight management, tobacco use and other aspects of wellness; and provide referrals for additional medical care and community services as needed.

The three-year project, which also includes research and dissemination components, has been funded by a $1.2 million cooperative agreement awarded by the Health Resources and Services Administration, U.S. Department of Health and Human Services.

At a January kickoff event, keynote speaker Michael C. Alfano, D.M.D., Ph.D., Professor, Dean and Executive Vice President Emeritus of New York University, addressed ways the academic and practice communities could further two goals of the NPD Model—overcoming the traditional isolation of dentistry within health care and promoting genuine interprofessional collaboration.

Dr. Alfano argues that two chains—the “silo effect” and the “high-low effect”—bind the health professions to the status quo. He attributed dentistry’s reluctance to abandon its cottage-industry business model to the silo effect—a business term referring to the lack of information flow between related entities. He also blamed the subtle pecking order among the health professions for inhibiting effective collaboration.

“It’s real. It’s breaking down, but it’s real,” he says of what he called the high-low effect. “I believe it’s part of what holds us back as we try to embrace the creativity that you are demonstrating here at Harvard and Northeastern.”

To achieve the paradigm change represented by the NPD Model will require both “push” and “pull,” says Dr. Alfano. His experience with other change initiatives suggests that push—getting out the word about the benefits of integrating oral health and primary care—will not be enough. He argued that advocates of care integration will also need to find ways to generate pull, which will come in the form of patient demand. Dr. Alfano expects that patients who experience the NPD Model will quickly come to appreciate its convenience, among other benefits.

The multi-faceted project includes a research component that will examine the impact of chairside primary care in the dental clinic on the health of patients over the age of 65. Toward the end of the three-year grant, the partners will begin working with other academic health centers that want to replicate the NPD Model.

Only one in five dentists in Massachusetts accepts payment from MassHealth, the state’s insurance plan for low-income residents. Dental school clinics, such as the one at Harvard, provide a vital safety net to those who cannot afford to pay for dental care.

Release courtesy of Jessica Holloman, M.S., B.S.D.H., Northeastern University Bouvé College of Health Sciences School of Nursing

Published on February 10, 2016.

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