When you think about the types of care that lend themselves most readily to telemedicine, dentistry may not rise to the top of the list. But in fact teledentistry is playing a crucial role in several communities across the country. At last month’s Delaware Telehealth Conference in Newark, Del., I saw a great presentation about the teledentisry efforts of Finger Lakes Community Health (FLCH), a migrant and community health center composed of eight federally qualified health centers in the Finger Lakes region of rural New York State.
Since 2009 Terry Yonker, R.N., telemedicine clinical care coordinator, has led program development for telemedicine applications in primary care at FLCH. She has launched telebehavioral health, and teledentistry programs that integrate specialty and primary health care within a patient centered medical home. She provides care coordination for patients on the telemedicine registries in order to improve access to care and high quality outcomes for patients at FLCH.
FLCH uses telehealth and care coordination to improve oral health outcomes for vulnerable, rural children who are at risk for early childhood caries (ECC), a disease characterized by severe decay in the teeth of infants or young children. The goal of the program is to prevent ECC, to promote access to a dental home, and to have timely evaluation and treatment by a pediatric dentist when necessary.
“Rural children face barriers to care,” Yonker said. In the Finger Lakes region, there are many immigrant farm workers and a large Mennonite community. They are well over 100 miles from specialists. First FLCH created a mobile dental program and sent teams out into the community to do dental cleanings in schools. But they found that when they referred children with more serious dental problems to specialists in Rochester, fewer than 15 percent showed up for appointments. So they got funding to develop a telehealth network, and teledental was the first application.
FLCH has created a “patient-centered dental home” with an integrated team approach of using health IT, community health workers, primary care and specialty care providers to improve outcomes for children with ECC.
They set up a relationship with the Eastman Institute for Oral Health at the University of Rochester. They use teledentristy for screening exams, urgent care, specialty care consults, pre- and post-operative, care follow-up, distance learning. In live video consults, a dental hygenist introduces the child to the dentist in Rochester, presents the case, and goes over the patient’s medical history with the dentist. The exam itself uses an intraoral camera to image teeth and tooth surfaces.
Besides access to the dental specialists, the network succeeds because of enhanced care coordination, Yonker said. “Social determinants can affect access.” Every case is assigned a community health worker who helps arrange transportation.
That decreases travel costs and lost work time for families. It leads to improved access to care, and decreases time to treatment and no-show rates. The specialist care completion rate has gradually climbed to 93 percent, she said.
Speaking by videoconference to the meeting, Tony Mendicino Jr., D.D.S., the program’s dental director, said, “What needs to be stressed is that our patient navigators have made this a success. They track and set patients up with a caseworker to schedule appointments and transportation and pre-op physicals. The addition of these navigators makes things work. “Parents knew we cared,” he said. “This program gets them care and decreases the down time for folks at Eastman. We have learned a lot. Tracking is a big thing. Care coordinators are the biggest part of the program.”
To me it was heartbreaking to see photos of little children with serious tooth decay, inspirational that this program is making such an impact, and interesting that the patient navigators are the linchpins in the program’s success.