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Archived Service Delivery Profile:

Free Oral Health Services Enhance Self-Esteem and Employability for Individuals Living With HIV/AIDS, the Homeless, and the Uninsured


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Snapshot

Summary

The Columbia Oral Health Clinic offers free oral health services to community members living with HIV/AIDS and to low-income individuals without health insurance (including the homeless). The clinic, which offers above-market compensation to its dentist and state-of-the-art facilities, serves patients referred from other community health organizations that serve the target population; these organizations typically reimburse the clinic for the services provided. Clinic staff conduct an initial diagnostic assessment to identify the patient's needs, develop and implement a comprehensive treatment plan to meet those needs, and provide education on good oral health habits. The clinic has served more than 9,400 patients since 2000, most of whom likely would not have had access to dental services in the absence of the program. Anecdotal reports suggest that the program has improved patients' self-esteem and employability and made it easier for them to take their medications.

Evidence Rating (What is this?)

Suggestive: The evidence consists of post-implementation data on use of clinic services and anecdotal feedback from patients.
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Developing Organizations

Columbia, SCend do

Date First Implemented

1999
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Patient Population

Vulnerable Populations > Homeless; Impoverished; Medically or socially complex; Medically uninsuredend pp

Problem Addressed

Individuals living with HIV/AIDS often experience increased risk of oral health problems due to a weakened immune system and/or medication side effects.1,2 Yet, access to oral health services is often limited for this population, particularly those without dental insurance. Untreated oral health problems carry a stigma, leading to difficulties securing employment and low self-esteem.
  • More dental problems: Individuals with HIV/AIDS face an increased risk of oral health problems because they have suppressed immune systems and often experience side effects from medications. Common oral health problems include oral warts, fever blisters, thrush, canker sores, dry mouth dental caries and abscesses, and periodontal disease.1,2
  • Limited access to dental services: Too few dentists exist who are willing to treat persons with HIV/AIDS. The difficulty that HIV/AIDs patients face in finding a dentist is often further complicated by the lack of dental insurance, which generally makes seeing a dentist in private practice prohibitively expensive.3 Uninsured individuals with HIV/AIDS may still be able to receive care at low or no cost through organizations funded by the Ryan White CARE Act, but often these organizations supply only basic dental services, and/or must put patients on a waiting list due to insufficient funding.4 This problem is particularly severe in South Carolina, which was identified by the Centers for Disease Control and Prevention in 2007 as being among the 10 states with the highest prevalence of HIV/AIDS.
  • Risk of lower self-esteem, employability: Untreated oral health problems, such as missing and discolored teeth, carry a social stigma that affects employability and self-esteem.3

What They Did

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Description of the Innovative Activity

The Columbia Oral Health Clinic offers free oral health services to community members living with HIV/AIDS and to low-income individuals without health insurance (including the homeless). The clinic, which offers above-market compensation to its dentist and state-of-the-art facilities, serves patients referred from other community health organizations that serve the target population; these organizations typically reimburse the clinic for the services provided. Clinic staff conduct an initial diagnostic assessment to identify the patient's needs, develop and implement a comprehensive treatment plan to meet those needs, and provide education on good oral health habits. Key program components include the following:
  • High compensation, autonomy, state-of-art facility: To attract top-notch providers willing to work with HIV-positive patients, the Columbia Oral Health Clinic offers an above-market starting salary (more than $100,000) and $50,000 in debt forgiveness for those dentists who commit to working in the clinic for 2 years. The clinic also offers its dentists complete autonomy in managing the treatment team and all other clinical aspects of operations. To attract dentists and help patients overcome the stigma associated with using free health services and being HIV positive, the clinic maintains a state-of-the-art dental facility that has the latest equipment, an onsite laboratory, a licensed professional surgeon under contract, and licensed dental and administrative staff.
  • Referrals from partner health clinics: Patients must come to the clinic through a referral from a partner health clinic. Approximately 85 percent of patients are HIV positive, with all referrals coming from one of the area's eight clinics funded through either Part B or Part C of the Ryan White CARE Act. All Ryan White CARE funds are intended to help provide medical care to individuals living with HIV/AIDS; Part B funds are grants provided to all 50 states, the District of Columbia, Puerto Rico, Guam, the U.S. Virgin Islands, and five U.S. Pacific Territories/Associated Jurisdictions, whereas Part C funds are provided directly to service providers. The clinic also accepts homeless and uninsured patients referred by the Free Medical Clinic, a nonprofit organization serving community residents; those referred must not have health insurance and have a household income below 133 percent of the Federal poverty level.
  • Comprehensive assessment and treatment: Patients receive an initial oral examination and diagnostic assessment to identify their dental health needs. The dentist then develops and executes a treatment plan that may include any or all of the following: partial and full dentures, extractions, restorations, limited endodontics, cleanings, and oral cancer screenings. All services are provided onsite.
  • Patient education: Staff educate clients during visits about how to develop and maintain healthy oral health habits.
  • Followup report for reimbursement: After services have been rendered, dental clinic staff prepare and submit a report on each patient to the referring clinic, which then reimburses the dental clinic for the services provided.

Context of the Innovation

The Columbia Oral Health Clinic, a nonprofit organization, is the brainchild of a community champion who noted the lack of dental providers willing to serve the many patients living with HIV/AIDS in Columbia, SC. The champion created a collaboration of dentists who agreed to treat patients living with HIV/AIDS. Over time, the program evolved into a nonprofit entity that employs its own dentist and dental staff.

Did It Work?

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Results

The clinic has served more than 9,400 patients since 2000, most of whom would likely not have had access to dental services in the absence of the program. Anecdotal reports suggest that the program has improved patients' self-esteem and employability and made it easier for them to take their medications.
  • Enhanced access to dental services: Since 2000, the clinic has served 9,400 patients. Between October 2008 and September 2009, the clinic served 1,237 HIV-positive individuals, providing them with 1,190 scheduled appointments (some patients received emergency appointments not included in this figure) and 3,084 procedures, including 93 sets of partial or complete dentures. In addition, the clinic served 846 homeless and uninsured individuals referred from the Free Medical Clinic. Most of these patients would likely not have had access to dental services in the absence of the program.
  • Improved self-esteem and employability: Patients report higher levels of self-esteem as a result of their improved physical appearance after receiving restorative dental services, particularly dentures. Many patients, especially those who work as cooks, housekeepers, and in other positions in which appearance matters, report an increased ability to secure and maintain their jobs after receiving clinic services.
  • Improved ability to take medications: Patients report that having a full set of teeth makes it easier to take antiviral medications (which typically must be taken with food).

Evidence Rating (What is this?)

Suggestive: The evidence consists of post-implementation data on use of clinic services and anecdotal feedback from patients.

How They Did It

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Planning and Development Process

Key steps in the planning and development process included the following:
  • Transitioning to nonprofit entity: The program started out as a consortium of community leaders and private dentists who received direct reimbursement for services provided in private offices through Ryan White funds. After providing services in this manner proved to be prohibitively expensive, the consortium brought in a consultant who recommended a transition to a nonprofit entity. Forming a nonprofit allowed the organization to increase charitable donations (donations became tax deductible), made the organization eligible to apply for grants and reduced its tax burden. In addition, paying the salary of one dentist who is employed directly by the nonprofit allowed care to be provided at a lower cost than paying private providers for individual services at market rate. The newly created entity initially served only HIV-positive patients in the dentists' offices.
  • Choosing clinic site, expanding to serve homeless, uninsured patients: Program leaders chose an old garage as the permanent location for the clinic site, largely due to its proximity to a men's and women's homeless shelter. Program leaders decided to use this change as an opportunity to expand services to homeless and uninsured patients.
  • Conducting regular meetings with partner organizations: Columbia Oral Health Clinic leaders meet with representatives of its partner organizations once a year to discuss the expected volume of referrals to the clinic and the terms of the partnership.

Resources Used and Skills Needed

  • Staffing: The clinic has five full-time staff, including a dentist, dental assistant, dental hygienist, patient specialist, and director, along with a part-time administrative assistant. The full-time director focuses primarily on fundraising activities to ensure that the organization has enough funds to provide services to all individuals seeking care.
  • Costs: The clinic has an annual budget of $437,600; the largest expenses include staff salaries, laboratory fees, and supplies. The average cost per patient is $210.
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Funding Sources

Blue Cross Blue Shield Foundation; Palmetto Health; AIDS Benefits Foundation of South Carolina; Ryan White/ Midland Care Consortium; United Way/ Free Medical Clinic; The Church of the Good Shepard; St. Martin-In-The-Field
The program is funded through reimbursement from referring clinics (which, in turn, are funded through Federal programs) and through a combination of donations from private foundations and individuals. Specifically, the Columbia Oral Health Clinic submits a monthly invoice to each referring clinic detailing the services provided for all patients referred from the organization. The referring clinic reimburses the Columbia Oral Health Clinic based on the previously negotiated, below-market, standard rate per procedure.end fs

Adoption Considerations

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Getting Started with This Innovation

  • Know the community: Analyze community needs and capabilities, including existing clinics and organizations that may be able to serve as partners.
  • Educate the community: Spend time educating the community about the need for good oral health services for HIV/AIDS patients; such efforts will serve to build community awareness and to secure financial support.
  • Create a high-end facility: Creating a clean, attractive, comfortable clinic makes clients feel welcome and helps them to overcome the stigma associated with receiving free health services and with having HIV/AIDS.

Sustaining This Innovation

  • Expand services to other populations: To ensure a stable funding base, reach out to multiple HIV/AIDS-affected populations and to other vulnerable populations in need of oral health services. This strategy will allow the program to secure a diverse group of funders.

More Information

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References/Related Articles

The Columbia Oral Health Clinic Web site is available at http://www.columbiaoralhealthclinic.org/.

Footnotes

1 National Institute of Dental and Craniofacial Research. HIV/AIDS and Oral Health. Available at: http://www.nidcr.nih.gov/OralHealth/Topics/HIV/.
2 Rosenstein DI. Oral Health and HIV. San Francisco AIDS Foundation. Bulletin of Experimental Treatments for AIDS. Winter 2003/2004. Available at: http://www.thebody.com/content/art2537.html.
3 Department of Health and Human Services. HRSA CARE Action: Increasing Access to Dental Care. Available at: http://hab.hrsa.gov/newspublications/careactionnewsletter/june2008.pdf (If you don't have the software to open this PDF, download free Adobe Acrobat ReaderĀ® software External Web Site Policy.).
4 The Well Project. HIV and Your Mouth: Getting Dental Care. Available at: http://www.thewellproject.org/hiv-information/hiv-and-your-mouth.
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Original publication: April 28, 2010.
Original publication indicates the date the profile was first posted to the Innovations Exchange.

Last updated: May 21, 2014.
Last updated indicates the date the most recent changes to the profile were posted to the Innovations Exchange.

Date verified by innovator: April 24, 2013.
Date verified by innovator indicates the most recent date the innovator provided feedback during the annual review process. The innovator is invited to review, update, and verify the profile annually.