The South Carolina Office of Rural Health is partnering with Dr. Amy Martin of the Medical University of South Carolina and SC Rural Health Research Center at the University of South Carolina to identify best practices to incorporate oral health interprofessionalism into rural health clinics.  SCORH wants to develop a national model for SORHs interested in providing technical assistance for oral health integration to meet the objectives of the Triple Aim.

Dr. Martin explains that, “After working on a 3-year grant to build capacity within oral health safety net clinics, it became apparent that we needed to look at a more systemic approach to building oral health capacity in our state.”  Dr. Martin approached Dr. Graham Adams with the SCORH to develop a partnership to investigate how to integrate oral health into rural health clinics for early identification of oral disease and how SORHs can best provide technical assistance for rural health clinics to integrate oral health services into primary care.

In rural South Carolina, oral disease is the number one avoidable reason an uninsured adult visits the ER.  Therefore, rural hospitals and clinics have a vested interest in addressing oral health shortages.  The SCORH is already working with 106 clinics to implement Primary Care Medical Homes, so this oral health project was a natural fit.  “Primary Care Providers will still be practicing medicine, but they will also be practicing medicine in the mouth,” says Dr. Martin.

For the past 18 months, Martin and Adams have worked with DentaQuest Institute to help them understand the breadth of rural health providers and the value of state offices of rural health in providing technical assistance.  “Amy is such a good advocate for the SORH model and a champion for integrating SORHs more broadly into the greater healthcare system.  She understands SORHs and sees the value there,” says Adams.  The DentaQuest Institute was convinced of the merit of this pilot and agreed to fund a one-year demonstration.

Over the next year, the SCORH will work with 7 clinics to integrate oral health services into its primary practice.  In addition, the SCORH has partnered with SORHs in Colorado, Iowa, New Mexico, and Pennsylvania to develop a national model for SORHs interested in providing technical assistance to rural health providers to help them become an integrator of oral health.

Using the 2014 HRSA report on “Integration of Oral Health and Primary Care Practice,” Martin developed a framework for oral health integration with three levels of care.  The primary intervention involves risk assessments and participatory guidance for children and adults.  The main focus for children is to identify caries and possibly provide fluoride varnish.  The main focus for adults is identifying periodontal disease with an additional focus of diabetes and oral cancer screeningSecondarily, doctors will be able to prescribe antibiotics, anti-inflammatories, mouthwash and toothpaste to ward off disease.

The third level of care is perhaps the most important.  One of the main components of this pilot is to develop partnerships with oral health providers to be able to refer patients that need oral health treatment.  Adams explains, “We are trying to build links with rural dentists so that patients have somewhere to turn to avoid going to ER.”

After the first year, they hope to ramp up the program to work with more practices and determine a set of best practices to help other SORHs interested in providing this type of assistance.  They are hopeful this work will provide a framework for other SORHs and turn into a national model.

For more information on the role of the SORH, contact Melinda Merrill.

Does your SORH have a “Promising Practice”? We’re interested in the innovative, effective and valuable work that SORHs are doing. Contact Kassie Clarke, NOSORH’s Communication and Development Coordinator to set up a short email or phone interview in which you can tell your story.


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