Ohio Targets High Blood Pressure Among Dental Patients

dentalEver see someone with a great idea and wonder why more people aren’t doing it? We found just such an example in Ohio.  Starting July 1, health centers will incorporate blood pressure screenings for hypertension during all oral health visits.  In a recent blog post, the Ohio Association of Community Health Centers (OACHC) explained that thanks to a partnership with the Ohio Dental Association (ODA), and with funding assistance from the Ohio Dental Association Foundation, all health centers offering dental services will check the blood pressure of patients before they undergo any dental treatment.   While preparing a patient to be seen by the dentist, a dental assistant will take a patient’s blood pressure right in the dental chair. Seamlessly, the assistant will offer health education and can even make a referral to a health center physician if necessary.

“We all know there is a connection between oral health and overall health,” said Ted Wymyslo, MD,  Chief Medical Officer of OACHC.  “This initiative illustrates our  commitment to provide comprehensive care, amplifying the dentist’s role as a health professional who sees the importance of addressing patients’ total health during their oral health visit.”

The project will make blood pressure cuffs available to all health centers that provide dental services.  There will also be uniform protocol for screening patients, a procedure pamphlet for patients and a pocket reference card for providers.   The blood pressure project makes sense for a host of reasons, argues Wymyslo, not the least of which is that many patients will see their dentists more often than their physician and “the mouth is the gateway to the body.”  Many health enters are also participating in the Million Hearts Project [see previous blog post], a national initiative to prevent one million heart attacks and strokes by 2017 by bringing together communities, and public and private organizations to fight heart disease and stroke.   Many people with hypertension, which puts them at risk for heart disease and stroke , go undiagnosed.  In fact, of the 75 million Americans who have hypertension, almost half do not have the condition under control. About 15 million of them don’t know their blood pressure is too high and are not receiving treatment to control it.   Yet, surprisingly, only 17 percent of dentists currently check patients’ blood pressure.

Many Ohio health centers have already put blood pressure checks into practice at their dental centers, sometimes with astonishing results.   Dr. David Hoag, a dentist with Third Street Family Health Services,  recalled receiving a 38-year-old walk-in female patient who needed a tooth extraction.  The first reading of her blood pressure was alarmingly high at 210/112.  A second reading was just a fraction lower  and the patient was told she needed to see her family doctor right away because it was not safe to undergo a dental procedure in the event her blood pressure could spike.  The patient did as she was advised and three weeks later the patient sent the following handwritten note:

“In all honesty my family dr. said you literally saved my life! I am eternally grateful.  Please enjoy a small token of our gratitude.  I will never forget your kindness.”

Beyond the positive patient stories another value to the practice will be data collection.  Once the blood pressure screening dental project gets underway each dental practices will collect data including the number of patients screened and how many referrals are made for further screening and treatment.  The results will be collected across the state and shared to underscore the value of a broader health perspective during dental visits.



Escalating Disparities Emerge in the War Against HIV/AIDS

NationalcountyprevalencerateNew interactive online maps showcase the impact of HIV across the U.S. and that two-thirds of all new HIV diagnoses occur in three percent of U.S. counties. The maps, released by a project called AIDSVu, uses the latest publicly available data at the city, state, and county levels to track disparities in HIV infections and mortality, both geographically and among different demographics.  Among the trends researchers found were that the Southern U.S. is home to nearly 37 percent of the country’s population, but these states account for half of all new HIV diagnoses (50 percent) and deaths among persons diagnosed with HIV (47 percent).

In 2014, eight of the ten states with the highest rates of new HIV diagnoses (Washington, D.C., Louisiana, Florida, Maryland, Georgia, Texas, Mississippi, South Carolina) and the top five cities with the highest rates of new HIV diagnoses were in the South (Miami, FL; Baton Rouge, LA; Fort Lauderdale, FL; New Orleans, LA; and Jackson, MS).

Even though the number of new HIV diagnoses is on the decline overall, the numbers of HIV diagnoses among youth is growing among  people ages 13 and 24, accounting for almost one quarter (22 percent) of all new HIV diagnoses.  African Americans, especially those who live in the Southern U.S., are also disproportionately impacted by the disease, accounting for 44 percent of all new HIV diagnoses in 2014, even though they make up just 12 percent of the U.S. population.

More alarming is that many people living with the disease do not know they have it.  Of the estimated 1.2 people living with HIV, one in eight do not know they are infected.

“AIDSVu’s data visualizations show us that HIV impacts every corner of the United States, and help us understand the geographic trends of the HIV epidemic. Looking back 35 years ago, the first HIV cases were reported in coastal cities, while HIV now disproportionately impacts Southern states. The new AIDSVu maps released today highlight how the epidemic has changed in recent years, and show how new diagnoses have grown among young people, especially young gay men of color,” said Patrick Sullivan, Ph.D., Professor of Epidemiology at Emory University’s Rollins School of Public Health, and principal researcher for AIDSVu. “The maps on AIDSVu allow for the most in-depth look at the HIV epidemic in the U.S. and enable people working in HIV research, prevention, and care to turn big data into action on the ground. Seeing where changes in the epidemic are happening helps people at the federal, state, and local levels to most effectively deploy resources to stop the spread of HIV.”

The data also show the importance of HIV testing. People who test positive can take HIV medicines that can keep them healthy for many years and greatly reduce their chance of passing HIV to others. At Community Health Centers 1,194,684 patients were given an HIV test in 2014. We should also note that Monday, June 27, is National HIV Testing day. Learn more about the value of getting tested for HIV by visiting this link at the Centers for Disease Control and Prevention and then contact your local health center to get tested.

AIDSVu is a project of Emory University’s Rollins School of Public Health in partnership with Gilead Sciences, Inc. Now in its sixth year, AIDSVu is continually expanding the data and resources available to give researchers, policymakers, and others working in HIV the most comprehensive understanding of the epidemic.  To view a press release about the project visit this link.

An Update on the Zika Virus

zikaThe Centers for Disease Control and Prevention (CDC) is reporting that the number of women in U.S. who have been infected with the Zika virus during their pregnancies has reached 234. The most common symptoms are fever, rash, joint pain, and conjunctivitis (red eyes). There is also evidence that the virus can cause an autoimmune disorder called Guillain-Barre. But it is Zika’s link to  poor pregnancy outcomes, such birth defects and microcephaly, that has alarmed federal health officials. The CDC has started to collect information on pregnant women affected by the virus to better track pregnancy outcomes. The Zika virus disease is spread to people primarily through the bite of an infected Aedes species mosquito [see CDC fact sheet], but can also be spread through sexual contact

No locally acquired mosquito-borne cases of Zika have been reported so far, but there have been 755 travel associated cases reported in the U.S., and there is evidence the virus can be spread through sexual contact. With the summer travel season underway, the CDC also has advice about  what to pack to protect oneself against Zika if you are visiting an area where the virus is active. With recent outbreaks overseas, the number of Zika cases among travelers is likely to increase and could possibly trigger the spread of the virus in some parts of the U.S.  There is also growing concern about the rapid increase of Zika in Puerto Rico, putting women of child-bearing age at risk. Public health officials in states where the virus can be spread by mosquito are already ramping up efforts to protect and educate the public, despite funding challenges, particularly in states that have chosen not to expand Medicaid, such as Florida and Texas. “Those decisions, many advocates say, are putting a squeeze on the health care system’s ability to educate women about Zika’s risks and minimize its impact,” according to an article in Kaiser Health News.   

As Health Centers on the Hill reported earlier, Congress is hammering out a measure to fund efforts to fight Zika — but progress is slow. The Obama administration has requested $1.9 billion in emergency Zika funding. The Senate approved $1.1 billion of that request, but the House of Representatives voted to allocate $622.1 million financed through cuts to existing programs, such as for Ebola.

What We Read (And Liked)

doctor-and-patient-silhouette_f1TNg-tu_LA few articles worth noting offer up a perspective on the important link between policy and healthcare delivery.  Here is a round up:

National Public Radio (NPR) features a fellowship program at George Washington University (GWU) in which medical residents learn about how the U.S. healthcare system works. The three-week work program exposes residents to lectures from policy experts in and around the nation’s capital, provides field trips to Capitol Hill, the Supreme Court, related health agencies, even a tour of a Community Health Center (Unity Health Care).  All this so residents can better understand the direct link between public policy and public health.

“Things such as public health were recognized with a one credit course in a curriculum that everyone thought was terrible, partly because it was and partly because they discounted it as being important,” explained Fitzhugh Mullan, MD, a pediatrician and GW professor, told reporter Julie Rovner.  “The notion of engaging with public policy or being concerned with the state of future of [healthcare] service delivery in the U.S. was not remotely part of our training.”

For more you can view the article, “For Doctors-In-Training, A Dose of Health Policy Helps the Medicine Go Down.”

How state policies affect access to treatment for addiction was recently the focus of the Los Angeles Times Reporter Noam Levey reports how thousands of poor patients are languishing on waiting lists for recovery programs or are unable to get medicine to combat addiction because they can’t afford prescriptions in states that opted out of the Medicaid expansion. For example, Missouri, a state with the 16th highest rate of opioid overdose deaths in 2014, is scrambling to fund addiction recovery programs from federal grants or state tax revenues after staunch opposition to the Affordable Care Act.

Levey explains that “without the steady funding that health insurance like Medicaid provides, addiction programs across the country were frequently overwhelmed, especially as the current epidemic intensified.”  As a remedy Congress is now preparing legislation that aims to strengthen federal support for addiction treatment efforts around the country,  expand prescription drug monitoring programs and expand the availability of naloxone, a drug used to reverse overdoses.

For more, read “Fighting Obamacare, Many Red States Find Fewer Tools to Fight Opioid Addiction Epidemic.”

Last but not least The Atlantic looks at access to care and the workings of a Community Health Center in rural Ajo, Arizona, where the nearest hospital is 100 miles away. Reporter Deborah Fallows visited Desert Senita Community Health Center , which is located in a former dormitory of workers at a copper mine which shut down in 1985. She chronicles the health center’s efforts to address health issues in the community, such as obesity, drugs and violence, and encourage residents to help take charge and manage their health.

Fallows writes, “Distance matters for what most of us think of as routine care. Jane Canon is a registered nurse who has been at the clinic for 16 years and is also its manager for quality improvement and also for outreach to the community and beyond. She told me that since there is no way to get prenatal care in Ajo, many pregnant women choose to put off those examinations and checkups for a while. And many decamp to Tucson or Phoenix a few weeks before their due date.”

Read the article. “Finding Health Care in the Desert,” at The Atlantic.





Making Sense of State Policies & Dental Health

maxey_hannah_hiresOur guest blog post today is by Hannah L. Maxey, PhD, MPH, RDH, Assistant Professor and Director of the Bowen Center for Health Workforce Research & Policy, Indiana University School of Medicine :

Community Health Centers and the professionals working within these organizations are the backbone of the dental safety-net. As a dental hygienist who spent years practicing in health centers, I know firsthand how important dental services are for health center patients. I also saw the influence state policy had on my professional practice and ability to provide care for patients in need. As with licensed health professions, the practice of dental hygiene is regulated at the state level through statute and licensing boards. Unfortunately, there are wide variations in these policies, depending where you practice.  I worked in a state where the policies where more restrictive.  I was not able to provide preventive services, such as fluoride varnish and dental sealants, without oversight by a licensed dentist.  Yet, I heard of dental hygienists in other states who were able to practice at health centers with fewer or even without any restrictions. Other states even allowed health centers to bill directly for services provided by the hygienist.   The differences in states across the map deserved a closer look.

Armed with my own experience, and after  spending years in graduate school, I was finally able to do just that.  Findings in my current Journal of Public Health Dentistry article, “State policy environment and the dental safety net: a case study of professional practice environments’ effect on dental service availability in Federally Qualified Health Centers” have been published and are available online at this link.    The takeaway is that health centers located in states which support greater independence among dental hygienists were more likely to provide dental services directly to their patients.  Additional research is needed, but these findings suggest a link between state workforce policies and the ability for health centers to provide needed services, most especially oral health.  It is critical for the health center community to be aware of this and similar issues so that they can advocate for policies that enhance access to care for the underserved.