ADA offers solutions on improving oral health for rural populations
October 14, 2019
Washington — How should we measure access to health care services in rural communities? What are the best ways of measuring quality of care in those communities?
These were two of several questions the ADA addressed in the Health Resources and Services Administration’s request for information on improving health care for rural Americans.
In an Oct. 9 letter to HRSA, the Association said that using “a one-size-fits-all approach to measuring need across rural communities is a disservice to patients” and encouraged HRSA to look at the ADA Health Policy Institute’s data to best see an accurate picture of where rural patients live relative to where dentists are located. This includes the Medicaid-insured population and also incorporates travel time data for how long it takes those patients to get to providers. The ADA noted that HRSA’s current model of “defining where the greatest needs lie in respect to number and distribution of providers” is outdated and inflexible.
“With an updated, technology-driven approach, we can better allocate resources to enact responsive policy that meets the unique needs of each community,” wrote the ADA, noting that HPI conducted a two-year research initiative to examine a more responsive approach to determining dental access shortage areas.
Another HRSA topic addressed the core health services most needed in rural communities. The ADA said community water fluoridation, prophylaxis and restorative services, tooth extractions and limited rehabilitative services are all examples of services that can help these communities and pointed out that Community Dental Health Coordinators can help connect patients to these services through targeted case management. CDHCs provide community-based prevention, care coordination and patient navigation to connect people who typically do not receive care from a dentist in underserved communities.
Regarding the numbers and/or ratios of health care professionals needed to provide oral health to rural populations of different compositions and sizes, the ADA cited a 2018 article in The Journal of the American Dental Association that found rural dental health needs depend on a range of factors including the number and type of schools in the area, whether a community is fluoridated and its Rural-Urban Commuting Area Score — a code that classifies U.S. census tracts using measures of population density, urbanization and daily commuting. The ADA also said that the ability of practices to have satellite locations is important since federally qualified health centers could potentially contract with providers to maximize efficiencies and cut down on costs. Many rural areas now receive dental services from the expanding mobile dental van industry, which is typically an extension of an FQHC, the ADA added.
Read the comments in full
Finally, when asked what other factors are important to consider, the ADA said sustainability is an important factor to consider since Medicaid dental benefits typically comprise 3% of a state Medicaid budget. The ADA said that federally designed dental services — including the Indian Health Service — may not be fully staffed, but private practices, CDHCs and teledentistry could all help improve access.
in the ADA's advocacy section.