The Collaborative Approach to Oral and Systemic Care
The need for progress is greater than ever
Richard W. Valachovic, DMD, MPH
There are a variety of forces that are moving health care towards an approach in education that is interprofessional, and an approach to practice that is team-based and collaborative. Growing evidence suggests that oral and systemic health care are intrinsically linked. This is now an important topic in dentistry that should be taken more seriously. The future of health care is going to be much more collaborative both on the education side and the practice side, and we need to find ways to integrate the care of our patients into that collaboration.
The Need for Collaborative Care
Collaborative approaches to oral and medical care have been discussed for about 40 years, but they have not been extensively researched. In 2007 to 2008, a number of factors led people to believe that we needed to take this idea more seriously. One of those things was the fact that more care was being provided in some kind of health system or network—an approach that used teams more effectively was beginning.
Controlling the way patients flow through a health care system can reduce the cost of care when a procedure or patient interaction is performed by a qualified professional but not necessarily the person with the highest level of education. An obvious example is what happened with vaccinations. There were laws that only physicians could give immunizations and now the majority of immunizations for certain cohorts of patients are given by pharmacists. Professional standards are needed to ensure the quality of care remains high. Six of us with a professional education perspective developed core competencies in professional education and collaborative practice. The resulting document triggered a lot of discussion.
Another key force at the time was the Affordable Care Act, which included the development of accountable care organizations where payments would be bundled into one institution or one provider and then funds would be distributed to individuals. The way that reimbursement occurs also directly affects the way care is provided, and one of the ways to reduce the cost of care is to give the care in a team-based collaborative way.
Ways to Integrate Collaboration
There are two schools of thought in terms of the collaborative approach to patient care, as shown in the April 2015 issue of Inside Dentistry in “Integrating Oral & Medical Health Care.” One is the IPE path that is trying to develop ways of educating health profession students in an interprofessional way, and the other option is the collaborative practice or team-based approach that delivers care and is developing somewhat independently. Both are moving very quickly, and comprehensive approaches to researching the outcomes of both are just beginning. Now that there is enough information and different models available, it is possible to investigate and research to determine what works and what does not.
One of the major obstacles of team-based professional education is the logistics, as there are different academic calendars for different schools and academic health centers, as well as different lengths of lectures and clinical experiences. While this presents a challenge in teaching collaborative care, there are also institutions where team-based care is being implemented. Identifying the obstacles and overcoming them is one of the key solutions to forming a collaborative, team-based approach.
In dentistry, we have more than 500 million patient encounters a year. We see patients when they are well for the most part. We have a history of prevention and we are used to working in teams. We have been doing things in teams for a long time. When you think about a health care professional impacting health behavior, the dental hygienist has to be considered an integral and influential part of that.
In 2013, we spent about $111 billion on cardiac care, $111 billion on cancer care, and $111 billion on dental care. We always get so overwhelmed thinking about the $2 trillion in health care and dentistry is $111 billion. This suggests that there is a world for collaborative care in which dentists are involved, which can ease patient experiences and cut costs.
From my perspective, collaborative care is a way of being engaging to other colleagues and health professionals, and it ultimately leads to more patient referrals.
About the Author
Richard W. Valachovic, DMD, MPH, is president and CEO of the American Dental Education Association.