Integrating Oral Health

Into Primary Care:

Development and Use of

PCOAT (Primary Care Oral Assessment Tool)

Alicia Grady, DDS

Christine Cogil, FNP-BC, DNP(c)

Objectives

Objective 1: Describe strategies in development of an inter-professional collaborative practice that innovates methods to integrate oral health knowledge effectively into a primary care environment.

Objective 2 – Discuss the difference between CAMBRA and the primary care oral assessment tool, evolution of the tool by primary care professional and staff trial use, and sporadic early adopter use.

Objective 3 – Employ a primary care oral assessment tool (PCOAT) as the keystone to assure and sustain implementation of oral assessment in clinical practice change and offer integrated medical/dental services.

EPIC

El Pueblo Inter-professional

Collaborative

HRSA NEPQR: Innovation in Primary Care Oral Health: Interprofessional Collaborative Practice UD7HP25045-02-00

EPIC: El Pueblo Inter-professional

Collaborative

UNM CON

Family Health Partnerships

El Pueblo Health

Services

UNM Dental

Services

Goals of the EPIC Project

1. Develop an inter-professional collaborative

in primary care

2. Improve the oral health of patients

3. Sustain and diffuse an inter-professional

primary care oral health delivery model

Barriers to Oral Health Care

Access to Oral Care Issues

• Lack of dentists in

rural areas

• Transportation

• Dental acceptance

of Medicaid

• Cannot afford out

of pocket expense

• Dental phobia

• Work release issues

• Lack of child care

resources

• Limited knowledge

of the importance

of dental care

Primary Care Oral

Assessment Tool

Why PCOAT?

Introduce oral health assessment to PCPs

Learn dental/medical terminology

Risk based assessment familiar to primary care

such as:

Depression screening

Alcohol/drug use

Cancer risk: breast/prostate/colon

Development of PCOAT

CAMBRA (CAries Management By Risk

Assessment)

Search for similar tool in primary care

Developed PCOAT (Primary Care Oral

Assessment Tool)

PCOAT addresses oral health conditions

Other CAMBRA Tools

PCOAT for Primary Dentition

Provider Protocol

PCOAT for Permanent Dentition

Provider Management Protocols

Protocols associated with patient level of risk

Guidance for provider about oral interventions

Recommendations appropriate for primary care

PCOAT scanned into the patient electronic

record

Self-Management Tool for Children

Self-Management Tool for Adults

Implementation

Implementation of PCOAT

Introduced to Providers

Use at new OB exams, yearly physicals,

well-child checks

Feedback after 3 months of use Time consuming

Difficult to add into routine

Some PCOAT questions unclear

Wanted more training on oral assessment

Four L’s for Oral Screening Exam

Lift/Lower Lips

Look at Teeth

Lasso the Tongue

Lap with finger around gumline

Revisions in the Process

A work in progress Include MAs in team meetings

Offer inter-professional education sessions

Ongoing evaluation after usage Multiple revisions from feedback

Providers and staff involved

Outcomes

Learnings

Provider and staff buy-in

Challenge of changing practice habits

Evolution from prevention to management

Utilization for target populations

Patients with diabetes

Outcomes

PCOAT is keystone for the oral health project

Dental referral network developed

Inter-professional medical/nursing/dental

relationship building

Inclusion of all clinic staff for successful practice

change

Thank You!

References

American Academy of Pediatrics (2003). Oral Risk Assessment Tool.

Retrieved from: http://www2.aap.org/oralhealth/riskassessmenttool.html

American Academy of Pediatrics (2003). Self Management Goal Tool. Retrieved

from: http://www2.aap.org/oralhealth/riskassessmenttool.html

American Dental Association (2010). Caries Risk Assessment Form. Retrieved from:

http://www.dentalcare.com/en-US/ dental-education/continuing-

education/ce387/ce387.aspx?ModuleName=coursecontent&PartID=3&Secti

onID=-1

Health Action New Mexico (2014). New Mexico Population to Dentist Ratio by

County. Retrieved from: http://www.healthactionnm.org/blog/word-

mouth/%092014/02/18/sobering-map-nms-dental-crisis