Improving access and provision of preventive oral health care for very young, poor, and low-income children through a new interdisciplinary partnership.

OBJECTIVES: We provided oral health care services at 2 sites using a nurse practitioner-dietitian team to increase dental workforce capacity and improve access to care for low-income preschool children. METHODS: Our team provided oral health assessments and education, fluoride varnish application, and dentist referrals. The primary endpoint was participants' access to oral health care. Secondary endpoints included increasing the practice scope of registered dietitians through training programs for oral health assessment and the application of fluoride varnishes for children. The oral health and hygiene and dietary habits of the participants were also determined. RESULTS: From 2010 to 2013, 4360 children received fluoride varnishes in 7195 total visits. Although the proportion of children with dental caries at the first visit was greater at the urban site, both sites were similar by visits 2 and 3. The number of caries declined with increased program visits, which coincided with an increase in the proportion of participants visiting a dentist. CONCLUSIONS: Progress toward eliminating dental health disparities requires addressing barriers to dental care access. We showed that expanding access to oral health services through nurse practitioner-dietitian cooperation improved access to preventive fluoride varnishing use in low-income children.

Seeking American Society of Clinical Oncology-Quality Oncology Practice Initiative (ASCO-QOPI) certification in a northern New England rural health system and cancer care network.

In 2006 following several years of preliminary study, the American Society of Clinical Oncology (ASCO) launched the Quality Oncology Practice Initiative (QOPI). This cancer-focused quality initiative evolved considerably over the next decade-and-a-half and is expanding globally. QOPI is undoubtedly the leading standard-bearer for quality cancer care and contemporary medical oncology practice. The program garners attention and respect among federal programs, private insurers, and medical oncology practices across the nation. The MaineHealth Cancer Care Network (MHCCN) has undergone expansive growth since 2017. The network provides cancer care to more than 70% of the cases in Maine in a largely rural health system in Northern New England. In fall 2020, the MHCCN QOPI project leadership, following collaborative discussions with the ASCO-QOPI team, elected to proceed with a health system-cancer network-wide QOPI certification. Key themes emerged over the course of our two-year journey including: (1) Developing a highly interprofessional team committed to the project; (2) Capitalizing on a single electronic medical record for data transmission to CancerLinQ; (3) Prior experience, especially policy development, in other cancer-focused accreditation programs across the network; and (4) Building consensus through quarterly stakeholder meetings and awarding Continuing Medical Education (CME) and American Board of Medical Specialists (ABMS) Maintenance of Certification (MOC) credits to oncologists. All participants demonstrated a genuine spirit to work together to achieve certification. We report our successful journey seeking ASCO-QOPI certification across our network, which to our knowledge is the first-of-its-kind endeavor.

Dietary challenges of managing type 2 diabetes in African-American women.

The purpose of this qualitative study was to explore the challenge of self-management of diet in African-American women living with type 2 diabetes. Specifically, the women were asked to talk about dietary challenges of managing diabetes in the context of their personal lifestyle factors, such as daily routines, family responsibilities, and individual needs. Using a phenomenological approach, a descriptive, exploratory design was implemented using four facilitated focus groups. A convenience sample of 24 African-American women was recruited from a family practice center in the midwest. Data from each of the four focus groups were audiotaped and transcribed verbatim. Themes were compared and contrasted within and across each of the four focus groups until consensus was reached. Four themes were identified: frequent difficulties in changing dietary habits, need for individual guidance, support, and misinformation gaps. Overall, the participants expressed the need for more attention to the personal lifestyle factors they viewed as obstacles to managing diabetes.

Obesity treatment: broadening our perspective.

OBJECTIVE: To selectively review the dietary literature to broaden perspectives on energy restriction as the primary determinant of successful obesity treatment. METHODS: Forty-five articles describing novel dietary behaviors and nutrient intakes that may impact obesity treatment are examined. RESULTS: Two areas of promising research were identified: (a) Dietary behaviors and patterns--eating frequency, meal timing, specific dietary pattern and (b) Nutritional factors--fat, fiber, glycemic load, carbohydrate. CONCLUSIONS: Caloric restriction leads to weight loss. However, promotion of dietary behaviors that focus primarily on cutting calories needs evaluation. There may be many dietary behaviors and patterns that promote weight loss and maintenance, making it essential to consider new nutritional approaches for obesity treatment.

Expanding oral health preventative services for young children: a successful interprofessional model.

Progressive solutions are needed to solve the oral health chronic disease problem in the U.S. The importance of oral health coupled with urgent community oral health needs, shortage of primary providers, and emphasis on interprofessional collaboration make the timing ripe for allied health training and practice in oral health preventative services. A successful model is described that addressed the unmet oral health care needs of low-income and at-risk children. The model is a guide for integrating an oral health screen, fluoride varnish, anticipatory guidance, and dental referrals into allied health practice. An alternative oral health provider approach was used to address the low rate of early caries detection, preventative oral care, and access for underserved children. A comprehensive system for the administrative and clinical components of the project, including implementation plan, clinical protocols, prescriptive authority, a dental home referral system, clinical training and competency testing, was developed. The interprofessional project increased oral health services capacity and practice acceptance of oral health screening and fluoride varnishing among dietitians. Oral health care services provide allied health practitioners with unique opportunities to impact the poor access and unmet needs of at risk children and adults and to improve overall health.

Navigating practice and academic change in collaborative partnership with a community advisory board.

University-based allied health programs must prepare entry-level professionals for a continually-evolving practice landscape. Health care education must demonstrate relevance to community needs in an environment of diminishing resources and increased scrutiny from governmental and accreditation bodies. Diverse perspectives, insights, and strategic counsel are needed to meet these challenges. Strategies associated with the development and functions of corporate and non-profit boards were used to tailor a community advisory board for a dietetics program at a public university. Over a 4-year period, this new board established an annual scholarship conference, funded an endowed scholarship, organized a student mentorship program, and secured new program equipment. The board played a pivotal role in development of and securing administrative approval for the establishment of a Nutrition Center for research, innovative practice, and service learning. In a recent accreditation site visit report, the role of the advisory board was cited as helping to meet education standards. An active advisory board can support strategic program innovation, resource development and help prepare health professionals for 21st century practice. The change-oriented, creative approach described can serve as a model for professional education programs seeking to engage the community in the success of their students.