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Clara Vista Medical Associates - Tucson, AZ |
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Program Description |
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The program is designed to provide training in oral health risk assessment and hands-on training in the application of fluoride varnish as a preventive treatment in children at risk for dental caries. The program will target training to pediatricians in a variety of practice settings in relatively small groups. Training will be provided for pediatricians in private practice, working at county hospitals, in community health centers, and for pediatric residents in order to maximize exposure to this valuable information. Emphasis will be on oral health risk assessment and application of fluoride varnish in at risk children under three years of age. Because of a matching grant, which we have obtained from the Arizona Department of Health Services, Office of Oral Health, we will be able to provide this training in both Tucson and Phoenix.
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Preceptor |
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Todd Hartsfield, MD has been a dentist for 34 years. He spent 2 years as a dentist in the US Army and had a full time family dental practice for 9 years in Louisiana. For 20 years he worked in children's dental public health programs in Canada with the First Nations and Inuit people. Dr. Hartsfield became the Dental Director at the Inter Tribal Council of Arizona in October 2001. His focus is on early intervention with American Indian children and their caregivers to prevent dental disease. He travels to Indian reservations throughout Arizona to coordinate dental care for children and adults. He has trained numerous local tribal nurses, medical assistants, and parents to perform regular oral health risk assessments on the children on these reservations. He has also established fluoride varnish and xylitol chewing gum programs in which local, non-dental personnel on the reservations are trained in applying fluoride varnish and treat children in programs such as Head Start. According to Keith Dveirin, MD, Clara Vista Medical Associates, Dr Hartsfield is an excellent preceptor for this type of training, and one that the national AAP or other state AAP chapters may want to consider using in the future. Dr Hartsfield has extensive experience in the use of fluoride varnish and in the education of non-dental personnel in doing oral health assessments and recognizing early signs of dental decay. He has worked extensively in public health dentistry, both in the United States
and Canada, as well as in private practice general dentistry. He brings
a passion to this subject that is infectious and helps make him a
great presenter.
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| Training Day |
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The training took place on September 14, 2004. A very full, busy day of training sessions were planned to take advantage of having Dr Hartsfield in town for the day.
7:30-8:20 AM: Presentation at the Children's Clinic for Rehabilitation Services (CCRS). This state-funded clinic provides coordinated, multidisciplinary specialty care to thousands of southern Arizona children with special health care needs (CSHCN) who have qualifying diagnoses (eg cerebral palsy, spinal bifida). In addition, CCRS provides primary pediatric care to over 400 of these CSHCN who for a variety of reasons do not get primary care elsewhere. Although CCRS does have a dental clinic, the dental clinic is limited to providing care primarily for children with cleft lip and palate.It does not provide routine dental care to the vast majority of children cared for at CCRS. Dr Hartsfield gave a presentation to an audience that included both pediatricians who provide primary care at the clinic as well as 2 registered nurses and 2 clinical nurse associates who work in the clinic.
8:30-9:15 AM: Presentation at the Tucson Medical Center to the pediatric residents at their "Morning Report" conference. There were 10 people in attendance including 2 pediatric faculty members, 6 residents, 1 medical student and 1 pediatric pharmacist.
10:00-11:00 AM: Informal meeting with pediatric residents at University Medical Center in the pediatric residency outpatient clinic. While scheduled dedicated time to a formal presentation had not been scheduled, the application of fluoride varnish and a discussion or oral health risk factors in children was conducted.The majority of the patients seen at this clinic are on Medicaid, which puts them at high risk for oral health problems for socioeconomic reasons.
12:30-1:30 PM: Presentation on Oral Health Risk Assessment and the application of fluoride varnish was provided to the Pima County Pediatric Society. There were 25 people in attendance including general pediatricians in private practice, pediatric residents, and several pediatric faculty from the medical school. 2:00-3:00 PM: Presentation at the Kino Community Hospital pediatric clinic, which is the local county hospital. Kino serves a typical county hospital population much of who are at risk for oral health problems. The hospital has a dental clinic providing care to many of the children who go to the pediatric clinic.
3:30-4:45 PM: Tour of the new, state of the art, fully digitized dental clinic at El Rio community Health Center's Southwest Clinic. El Rio is a federally funded community health center, which serves a medically and dentally at-risk population that is primarily Hispanic.
5:00-6:00 PM: Presentation of the Oral Health Risk Assessment and fluoride varnish to the El Rio Community Health Center. The audience consisted of the pediatric medical director, the dental director, and pediatricians. The discussion included possible ways that fluoride varnish could be administered to pediatric patents at the health center. Because the pediatric and dental clinics are housed under one roof at the Center, the pediatricians and dentist may be able to work together to provide the fluoride varnish treatments.
Because of Dr Hartsfield's energy, cooperation and willingness to work very hard, the day's events were very successful. At each teaching stop, Dr Hartsfield provided teaching materials and samples that the pediatricians could use in their offices and clinics, including many samples of fluoride varnish so that they could start to get experience using it right away. Education booklets and pamphlets on routine childhood dental care and problems and emergency dental problems were also provided. Dr Hartsfield also provided educational videos training parents to "Lift the Lip" to check for early signs of dental caries, and "Lift the Lip" flip charts that pediatricians could use in their offices to teach parents how to check their own children at home. He also had other pamphlets and brochures the pediatricians could use in their practices. |
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| Next Steps |
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The training will be shared with others through a matching grant received from the Arizona Department of Health Services, Office of Oral Health. With the matching grant, the site will be able to have Dr Hartsfield do additional training sessions in the Phoenix area. The plan is to have a pediatric grand rounds presentation at Phoenix Children's Hospital and smaller group training sessions in different venues as was done in Tucson. Dr Hartsfield has also agreed to return to Tucson to do a pediatric grand rounds presentation in the future. Our future goal is to train pediatricians in a variety of practice settings to perform oral health risk assessments on their patients under three years of age, so that they will feel comfortable doing so and incorporate this into their routine daily practice. At the same time, we want to introduce pediatricians to fluoride varnish as a preventive measure and train them in its use. We are working with the state Medicaid office to reimburse pediatricians for applying fluoride varnish to at-risk infants and children. We would like
to have pediatricians trained in oral health risk assessment and fluoride varnish application already if and when Medicaid reimbursement
is approved.
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