iMPROve Health has teamed up with My Community Dental Centers (MCDC), a statewide dental clinic network with 34 sites, providing dental care to everyone – including uninsured people. The partnership addresses the link between high blood pressure (BP) and oral health.
“Oral health providers are important care team members, and evidence shows associations between oral and cardiovascular health. We saw this as a great opportunity to collaborate on efforts to increase screening for hypertension and improve care,” said Julee Campbell, MPH, senior quality consultant for iMPROve Health.
Since iMPROve Health and MCDC are working on similar grant projects with the Michigan Department of Health and Human Services (MDHHS), the partnership was a natural fit. It marked a continuation of all three organizations’ goals of improving the health of Michigan residents.
“Before this grant, we always used automated wrist cuffs when taking blood pressure. Part of the reason for that was because the staff were not comfortable taking them manually and didn’t realize the importance of this vital sign or the inaccuracy of a wrist cuff,” said Gina Cole, RN, infection control and safety coordinator for MCDC. “We’re hoping that by talking to staff about the importance of blood pressure and how it relates to oral care, we’ll see a greater focus on blood pressure accuracy and staff follow-up actions.”
Intervention
iMPROve Health’s train-the-trainer presentation for dental staff addressed:
- Information linking hypertension and oral health.
- Current recommendations for measuring BP in oral health settings, BP thresholds, techniques, and measurement equipment; and
- Strategies for sustainability.
iMPROve Health also provided training slides, a patient positioning poster, and an electronic copy of the MDHHS Oral Health Unit Hypertension Screening Guidance for Michigan Oral Health Professionals, among other tools. “At the February 2021 session, we provided Gina with materials she could use for training staff, including pre/post-tests, a competency checklist, and a BP proper-positioning scavenger-hunt activity. These materials will help Gina facilitate future trainings,” said Julee.
Results
“Everyone found good value in the workshop,” said Gina. “By the end, even previously untrained dental office staff realized the factors contributing to blood pressure and the importance of taking it correctly.”
Following the train-the-trainer session, Gina immediately scheduled MCDC BP trainings at two locations in her network: Ypsilanti and Mt. Pleasant. The workshops were designed to accommodate any dental support staff who wanted to attend, including registered dental assistants, dental hygienists, office managers, and front desk staff.
“We had good buy-in when rolling out the training. Providers partnered with front desk staff for the technique practice portion of the session and practiced different office scenarios,” noted Gina.
Following the BP trainings, the two sites used grant funds to replace all wrist cuffs with automated arm cuffs and manual blood pressure cuffs in all sizes. Some procedures were also improved, such as taking two BP measurements, one in each arm, and using the higher reading for treatment purposes. They also started taking blood pressure readings for every patient at every visit.
Next Steps
MCDC will revise its BP policy based on the new guidance. “For example, the new draft policy requires a medical evaluation for borderline BPs, and it differentiates between a medical evaluation and a medical consult with the patient’s provider,” said Gina. When finalized, the policy will be rolled out to all 34 MCDC sites electronically and require a signature from the dental office staff to acknowledge compliance.
MCDC hopes to roll out further initiatives, such as:
- Making these skills part of annual training at each center.
- Tracking referrals to primary care providers from dental care sites; and
- Checking to ensure borderline BPs are managed correctly.
“I’m eager to develop and expand this initiative throughout our entire network. It can significantly enhance the quality of care MCDC gives our clients,” Gina concluded.