By Aron Goffin, Program Senior Specialist & Kate Cooper, Interim Deputy Director

The COVID-19 pandemic has relentlessly challenged health care systems. In order to respond to this emergency situation Multnomah County Integrated Clinical Services (ICS) had to quickly set up an Incident Command Center. This serves as the key decision making unit for service provision. Incident Commander and ICS Executive Director Tasha Wheatt-Delancy says, “The challenge has been to keep multiple doors open for our patients to access care during this time of fear and anxiety. We are committed to making sure all in our community continue to receive quality care, even if this looks different. We are both responding to the pandemic and seeing how we can provide innovative new services like teledentistry while also having an eye to the future and considering how these new initiatives will be sustained.”

For the nearly 30,000 patients served at the state’s largest safety net dental provider, the stakes have never been higher. Multnomah County Dental Program, like dental programs across the nation, were mandated to halt all routine and elective services in March and provide urgent and emergency visits only. A rapidly declining financial picture, coupled with continued oral health demand, spurred the launch of a telephone-based teledentistry platform. This system allows the program to bill the state Medicaid program for services provided to patients over the phone, while adhering to infection control and physical distancing guidelines.

With a network of six (soon to be seven) dental clinics and approximately 80,000 visits a year, change doesn’t happen overnight. Yet, the urgency of COVID-19 resulted in implementation of teledentistry with unprecedented speed. In just two weeks, staff were able to connect with resources and come together to pilot and refine workflows, provide training, and roll out the change. “The dentists were surprised at how useful a phone visit was, even without photographs or synchronous video visit,” says Len Barozzini, DDS, Dental Director for the program. “Teledentistry seems to have opened up a conversation about how best to deliver quality care.”

Dr. Vives-Barreto, DMD, talks with a patient during a teledentistry visit at the Multnomah County Northeast Dental Clinic.

Dr. Melissa Brady, a dentist at the East County Dental Clinic in Gresham, recently started providing teledentistry visits. “Teledentistry is an excellent addition to our toolbox, and has allowed us to triage patients, and get urgent patients relief, like antibiotics, even faster,” she shares. “It’s been helpful to keep patients that don’t need office visits out of the clinic for their own safety.” Even as recent state guidance loosens, allowing dental offices to resume non-essential services, the dental program remains cautious. Plans will allow for targeted outreach to patients and phasing in of additional visits beyond emergency care. Although visits are being provided over the telephone for the time being, the program is looking at rolling out a longer term strategy that includes video visits. “Video visits, or the option to submit photographs, will allow our clients to see their dentist without having to come into the office–this should give comfort to our patients knowing they can be heard, if not always seen, right away. Being able to diagnose virtually saves critical chair space, yet
increases overall care,” states Barozzini.

As health center staff adapt indefinitely to more mindful physical distancing and limited personal protective equipment, decisions on how to triage visits using teledentistry will be ongoing. And this strategy extends beyond the current public health emergency. Even in less tumultuous times, being able to offer additional access points for the County’s most vulnerable community members is essential.

“Our patients have multiple barriers, which make it difficult, if not impossible, to prioritize oral health. Teledentistry is a tool we can use to provide care to a subset of our patients we may not otherwise engage with,” shares Aron Goffin, senior specialist with the program. “Connecting with patients virtually will happen incrementally. Not only will patients need to be told about a virtual option, they must be willing to learn how to use it, and must have devices to support it. It will take time. Despite the setback this crisis has resulted in, it has helped us realize new possibilities to care for our patients.”

For more information or questions on teledentistry or other services offered at Multnomah County Dental Program, contact Len Barozzini, DDS.

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