Kiersten Bethea and Samantha Forlenza broke new ground in 2017-2018 as the first interdisciplinary dental-medical team to be awarded a North Carolina Albert Schweitzer Fellowship, a year-long leadership program for graduate health professional students at East Carolina University (ECU) to learn how to address health disparities in vulnerable communities.
With sponsorship from the Blue Cross and Blue Shield of North Carolina Foundation, the Fellows developed a clinic that combined dental and medical services for the homeless. Many dental conditions such as infections are strongly correlated with systemic diseases such as cardiovascular disease and diabetes, according to ECU.
“Unfortunately for many people, dental care is either not an option or is low on the priority list,” said Bethea, a fourth-year student at the ECU School of Dental Medicine. She is passionate about increasing access to oral healthcare and educating the public about the connection between oral health and overall health, ECU reports.
Forlenza, a student at the ECU Brody School of Medicine, says her undergraduate degree in public health and nutrition sparked her interest in interdisciplinary care. When she volunteered at the Greenville Homeless Shelter Clinic in Greenville, NC, she noticed the long wait times that patients faced before receiving dental care at the James D. Bernstein Community Health Center, a local safety net provider that serves patients on a sliding scale fee.
The students believed they might be able to care for some of the patients on the center’s waiting list, and their idea for their Schweitzer project was born. They launched the Holistic Interprofessional Program (HIP), a free clinic providing emergency dental care, diabetes testing, and nutrition counseling for homeless people in the Greenville area.
HIP was housed in the School of Dental Medicine’s Emergency Care Clinic in Ross Hall once a week from August 2017 through March 2018 and integrated into the fourth-year dental school curriculum. Patients were referred to the program by local free clinics.
Dental students provided oral healthcare for patients while medical students provided diabetes testing and nutrition counseling. The program provided 43 patients with free services worth nearly $8,700, partly funded by the School of Dental Medicine’s Patient Care Fund.
“With two different specialties, we wanted to deliver care in a way that would be comfortable for the patients and provide cross education between specialties,” said Bethea. “The medical students observed the dental students interviewing patients and performing initial assessments, and the medical students modeled diabetes testing and motivational interviewing concerning diet.”
“Interprofessional collaboration translates into improved healthcare delivery,” said Kimberley Gise, DDS, director of the dental school’s emergency clinic and an academic mentor on the project.
“HIP is a special project that has improved the coordination and communication between dental, medical, and social work healthcare professionals. This collaboration has been a safety net for our homeless, uninsured, and underinsured community members and has improved access to care and health equity,” said Gise.
“It’s very exciting that dental and medical students are working together to provide quality healthcare services for those most in need and for everyone,” said Tom Irons, MD, associate vice chancellor for regional health services and another academic mentor for HIP. “Interprofessional education must be our vision for the future in order to meet the needs of a population with complex medical conditions.”
Also advising Bethea and Forlenza were site mentors Robert Doherty, DDS, dental director of the James D. Bernstein Community Health Center, and Maudia Ahmed, a social worker at Access East/Health Assist.
“The project needed a care manager to communicate and follow up with patients from local shelter clinics,” said Forlenza. “Maudia Ahmed and AccessEast stepped up to this challenge and integrated HIP as another site in their organization. Ms. Ahmed’s communication between the dental school and the patients was the glue that made the project work.”
The students also gained help from two Greenville churches whose members provided patients with transportation to the dental school from area shelters and shelter clinics.
Although the project ended in April, Barbara Heffner, director of the North Carolina Albert Schweitzer Fellowship, announced in July the list of 2018-2019 Schweitzer Fellows. Among them is another ECU dental/medical team that will continue the HIP program.
Dental student Jiwon Lim and medical student Niki Winters are planning to expand HIP next year by accepting patients from the Vidant Medical Center’s minor emergency department as well as from local shelters and shelter clinics. Patients will be referred to the James D. Bernstein Community Health Center for continued medical and dental needs.
“I came into medical school positive I would go into primary care, and those thoughts have not changed. But what has changed for me is the importance of partnering with a dentist later on in my practice,” said Forlenza. “The crossover between oral health and medical preventive care is unavoidable. No matter what specialty you go into, oral health impacts patients’ overall health.”