Effects of a Brief Case Management Intervention Linking People With HIV to Oral Health Care: Project SMILE

Abstract

Objectives. Although people with HIV experience significant oral health problems, many consistently identify oral health as an unmet health care need. We conducted a randomized controlled trial to evaluate the impact of a dental case management intervention on dental care use. Methods. We evaluated the intervention according to self-reported dental care use at 6-, 12-, and 18-month follow-ups. Multivariable logistic models with generalized estimating equations were used to assess the effects of the intervention over time. Results. The odds of having a dental care visit were about twice as high in the intervention group as in the standard care group at 6 months (adjusted odds ratio [OR] = 2.52; 95% confidence interval [CI] = 1.58, 4.08) and 12 months (adjusted OR = 1.98; 95% CI = 1.17, 3.35), but the odds were comparable in the 2 groups by 18 months (adjusted OR = 1.07; 95% CI = 0.62, 1.86). Factors significantly associated with having a dental care visit included frequent physician visits and dental care referrals. Conclusions. We demonstrated that a dental case management intervention targeting people with HIV was efficacious but not sustainable over time. Barriers not addressed in the intervention must be considered to sustain its use over time.

Barriers and facilitators to dental care among HIV‐Infected adults

“…An analysis of baseline data from the parent trial found that having a case manager was the only care‐related factor associated with having used dental services in the past year . Furthermore, analysis of the outcome data from the parent trial showed that the odds of utilizing dental services were, after 6 and 12 months, about twice as high among individuals assigned to a dental case manager compared to those without access to case management services . Dental case management can encapsulate responsibilities beyond those at just the administrative level, and can include motivational interviewing, health literacy activities, care coordination, community outreach, and education .…”

“…Dental case management can encapsulate responsibilities beyond those at just the administrative level, and can include motivational interviewing, health literacy activities, care coordination, community outreach, and education . Studies on dental case management have shown that it leads to improved retention in dental care, completion of treatment plans, and improvements in oral health . In the era of interdisciplinary health‐related practices, medical case management could also potentially play a role in encouraging oral health prevention as well, given its documented ability to help improve overall morbidity and mortality, medication adherence, and continuity of care .…”

“…31 Furthermore, analysis of the outcome data from the parent trial showed that the odds of utilizing dental services were, after 6 and 12 months, about twice as high among individuals assigned to a dental case manager compared to those without access to case management services. 30 Dental case management can encapsulate responsibilities beyond those at just the administrative level, and can include motivational interviewing, health literacy activities, care coordination, community outreach, and education. 32 Studies on dental case management have shown that it leads to improved retention in dental care, completion of treatment plans, and improvements in oral health.…”

“…32 Studies on dental case management have shown that it leads to improved retention in dental care, completion of treatment plans, and improvements in oral health. 30,33 In the era of interdisciplinary health-related practices, medical case management could also potentially play a role in encouraging oral health prevention as well, given its documented ability to help improve overall morbidity and mortality, medication adherence, and continuity of care. [34][35][36] Such findings underscore the significant role that case management plays in facilitating and maintaining health care utilization and improved disease outcomes amongst underserved population.…”

Vanadium haloperoxidases: From the discovery 30 years ago to X-ray crystallographic and V K-edge absorption spectroscopic studies

“…In 1986, the vanadate cofactor was finally confirmed for the vanadiumdependent haloperoxidase from A. nodosum [26] and for the alternative nitrogenase in Azotobacter chroococcum [27]. In parallel, several reports indicated that vanadium was indeed an essential trace element for animals [28], Chlorella [29][30][31][32], Enteromorpha and Fucus [33]. Since its discovery, AnI was used as a laboratory model enzyme for the understanding of VHPO properties.…”