The data source is the Arkansas Behavioral Risk Factor Surveillance System and this is a self-report. The outcome measure describes the percentage of adults in Arkansas who were treated for oral health care at a dental clinic within the past year.

There is data connected to claims that would not include those individuals accessing care at free clinics. ACHI has a report that shows those who have health insurance that file a claim for dental health care.

When asked how Arkansas adults are doing relative to the trendline data for the indicator, the stakeholders stated the following:

• Things are staying the same, static
• 4 out of 10 adults did not visit the dental clinic in the past year
  • Extrapolating from the 2020 census data, this is roughly 700,000 adults in the state

Stakeholders identified the following positive factors helping Arkansas adults to access a dental care visit in the past year.

• Expanded coverage happened in 2014 and might be pushing up the percentage
• Patients have an established relationship with a dental provider
• Individuals who live in more urban areas of the state likely have more access to providers
• Financial means to go to the dentist
  • Dental coverage or some other type of access
  • No or low cost provider
  • Disposable income
• Because it is not limited to preventative care, pain might be driving these numbers
• AR MOM annual event provides services to Arkansans across the state
• Once you value oral health that stays with you through your life
• Transportation
• Flexbility of work schedules - employers offering some type of sick leave to employees
• GPR advanced training program

Stakeholders identified the following negative factors preventing Arkansas adults from accessing a dental care visit in the past year.

• AR dental practices are only about 80% as busy to pre-pandemic
  • Lower numbers might be related to challenge of running at full capacity
• COVID-19 fog (okay to not to return to business as usual)
• Fear
  • Sound of the drill
  • Feel of injection
  • Negative experiences
• Shame/guilt of not going was a big factor
  • Patients don't want to be judged (worst thing a provider could do is to scold someone)
  • Not going to the dentist excarcerbated by the pandemic
• Money
  • Cost associated with care
• Time
• Transportation in rural areas presents a deep challenge for people wanting to access care
  • Most people in rural parts of the state understand that they will have to drive to access services

Stakeholders identified the following potential partners to strengthen the positive factors or address the negative factors, impacting how adult Arkansas access dental care.

• ADH including Hometown Health- outreach and education 
• Arkansas State Dental Association
• Arkansas Dental Hygiene Association
• Arkansas Department of Human Services
• Arkansas Hospital Association - discussion related to use of emergency rooms for non-emergency dental treatments
• Arkansas State Board of Dental Examiners
• Arkansas Transportation Association
• AMDPA
• Critical Access Hospitals/Rural Health care systems (linkage to care/medical dental integration)
• Dentists
• Employers and Hygienists
• FQHCs
• Insurance
• Literacy partners (adult illiteracy in the Delta region is high, which often prevents adults from understanding medical history forms or brochures)
• Lyon College
• Medical schools/providers - educate non-dental providers on oral/systemic link
• Office of Oral Health
• Providers
• Public transit organizations - can there be a partnership to help get people to appointments
• School-Based Health Centers (some see adults)
• School nurse association or school nurse organization can provide a direct link to students who help them learn about health care – and can perhaps kids can engage their parents into improving dental health for the family  
   

Stakeholders proposed the following potential solutions to strengthen the positive factors or address the negative factors, impacting how adult Arkansas access dental care.

• Attract new dentists to rural areas that are underserved.
• Co-locate medical/dental services 
• Continue to build and expand the oral health coalition 
• Data collection for services provided to individuals that are not tied to claims
• Development of dental school that will train professionals at the state level (One Health/Lyon College) and then rotate sites for new dental school - strategically placed in underserved areas 
• Engage care coordinators that create an integration between medical and dental care providers (bi-directional referrals, appointment reminders, “warm handoffs”)
• Evaluate the cost of dental school/student loans compared to reimbursements for services - value based care instead of fee for service
• Focus on preventive education - educate more on the concept of oral health is preventive care and also the value of dental care (including ties to systemic conditions)
• Engage Pharmacist groups for referrals to dental care
• Enhance adult Medicaid coverage
• Expanded scope of practice to allow licensed professionals to serve in underserved areas at the top of their licensure
• Expanded hours of service and/or allow for walk-in availability for individuals who do not have the flexibility to take time off work
• Incorporate programs into dental colleges on mental health, openness of talking with patients and easing fears
• Incentivize service in rural areas - perhaps including loan payment
• More AR MOM events
• More accessible platform for the public related to appointment scheduling among Medicaid providers
• Patient education on insurance benefits - to understand that "having insurance" doesn’t mean that all their care needs are covered
• Build robust oral health mobile unit for rural areas
• Promote stronger levels of health literacy on dental insurance and navigating the health/dental care system
• Provide better insurance benefits (Medicaid and commercial) with higher annual limits
• Promote programs/techniques that ease a dental care visit-sedation , nitrous oxide, mental health visits to cope with fear
• Promote employer-based sick leave policies to support time away for dental care
• Provide education to dentists that help them develop better, long-term relationships with their clients.
• Provide oral health resources to PT/OT
• Provide transportation to dental visits/expecting funding from some grant to fund the community-based organization so they could secure vehicle, insurance, drivers, and vehicle maintenance
• Rural Health Public Health Campaign on Oral Health
• Social media campaigns
• Start to build a pipeline with students engaging at earlier age in the field of oral health
• Survey dentists to get average cost for check-up/cleaning to provide uninsured with an expected estimate
• Teledentistry to screen before the actual appointment- assists in easing fear of patients.
• To achieve a higher dental IQ, Arkansas should concentrate on transportation and significant public education outreach.
• Well-funded public education programs
• Work with HBCUs to identify potential BIPOC students to foster a pipeline in oral health

The stakeholders prioritized the four following strategies to increase the percentage of adult Arkansas accessing dental care. The strategies were prioritized over other strategies based on scoring across four criteria: Impact, Feasibility, Specificity, and Value.

• Engage HBCUs to identify potential BIPOC students to foster a pipeline in oral health
• Expand the hours of service and/or allow for walk-in availability for individuals who do not have the flexibility to take time off work
• Focus on preventive education - educate more on the concept of oral health is preventive care and also the value of dental care (including ties to systemic conditions)
• Start to build a pipeline with students engaging at earlier age in the field of oral health

Strategy: Focus on preventive education - educate more on the concept of oral health is preventive care and also the value of dental care (including ties to systemic conditions).

Work plan for the strategy

Strategy: 

Shift or expand the hours of service and/or allow for walk-in availability for individuals who do not have the flexibility to take time off work.

Strategy: Work with HBCU to identify potential BIPOC students to foster a pipeline in oral health.

Work plan for the strategy