Pri­mary care within a dental practice?

It’s an inter­dis­ci­pli­nary idea that has teeth: Your mouth, noted the U.S. sur­geon gen­eral in the Oral Health in America report, pro­vides a window into your overall health.

Now, a research team led by Maria Dolce, an asso­ciate pro­fessor in the School of Nursing at North­eastern, will make that idea a reality.

On Wednesday, the School of Nursing and the Har­vard School of Dental Med­i­cine will launch a three-​​year inter­pro­fes­sional pro­gram funded by a $1.2 mil­lion coop­er­a­tive agree­ment from the U.S. Depart­ment of Health and Human Ser­vices’ Health Resources and Ser­vices Admin­is­tra­tion. Called the Nurse Practitioner-​​Dentist Model for Pri­mary Care, it will bring North­eastern nurse-​​practitioner stu­dents and Har­vard dental stu­dents together in the Har­vard Dental Center’s Teaching Prac­tices clinic to pro­vide both pri­mary care and dental ser­vices to cul­tur­ally diverse, med­ically under­served pop­u­la­tions, par­tic­u­larly older adults.

Through hands-​​on inter­ac­tions, the stu­dents will come to under­stand the oral-​​systemic con­nec­tion in a com­pre­hen­sive and holistic way.
— Maria Dolce, asso­ciate professor

Har­nessing the power of den­tistry and nursing is a cutting-​​edge model of care that enhances health-​​professions edu­ca­tion and offers patients access to health­care that they oth­er­wise might not have,” says School of Nursing Dean Nancy P. Han­rahan. “Maria Dolce is a national thought leader in this new model.”

Improving best practices

The team approach is key not just for instilling best prac­tices but actu­ally improving them. The nursing and dental stu­dents will learn from one another by attending both dis­ci­plines’ clin­ical rota­tions, engaging in joint problem solving, and nego­ti­ating to coor­di­nate care.

Through hands-​​on inter­ac­tions, the stu­dents will come to under­stand the oral-​​systemic con­nec­tion in a com­pre­hen­sive and holistic way,” says Dolce. That includes rec­og­nizing the role, for example, that plaque, a reser­voir for bac­teria, plays in sys­temic infec­tions such as pneumonia.

Dolce knows whereof she speaks: With a grant from the Den­taQuest Foun­da­tion, she has already inte­grated oral-​​health instruc­tion across all pro­grams in the Bouvé Col­lege of Health Sci­ences, ranging from applied psy­chology to phar­macy to com­mu­ni­ca­tion sci­ences and disorders.

Har­nessing the power of den­tistry and nursing is a cutting-​​edge model of care that offers patients access to health­care that they oth­er­wise might not have.
— School of Nursing Dean Nancy P. Hanrahan

Inter­pro­fes­sional demon­stra­tion projects such as the NPD Model for Pri­mary Care send an impor­tant mes­sage,” says R. Bruce Donoff, dean of HSDM. To artic­u­late it, he quotes Pulitzer Prize-​​winning author Louis Menand: “‘The key to reform of almost any kind in higher edu­ca­tion lies not in the way that knowl­edge is pro­duced. It lies in the way that the pro­ducers of knowl­edge are produced.’”

A “roadmap” for other institutions

Practice-​​based training is not the researchers’ only goal. Dolce and co-​​principal inves­ti­gator John Da Silva, vice dean of HSDM, will also eval­uate the model by ana­lyzing patient health out­comes using detailed met­rics. Among the mea­sures they’ll track is the man­age­ment of chronic con­di­tions such as dia­betes and car­dio­vas­cular dis­ease,  both of which are linked to peri­odontal dis­ease. Finally, they will develop a “roadmap” of the pro­gram so other nursing and dental schools can follow their lead.

Under the new model of care, patients who come to the Har­vard clinic for rou­tine dental care—many of whom don’t even have pri­mary care providers—will have the oppor­tu­nity to undergo an annual well­ness exam­i­na­tion with a nurse prac­ti­tioner at the same time. If the nurse prac­ti­tioner deems it nec­es­sary, she or he may refer patients to a pri­mary care provider for follow-​​up.

We have had a very siloed approach to health-​​professions education—nurses, physi­cians, phar­ma­cists, and den­tists are all trained sep­a­rately,” says Dolce. “But with appro­priate edu­ca­tion, all health pro­fes­sionals, specif­i­cally non-​​dental health pro­fes­sionals, can pro­mote oral health as a com­po­nent of overall health and wellness.”