Why Vaccines Could Signal a Future of Integrated Care

Do you have any symptoms of COVID-19?
Have you been in contact with anyone who tested positive for COVID-19?
Have you had a positive COVID-19 test in the last 14 days?

These familiar questions won’t go away anytime soon when visiting a dental or medical office. However, patients of the dental clinic at Harbor Health Services, where Dr. Matthew Horan is executive director of dental services, are now being greeted with an additional question that may surprise them:

Can we offer you a COVID-19 vaccine at your appointment today?

The effort is part of a new pilot project at Harbor Health Services, a Federally Qualified Health Center (FQHC) in Massachusetts. As the state’s major vaccination sites are now shutting down and community-based settings are being prioritized, it's part of a broader movement for dentists to be involved in vaccinations.

“These community partnerships couldn’t be more important to developing trust with patients as we go forward,” Horan says. “It helps with vaccine hesitancy but, even more, it helps provide access to those who otherwise could not or would not get a vaccine for any number of reasons.”

The Value of Community-Based Care

“Since the start of the pandemic, Harbor Health Services’ relationships with community partners has been critical to maintaining operations and to delivering over 30,000 vaccines,” Horan says. 

The health center worked with the contact tracing team at Partners in Health to provide outreach to local businesses, directing them to the vaccine clinic. Community organizations and individuals such as the Cape Cod Council on Churches and elected officials also helped spread the word about vaccine availability. In establishing and operating three large vaccination clinics in Boston, the South Shore, and Cape Cod, the health center also partnered with a local college, firefighters, town administrative officials, local health departments, and the National Guard. 

While large-scale vaccination sites were an important community asset to establish early in the pandemic, this new unique pilot approach, Horan says, takes community-based vaccination to the next level. Now, when patients arrive for a dental appointment at the Harbor Health Services location in Hyannis, they are screened and offered a vaccine right in the dental center — no additional appointment necessary. They have an opportunity to talk about any concerns with a trusted provider and get their shot in the convenience of the dental chair, with the post-vaccination wait time built-in as they get their cleaning or other planned dental care.

The pilot bolsters the state’s push toward equity in vaccine distribution, helping to ensure that all communities have access. Data from the CDC show that COVID-19 has disproportionately affected groups that have been historically marginalized, a trend that continued with vaccination distribution. A recent research report from CareQuest Institute for Oral Health showed that vulnerable and underserved populations, such as those with lower income and education and those living in rural areas, report lower rates of vaccine willingness. (CareQuest Institute was also an early advocate for the involvement of dentists in the vaccination process.)

“Stepping back to the state-wide level, community health centers have played a critical role in the vaccination rollout’s success in Massachusetts,” says Horan, who also serves part-time as a state dental director. “Health centers are part of the recipe for vaccine equity which remains at the front of our minds. A variety of methods are being used by the state, including community-specific vaccination data and targeted additional support, focused grassroots outreach, support for municipalities and local boards of health, mobile vaccination services, and communication materials.”

Building Patient Trust

Horan says the key to combating vaccine hesitancy is trust and being in the right place at the right time.

“Dentists often have a unique doctor-patient relationship,” he says. “Many of our patients might not have a medical home at all, but we typically see dental patients 2-3 times a year, so we can review their vaccination status and provide guidance.”

That could be especially important in the coming weeks and months when the health system is trying to reach people who have delayed access or are experiencing some vaccine hesitancy. Getting the vaccine in a trusted and convenient clinical setting, Horan says, can help make the patient feel comfortable.

“There is a lot of misinformation out there,” he says. “As dentists, we can and should be a trusted resource for our patients — whether helping them understand where to get reliable information or addressing concerns about how it might impact other health conditions. Being able to also do this in an extremely convenient way opens the door to more people getting vaccinated.”

While the pilot is still in its early stages, Horan says the reception from patients has been positive.

“Many are surprised by the offer,” he says. “I think for those who were on the edge of deciding, the convenience helps them to say they might as well do it.”

Modeling Integrated Care

The program is also an example of medical-dental integration — an approach to care that integrates and coordinates dental medicine into primary care and behavioral health — working in daily practice. Horan is quick to point out that FQHCs have been leading the way on this front. They often work closely with primary care associations and meet, as a larger provider group, to share best practices and problem solve together. Horan loves that spirit of innovation and collaboration.

“In a fast-paced, challenging environment with limited resources, you feel like you’re not going at it alone. It makes you more willing to get creative and try new things,” Horan says. “The pandemic has led to rapid changes that allowed for an environment of crazy care innovation including telehealth, vaccinations, and working closer with clinical pharmacists, nursing, and primary care teams.”

Horan says that if we want these changes to stick post-pandemic, however, the industry will need to continue to demonstrate that medical-dental integration can help achieve the goals of better care, lower costs, improved health outcomes, and satisfied providers and patients.

“In my experience, all those things are true,” Horan says. “Dental and medical working together is logical.”

What does that mean for the future?

Horan says vaccines, more generally, will become an established part of comprehensive dental care in the same way that monitoring blood pressure is now. He can imagine working with medical providers in managing diabetes screening, rapid HIV testing, and depression screening, to start.

“There are lots of ways we can help out on the dental side,” he says. “Vaccines are just the tip of the iceberg of where we can collaborate as health systems.”

Editor’s Note: Read more about the role dental providers can play in administering COVID-19 vaccines and booster shots.