Running head: ORAL HEALTH IN COLLIER COUNTY 1

A Closer View of Oral Health in Collier County

Marline Faustin

University of South Florida

Running head: ORAL HEALTH IN COLLIER COUNTY 2

A Closer View of Oral Health in Collier County

Having health insurance in the United States is a significant factor in managing health.

Without health insurance, it is harder for certain individuals to seek medical attention and this

leads to a risk of undiagnosed illnesses (County Rankings, 2013). A community assessment was

completed for Collier County and the nursing process was used to analyze and interpret the data.

Oral health was the priority issue identified among the population of Collier County. A health

policy was developed using the determinants of health model to address oral health in Collier

Countys population.

Local vs. State Findings

Located in the southwestern region of Florida, Collier County holds a population of

348,777 individuals which is only 1.8 % of the entire state of Floridas population (Regional

Population-Collier County, n.d.). Naples, Golden Gate, Immokalee and Marco Island are the four

cities that make up Collier County. Collier is composed of a larger populated coastal urban area,

while inland is composed of a lesser populated rural area. The Naples Community Hospital, Ritz-

Carlton of Naples and Garquilo Inc. are three of the main top employers in Collier County. The

major health care system in Collier County is comprised of the Naples Community Hospital,

which is a not-for-profit multi-facility that in total holds 681 beds (Regional Population-Collier

County, n.d.).

According to the Collier County Community Assessment (2013), Collier County is one of

the wealthiest counties in Florida- although, there are those who live in significant poverty.

There are 8.9 % of families that live below the poverty level as compared with the state average

of 11.9%- which would be expected with this county being one of the wealthiest counties.
COLLIER COUNTY POPULATION 3

Collier County and the state of Florida have similar rates of individuals who are 25 or greater

with high school diplomas, 84.8% and 85.3% respectively (Florida Charts, 2010). When

compared with the states average of 11.7% of individuals five years or greater who did not

speak English, Collier Countys average was 15.8%(Florida Charts, 2010). Collier County is also

a diverse county like many other counties in the state of Florida. When it comes to primary care

providers in Collier County, the ratio is 1,390 to 1 compared to the states ratio of 1,040 to 1,

which is the number of population to primary care providers (County Health Rankings, 2013).

All of these factors are important in defining the characteristics of a county.

Analysis and Interpretation of Data

Strengths

Three health indicators that demonstrate strength for Collier Countys population are

lower rates of adult obesity, preventable hospital stays and sexually transmitted diseases (County

Health Rankings, 2014). Obesity can lead to many health complications like, coronary heart

disease, diabetes, hyperlipidemia and much more complications that may become detrimental

overtime if the correct interventions arent implemented (County Health Rankings, 2013).

Collier Countys rates of adult obesity show a rate of 19% as compared to the higher state rate of

25%, according to the County Health Rankings (2012). This population measurement of adult

obesity accounts for the individuals who are 20 years or older with a body mass index that is

greater or equal to 30.

In comparison, preventable hospital stays have a rate that is significantly lower than the

states rate, 38% and 55% respectively (County Health Rankings 2013). These rates represent

preventable hospital stays for ambulatory care-sensitive conditions per 1,000 fee-for-service

Medicare enrollees.
COLLIER COUNTY POPULATION 4

The last health indicator that demonstrates strength in the health of Collier Countys

population are the lower rates of sexually transmitted diseases than that of the states rate. Collier

Countys rates of reported STDs are 241.3 per 100,000 population while the states rate were

415.1 per 100,000 population (County Health Rankings, 2013). This report only accounts for the

number of chlamydia cases detected in Collier Countys population. Sexually transmitted

diseases affect more than 13 million people each year, both male and female. The health

complications that occurs are more severe in women (Florida Charts, 2015).

These three areas of strength can create a great opportunity for primary level

interventions by community health nurses or even interdisciplinary teams to keep the rates on a

downwards trend.

Weaknesses

Collier County may be one of the wealthiest counties in Florida, but there are a few areas

of improvement that needs to be addressed to eliminate disparities among the entire population.

Three areas of weakness that can be identified in the population of Collier County are higher

rates of the uninsured individuals than of the states (County Health Rankings, 2013), an increase

number of ER visits for preventable dental conditions (Collier County Community Health

Assessment, 2013) and high drug overdose deaths rates than of the states average rates.

Collier Countys rate of the uninsured is higher than the states rate, showing 30% and

24% respectively (County Health Rankings, 2013). These rates account for the percentage of

uninsured individuals in the population that are younger than 65 years of age. Not having health

insurance puts a significant barrier in access to needed healthcare which leaves individuals with

undiagnosed illnesses that can lead to premature deaths (Collier County Community Health
COLLIER COUNTY POPULATION 5

Assessment, 2013). This issue poses a threat to the population of individuals who are below the

age of 65 and arent eligible for Medicaid.

In 2010, 756 Collier County residents visited hospital emergency rooms for dental

conditions considered avoidable with proper preventative dental care (Collier County

Community Health Assessment, 2013). This is another important area that needs improvement in

Collier County. Oral health is essential to a persons overall health. These individuals who seek

preventable care through the emergency room are individuals who are uninsured or have

Medicaid coverage that most dentists dont accept due to low reimbursement rates (Collier

County Community Health Assessment, 2013). The need of oral health should be assessed as one

component to the individuals overall health needs.

The final of the three areas that Collier County needs improvement on is the rate of

overdose deaths. In a 2014 study done by the National Center for Health Statistics, there were

greater than or equal to 20 overdose deaths per 100,000 population as compared to 13.2 per

100,000 population of the states (County Health Rankings, 2014). There has been a drastic

increase of overdose death nationwide. Since 2002, theres been a 79% increase of drug overdose

deaths with a 200% increase of opioid involving deaths nationwide, according to County Health

Rankings (2014). Drug overdose deaths is a good indicator on estimating the size of prescription

and illicit drug use in a population. Therefore, interventions from different levels should be

implemented to decrease these rates of deaths by finding the root of the cause.

Priority Health Issue

The rising number of emergency room visits for preventable oral health conditions is the

priority health issue that presents for Collier Countys population assessment -which leads to the

focus of the importance of oral health in its community. This presents as a priority health issue
COLLIER COUNTY POPULATION 6

because oral health is crucial to a persons general health and wellbeing- that is reflected

throughout a persons lifetime (American Journal of Public Health, 2011). The failure to control

or prevent oral health complications puts individuals at higher risk for adverse health outcomes.

Studies show that invasive oral procedures that could have been avoided with early treatment

increase the incidence of stroke and myocardial infarctions (Minassian C, 2010). Enhancing oral

health brings about positive health outcomes- For example, studies show increased tooth

brushing was associated with lower levels of cardiovascular disease, which is Americas number

one leading cause of death (American Journal of Public Health, 2015). With oral health being

the focused priority health issue in Collier County, interventions starting from the primary level

to the tertiary level should be implemented to decrease the numbers of preventable emergency

room visits.

Determinants of Health Model

The question that arises when thinking of the determinant of health model is-what makes

some individuals healthy and others unhealthy? The determinants-of-health model is a tool used

to determine what health services, biological, environmental, social and economic factors that

influence the health status of individuals in a community (Oral Health, Healthy People 2020,

2010). According to Healthy People 2020 (2010), it is the interrelationships among these factors

that determine individual and population health. Interventions that are created using this model

aid in targeting multiple factors that become more effective in the health of the population.

Developing interventions using the determinants-of-health model helps answer the question -

how can we create a society where everyone has a chance to live long healthy lives (Healthy

People 2020,2010)?
Running head: ORAL HEALTH IN COLLIER COUNTY 7

Health Service Factor

An important factor that affects the oral health of Colliers population is the lack of

providers that are available for the uninsured and even individuals with Medicaid. Viewing the

number of dental health providers in an area helps us determine the access to oral health services

and its quality. In a three-year rolling rate average, Collier had an average of 701 licensed

dentists (Florida Charts, 2014). Only four dental providers were available for the uninsured and

individuals with Medicaid (Floridahealth.org, 2013). According to Collier Count Community

Health Assessment (2013), the majority of dental providers were not accepting individuals with

Medicaid because of the low reimbursement rates. Therefore, because of the lack of access to

outpatient dental services between 2000 and 2011, there was a 192% increase in hospitalizations

for preventable dental conditions for people under 65 years of age (Collier County Community

Health Assessment, 2013). This situation exemplifies a factor of the determinant-of-health model

that affects a sector of Collier Countys population, which is access to health services and the

impact of the health systems.

Lifestyle Factor

Another determining factor of oral health is lifestyle. This can have a profound effect on

oral health. Evidence has shown that smoking, poor diet, and alcohol consumption can lead to

very poor oral health. According to a scholarly article, there was a strong negative impact of

smoking to periodontal health in a cross-sectional study (International Dental Journal, 2010).

Eating foods high in sugar is shown to cause higher risk in developing dental carries which can

also take a toll on oral health. Eating healthy, not smoking and alcohol consumption in
COLLIER COUNTY POPULATION 8

moderation, along with physical activity confers an addition of 14 years of life expectancy

(Dental Health Foundation, n.d.).

Biological Factor

The aging process is an important factor in regards to oral health. As people age their

bones and organ functions start to decline. Studies show that with growing age teeth enamel

begins to decline and this causes a risk of tooth fractures in senior adults (Acta Biomaterialia

,2015). It is essential to consider the importance of oral health throughout the lifespan so that as

people age they can preserve as much of their dental health as possible. That is why the

promotion of oral health at a young age and throughout the whole lifespan is beneficial to the

growing population.

Population Diagnosis

Collier Countys population has risk for poor oral health for the uninsured individuals

and individuals with Medicaid, who are less than 65 years of age, as evidence by the increased

rates of emergency room visits for preventable dental conditions for the less than 65 age group

and the lack of dental providers that offer their services to this subgroup. Poor oral health is the

risk situation identified. The population subgroup identified are uninsured individuals and

individuals with Medicaid, who are less than 65. The evidence presented are the lack of

providers that only offer services to individual with private insurances and the increase rate of

emergency room visit for preventable dental conditions (Collier County Community Health

Assessment,2013).
Running head: ORAL HEALTH IN COLLIER COUNTY 9

Population-Based Intervention

Primary Level Prevention

Primary level prevention promotes and protects individuals before the problem ever

exists. It reduces susceptibility and exposure to risk factors (Applications for Public Health

Nursing Practice, n.d.). The level of recipient that is being reached out to is system-wide. The

intervention that is being looked at to help Collier County decrease the number of emergency

room visits, for preventable oral health issues is by making oral health an included part of health

insurance. Just as The Affordable Act is required for everyone to have health insurance, oral

health is vital to an individuals overall health and should not be compartmentalized as a separate

entity from general health insurance. Evidence show that oral health is an integral part of an

individuals general health because of its impact on ones quality of life (Dental Health

Foundation, n.d.). The stakeholders for this intervention will be state legislators who have to

decide whether or not this can be passed. The government can give higher priority to health in

their budget allocations so that this intervention can be funded (World Health Organization,

n.d.). The role of the community health nurse here is to advocate by fighting for this to be

presented to the state legislator. The community health nurse can bring it forth to the board of the

American Nurses Association so they can come together as one to help this move forward

(Online Journal of Issues in Nursing, n.d.).

Secondary Level Prevention

At the secondary level of prevention, the problem is detected at its early stages, and

something is done to stop it so it doesnt become a long-term issue (Applications for Public

Health Nursing Practice, n.d.). The intervention that can be implemented here to lower Collier
COLLIER COUNTY POPULATION 10

Countys ER visits for dental issues, is a semiannual screening, every six months, for the

population of uninsured individuals. This event will provide low cost to free treatment to those

that arent able to afford it. Evidence shows that through dental health screenings it plays a key

role in ensuring oral health function (Canadian Pediatric Society,2013). The level of recipient in

this prevention plan is the community. Public officials and health care providers will be the key

stakeholders because they are the ones who will organize and provide the necessary resources for

this intervention to work. Funding for this oral health screening can be given from the county

level by making health a priority and allocating more funds to that budget, meeting the needs of

the percentage of uninsured individuals without dental insurance. The community health nurse

can play key roles in this intervention as in advocating this to the public officials of Collier

County and also educating the community on the importance of oral care.

Tertiary Level Prevention

Tertiary prevention is carried out after a problem has occurred (Applications for Public

Health Nursing Practice, n.d.). The goal of the intervention at this stage is to prevent existing

problems from getting worse by monitoring compliance, monitoring treatment effects, dealing

with consequences, preventing the spread or preventing further negative impact on health.

Collier Countys population of individuals visiting the emergency room for preventable dental

conditions shows the need for tertiary prevention interventions for those individuals. The

intervention that can be implemented here to maintain the individuals optimal level of

functioning is monitoring compliance after medical attention has been sought (International

Dental Journal, 2012). A community health nurse can follow up with these individuals to see if

there is active decline in their quality of life or improvement. Based on their assessment the

community health nurse can figure out interventions that can better assist the individual. The
COLLIER COUNTY POPULATION 11

level of recipient for this intervention are the individuals. The health providers of the community

are the key stakeholders because they have to determine whether or not they can provide nurses

to maintain these follow ups. The source that can help push this forth is the advocating of the

community health nurse by presenting this as a priority to legislators with the help of members of

the Association of Public Health Nurses (2013).

Reflection and Synthesis of Health Policy

The decisions, plans, and actions that are undertaken to accomplish specific healthcare

goals within a society define the meaning of a health policy (World Health Organization, n.d.).

Health policy has a strong impact on healthcare because it forms a vision for the future which

helps outline priorities and the expected roles of individuals in the health care community.

Collier Countys Health Policy Proposal

The proposed policy for Collier County is to integrate oral health as one entity in health

insurance instead of compartmentalizing it as a separate entity. The goal of this policy is to lower

the amount of people in the community that go to the ER for preventable dental conditions and to

decrease the cost of ER visits. According to a scholarly article, the implementation of the

Affordable Care Act and the potential for increased access to care among adults has a unique and

novel opportunity to improve equity in oral health care and outcomes (American Journal of

Public Health,2015). The level of prevention that this policy focuses on is primary level

prevention. The key stakeholders of this policy are state legislators because they again decide

whether or not if policies should be passed or not. The funding for this policy can be allocated

from the same funds that finance the ACA which are; collected taxes, penalties and spending

cuts (Insure the Uninsured Project, 2012). Public health advocates that have the same view on

oral health being included in the overall health and seek equality in healthcare will be supporters
COLLIER COUNTY POPULATION 12

of this policy. Opponents of this policy would be employers who have to make payments to

cover health expenses for their employees.

Steps Towards Presenting the Policy

The plan that needs to take place to push this policy forward is to gather healthcare

professionals from different disciplines to describe this health policy proposal. Once a group of

interest is created and the vision is seen then the proposal can be discussed in public meetings.

This will be a great initiative for Collier Countys population since there are no established

communication mechanisms that provide for ongoing, informed participation in community

decision designed to address strategic health issues (Collier.floridahealth.gov, 2013). The first

person that will be approached is a public health lobbyist- which is the person who will voice

these concerns regarding this proposal to state legislators at the capitol. Creating this health

policy will allow individuals to take preventive measures in protecting their oral health care

needs. This policy will drive down the cost of emergency room visits for Collier County. The

policy will also help those individuals who are covered by the required health insurance from the

ACA, that cant afford dental insurance. Making oral health an integral part of health insurance

will enhance the general health of Collier Countys population because preventative measures

will be easier to access.

Conclusion

In summary, oral health is an essential component of our overall health and quality of

life. Advocating for a health policy that includes dental care as a required entity to health

insurance gives Collier Countys population a primary prevention plan for their increase

emergency room visits for preventable oral health conditions. Oral health screenings and the

monitoring of compliance for those already at risk was also looked at as secondary and tertiary
COLLIER COUNTY POPULATION 13

preventions respectively. As emerging nurses, I believe being vigilant to what is going on in our

healthcare system is highly important. This paper gives us the blueprint on how one day in our

future roles as nurses, we can plan out a health policy proposal to advocate for our patients that

we serve at the bedside.

.
Running head: ORAL HEALTH IN COLLIER COUNTY 14

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