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Grant SJ, Yanguela J, Odebunmi O, Grimshaw AA, Giri S, Wheeler SB. Systematic Review of Interventions Addressing Racial and Ethnic Disparities in Cancer Care and Health Outcomes. J Clin Oncol 2024; 42:1563-1574. [PMID: 38382005 PMCID: PMC11095878 DOI: 10.1200/jco.23.01290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 10/19/2023] [Accepted: 11/16/2023] [Indexed: 02/23/2024] Open
Abstract
PURPOSE Cancer health disparities result from complex interactions among socioeconomic, behavioral, and biological factors, disproportionately affecting marginalized racial and ethnic groups. The objective of this review is to synthesize existing evidence on interventions addressing racial or ethnic disparities in cancer-related health care access and clinical outcomes. METHODS A comprehensive search of Cochrane Library, Google Scholar, Ovid MEDLINE, Ovid Embase, PubMed, Scopus, and Web of Science Core Collection was conducted from database inception to February 23, 2023. Controlled vocabulary and keywords helped to identify studies on cancer-related disparities and interventions in adults age 18 years or older. Two reviewers followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis reporting guidelines. Study quality was assessed using the Joanna Briggs Institute Critical Appraisal Tool. RESULTS Of 7,526 screened studies, 34 met the inclusion criteria involving 24,134 participants. Most studies focused on breast cancer (n = 17) and Hispanic/Latino populations (n = 10) and enrolled participants primarily from community-based sites (n = 19). Twenty-one studies examined patient-centered outcomes, such as health-related quality of life and psychological well-being, while 15 studies assessed process-of-care outcomes, such as timeliness of care. Most studies followed a community-based participatory research framework. Five patient-centered outcome studies reported a positive intervention effect, often combining cancer education with psychological well-being interventions. Among the 15 process-of-care outcome studies, nine reported positive effects, with the majority (n = 8) being navigation-based interventions. CONCLUSION This systematic review emphasizes the vital role of community partnerships in addressing racial and ethnic disparities in oncology care and highlights the need for standardized approaches in intervention research because of the heterogeneity of studied interventions. Furthermore, the prevailing emphasis on breast cancer and Hispanic populations indicates the need for future investigations into other priority demographic groups.
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Affiliation(s)
- Shakira J. Grant
- Division of Hematology, Department of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Juan Yanguela
- Lineberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC
- Department of Health Policy and Management, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Olufeyisayo Odebunmi
- Lineberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC
- Department of Health Policy and Management, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Alyssa A. Grimshaw
- Harvey Cushing/John Hay Whitney Medical Library, Yale University, New Haven, CT
| | - Smith Giri
- Institute for Cancer Outcomes & Survivorship, University of Alabama at Birmingham, Birmingham, AL
| | - Stephanie B. Wheeler
- Lineberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC
- Department of Health Policy and Management, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC
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Yee MK, Sereika SM, Bender CM, Brufsky AM, Connolly MC, Rosenzweig MQ. Symptom incidence, distress, cancer-related distress, and adherence to chemotherapy among African American women with breast cancer. Cancer 2017; 123:2061-2069. [PMID: 28199006 DOI: 10.1002/cncr.30575] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 12/20/2016] [Accepted: 01/03/2017] [Indexed: 01/30/2023]
Abstract
BACKGROUND There is a persistent racial survival disparity between African American (AA) and white women with breast cancer. There is evidence that symptom incidence, associated distress, and overall cancer-related distress may be unexplored, important contributing factors. The purpose of the current study was to: 1) describe and compare the number of chemotherapy-related symptoms and associated distress among AA women with breast cancer over the course of chemotherapy at 3 time points (at baseline before initiating chemotherapy, midpoint, and at the completion of chemotherapy); and 2) to describe the relationship between the number of chemotherapy-related symptoms and overall cancer distress compared with the ability to receive at least 85% of the prescribed chemotherapy within the prescribed timeframe. METHODS Descriptive, comparative, and correlational analyses of symptom incidence, symptom distress, cancer-related distress, and prescribed chemotherapy dose received among a cohort of AA women receiving chemotherapy for breast cancer were performed. RESULTS AA women (121 women) experienced worsening symptoms from baseline to midpoint in chemotherapy and then stabilized for the duration of therapy. The inability to receive 85% of the prescribed chemotherapy within a prescribed time point was found to be significantly correlated with midpoint symptom distress. CONCLUSIONS The main findings of the current study were that AA women experience a deterioration in symptom distress over the course of chemotherapy from baseline (before chemotherapy) to the midpoint, which was found to be associated with less adherence to chemotherapy overall. Thus, the incidence and management of physical and emotional symptoms, as measured through a multidimensional symptom measurement tool, may be contributing to breast cancer dose disparity and should be explored further. Cancer 2017;123:2061-2069. © 2017 American Cancer Society.
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Affiliation(s)
- Melissa K Yee
- Department of Medical Oncology at Dana-Farber/Brigham and Women's Cancer Center in clinical affiliation with South Shore Hospital, Harvard University, Cambridge, Massachusetts
| | - Susan M Sereika
- Department of Epidemiology, School of Nursing and Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | - Adam M Brufsky
- Department of Hematology/Oncology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Mary C Connolly
- School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Margaret Q Rosenzweig
- Acute and Tertiary Care Department, University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania
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Plaisime MV, Malebranche DJ, Davis AL, Taylor JA. Healthcare Providers' Formative Experiences with Race and Black Male Patients in Urban Hospital Environments. J Racial Ethn Health Disparities 2016; 4:1120-1127. [PMID: 27928771 DOI: 10.1007/s40615-016-0317-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 09/15/2016] [Accepted: 11/14/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE We explored health providers' formative personal and professional experiences with race and Black men as a way to assess their potential influence on interactions with Black male patients. METHODS Utilizing convenience sampling with snowballing techniques, we identified healthcare providers in two urban university hospitals. We compared Black and White providers' experiences based on race and level of training. We used the Gardener's Tale to conceptualize how racism may lead to racial health disparities. A semi-structured interview guide was used to conduct in-person interviews (n = 16). Using the grounded theory approach, we conducted three types of coding to examine data patterns. RESULTS We found two themes reflective of personally mediated racism: (1) perception of Black males accompanied by two subthemes (a) biased care and (b) fear and discomfort and (2) cognitive dissonance. While this latter theme is more reflective of Jones's internalized racism level, we present its results because its novelty is compelling. CONCLUSIONS Perception of Black males and cognitive dissonance appear to influence providers' approaches with Black male patients. This study suggests the need to develop initiatives and curricula in health professional schools that address provider racial bias. Understanding the dynamics operating in the patient-provider encounter enhances the ability to address and reduce health disparities.
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Affiliation(s)
- Marie V Plaisime
- Department of Sociology and Criminology, Howard University, 2400 Sixth Street, NW, Washington, DC, 20059, USA
| | | | - Andrea L Davis
- Department of Environmental and Occupational Health, Drexel University Dornsife School of Public Health, Nesbitt Hall, 6th Fl., Rm. 656, 3215 Market Street, Philadelphia, PA, 19104, USA
| | - Jennifer A Taylor
- Department of Environmental & Occupational Health, Drexel University Dornsife School of Public Health, Nesbitt Hall, Room 655, 3215 Market Street, Philadelphia, PA, 19104, USA.
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Alrqiq HM, Scott TE, Mascarenhas AK. Evaluating a Cultural Competency Curriculum: Changes in Dental Students’ Perceived Awareness, Knowledge, and Skills. J Dent Educ 2015. [DOI: 10.1002/j.0022-0337.2015.79.9.tb05993.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Hosam M. Alrqiq
- College of Dental Medicine; Columbia University; Dental Public Health Program; Boston University Henry M. Goldman School of Dental Medicine
| | - Thayer E. Scott
- Department of Health Policy and Health Services Research; Boston University Henry M. Goldman School of Dental Medicine
| | - Ana K. Mascarenhas
- College of Dental Medicine; Nova Southeastern University; Department of Health Policy Services and Research; Director of the Division of Dental Public Health; Boston University Henry M. Goldman School of Dental Medicine
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Garcia D, Tarima S, Okunseri C. Periodontitis and glycemic control in diabetes: NHANES 2009 to 2012. J Periodontol 2014; 86:499-506. [PMID: 25427615 DOI: 10.1902/jop.2014.140364] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND This study examines the association between periodontitis, diabetes (DM), and glycemic control. METHODS National Health and Nutrition Examination Survey data for 2009 to 2012 were analyzed. Periodontitis status of each participant was assessed using the full-mouth periodontal examination protocol, classified using the Centers for Disease Control and Prevention and the American Academy of Periodontology surveillance case definition for total periodontitis. Self-reported DM status was defined as yes or no. Glycemic control was assessed using glycohemoglobin data at cutoff points of 7.0%, 7.5%, 8.0%, 8.5%, and 9.0%. Descriptive statistics and logistic regression analyses were performed, and all analyses were adjusted for the survey design. RESULTS Overall, 7,042 adults ≥30 years old with complete data were included in the study. The mean glycohemoglobin levels for individuals with and without periodontitis were 5.9% and 5.6%, respectively, and increased to 7.4% and 7.0% for participants with DM. The majority of participants with and without periodontitis were aged 50 to 64 and 35 to 49 years (37.4% versus 44.5%), respectively. In the bivariate analysis, several demographic factors were significantly associated with having periodontitis, including self-reported DM status and glycemic control. In the multivariate analysis, demographic factors, glycohemoglobin cutoff values of 8.0%, 8.5%, and 9.0%, and mean glycohemoglobin level remained significant, but self-reported DM status was not. CONCLUSION This study demonstrates that glycohemoglobin and demographic factors are significantly associated with periodontitis, but not self-reported status.
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Affiliation(s)
- Dina Garcia
- Institute for Health & Society, Medical College of Wisconsin, Milwaukee, WI
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Schwartz B, Bohay R. Can Patients Help Teach Professionalism and Empathy to Dental Students? Adding Patient Videos to a Lecture Course. J Dent Educ 2012. [DOI: 10.1002/j.0022-0337.2012.76.2.tb05244.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Barry Schwartz
- Schulich School of Medicine and Dentistry University of Western Ontario
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Benz JK, Espinosa O, Welsh V, Fontes A. Awareness Of Racial And Ethnic Health Disparities Has Improved Only Modestly Over A Decade. Health Aff (Millwood) 2011; 30:1860-7. [DOI: 10.1377/hlthaff.2010.0702] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Jennifer K. Benz
- Jennifer K. Benz is a research scientist at NORC at the University of Chicago, in Illinois
| | - Oscar Espinosa
- Oscar Espinosa is a senior research scientist at NORC at the University of Chicago
| | - Valerie Welsh
- Valerie Welsh is a senior health policy analyst and the performance improvement and evaluation officer in the Office of Minority Health, Office of the Assistant Secretary for Health, at the Department of Health and Human Services, in Rockville, Maryland
| | - Angela Fontes
- Angela Fontes is an assistant professor in the Family and Consumer Sciences Department at Illinois State University, in Normal
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Rosenzweig M, Brufsky A, Rastogi P, Puhalla S, Simon J, Underwood S. The attitudes, communication, treatment, and support intervention to reduce breast cancer treatment disparity. Oncol Nurs Forum 2011; 38:85-9. [PMID: 21186164 DOI: 10.1188/11.onf.85-89] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE/OBJECTIVES to test the effect of a supportive, one-time psychoeducational intervention on treatment adherence among African American women receiving first adjuvant therapy for breast cancer. DESIGN a pilot, randomized, controlled clinical trial, two-group design, with one-time intervention and four data collection points. SETTING two University of Pittsburgh Cancer Institute clinics. SAMPLE 24 African American women. METHODS the Attitudes, Communication, Treatment, and Support (ACTS) intervention is a 45-minute one-on-one session with an African American woman recommended to have chemotherapy for breast cancer. The interventionist is an African American breast cancer survivor. The intervention consists of a discussion about chemotherapy and the importance of communicating knowledge needs and distress, an explanation of the specific treatment plan according to pathology, and support through the survivor testimonial and video clips from the African American community. MAIN RESEARCH VARIABLES dose of chemotherapy received and dose of chemotherapy prescribed. FINDINGS Twenty patients completed chemotherapy, and four chose not to begin or discontinued recommended chemotherapy. The groups were equal in key sociodemographic variables. Compared to usual care, the ACTS intervention participants demonstrated trends toward initiation of chemotherapy (100% versus 82%), overall adherence to chemotherapy (92% versus 73%), and percentage of total dose of chemotherapy received or prescribed (94% versus 74%). Compared to usual care, the ACTS intervention participants demonstrated more rapid initiation of chemotherapy and better overall adherence to chemotherapy. CONCLUSIONS the pilot ACTS intervention shows promise as a psychoeducational intervention to assist with chemotherapy decision making among African American women. IMPLICATIONS FOR NURSING African American women are at high risk of not receiving the full dose of prescribed chemotherapy for breast cancer for multiple reasons. Nurses must be sensitive to the unique fears and concerns of this population regarding chemotherapy decisions. An intervention addressing these fears and concerns may help to increase adherence.
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Irwin JY, Thyvalikakath T, Spallek H, Wali T, Kerr AR, Schleyer T. English and Spanish oral cancer information on the Internet: a pilot surface quality and content evaluation of oral cancer Web sites. J Public Health Dent 2011; 71:106-16. [DOI: 10.1111/j.1752-7325.2010.00207.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Milgrom P, Spiekerman C, Grembowski D. Dissatisfaction with dental care among mothers of Medicaid-enrolled children. Community Dent Oral Epidemiol 2008; 36:451-8. [PMID: 18284431 DOI: 10.1111/j.1600-0528.2007.00423.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVES This paper is part of a larger study examining the impact of mothers' having a regular source of dental care (RSDC) on utilization of dental care and oral health of their preschool children. We describe levels of satisfaction with care among mothers whose preschool children were enrolled in Medicaid in Washington State. We report mothers' satisfaction related to having a RSDC by type of dental setting/office. METHODS Disproportionate stratified sampling by racial/ethnic group selected 11 305 children aged 3-6 in Medicaid in Washington State. Mothers (n = 4373) completed a mixed-mode survey. Satisfaction with dental care was measured using the Dental Satisfaction Questionnaire (DSQ). RESULTS Overall mean DSQ was 57.1 +/- 9.9 (range 18-89). A higher score indicates greater satisfaction. There was not evidence of a difference in dissatisfaction by race/ethnicity but Blacks and Hispanics were less satisfied with pain management than Whites. The majority of respondents agreed with the statement that 'Dentists sometimes act rude to their patients.' Satisfaction is higher for mothers who have a regular private dentist they see consistently versus having a regular dentist through a public or non-profit clinic. CONCLUSIONS The satisfaction with dental care for this population is low, and considerably lower than found in other studies for primary medical care. Steps need to be taken to increase dental satisfaction and access to private dental clinics, and to increase perceived quality and pain management of dental care in both private clinics and public/non-profits serving low-income populations.
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Affiliation(s)
- Peter Milgrom
- Department of Dental Public Health Sciences, University of Washington, Seattle, WA 98195-7475, USA.
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Donaldson A, Everitt B, Newton T, Steele J, Sherriff M, Bower E. The Effects of Social Class and Dental Attendance on Oral Health. J Dent Res 2008; 87:60-4. [DOI: 10.1177/154405910808700110] [Citation(s) in RCA: 123] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The relationship between socio-economic status (SES) and oral health is well-established. We investigated whether the association between SES and the number of sound teeth in adults is explained by dental attendance patterns, in turn determined by the effect of SES on barriers to dental attendance. Data on 3817 participants from the 1998 Adult Dental Health Survey in the UK were analyzed. Using structural equation modeling, we found a model with 4 factors (aging, SES, attendance-profile, and barriers-to-dental-attendance) providing an adequate fit to the covariance matrix of the 9 covariates. The final model suggests that the association between SES and the number of sound teeth in adults in the UK is partially explained by the pathway [SES → barriers-to-dental-attendance → dental-attendance-profile → number-of-sound-teeth]. A direct relationship, SES → number-of-sound-teeth, is also significant.
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Affiliation(s)
- A.N. Donaldson
- King’s College London Dental Institute, Weston Education Centre, Off 262 Cutcombe Road, Denmark Hill, London SE5 9RJ, UK
- Emeritus Professor of Biostatistics, King’s College London, UK
- Department of Oral Health Services Research, King’s College London Dental Institute, Weston Education Centre, Off 262 Cutcombe Road, Denmark Hill, London SE5 9RJ, UK
- School of Dental Sciences, University of Newcastle, UK
- Department of Dental Biomaterials Science, King’s College London Dental Institute, UK
| | - B. Everitt
- King’s College London Dental Institute, Weston Education Centre, Off 262 Cutcombe Road, Denmark Hill, London SE5 9RJ, UK
- Emeritus Professor of Biostatistics, King’s College London, UK
- Department of Oral Health Services Research, King’s College London Dental Institute, Weston Education Centre, Off 262 Cutcombe Road, Denmark Hill, London SE5 9RJ, UK
- School of Dental Sciences, University of Newcastle, UK
- Department of Dental Biomaterials Science, King’s College London Dental Institute, UK
| | - T. Newton
- King’s College London Dental Institute, Weston Education Centre, Off 262 Cutcombe Road, Denmark Hill, London SE5 9RJ, UK
- Emeritus Professor of Biostatistics, King’s College London, UK
- Department of Oral Health Services Research, King’s College London Dental Institute, Weston Education Centre, Off 262 Cutcombe Road, Denmark Hill, London SE5 9RJ, UK
- School of Dental Sciences, University of Newcastle, UK
- Department of Dental Biomaterials Science, King’s College London Dental Institute, UK
| | - J. Steele
- King’s College London Dental Institute, Weston Education Centre, Off 262 Cutcombe Road, Denmark Hill, London SE5 9RJ, UK
- Emeritus Professor of Biostatistics, King’s College London, UK
- Department of Oral Health Services Research, King’s College London Dental Institute, Weston Education Centre, Off 262 Cutcombe Road, Denmark Hill, London SE5 9RJ, UK
- School of Dental Sciences, University of Newcastle, UK
- Department of Dental Biomaterials Science, King’s College London Dental Institute, UK
| | - M. Sherriff
- King’s College London Dental Institute, Weston Education Centre, Off 262 Cutcombe Road, Denmark Hill, London SE5 9RJ, UK
- Emeritus Professor of Biostatistics, King’s College London, UK
- Department of Oral Health Services Research, King’s College London Dental Institute, Weston Education Centre, Off 262 Cutcombe Road, Denmark Hill, London SE5 9RJ, UK
- School of Dental Sciences, University of Newcastle, UK
- Department of Dental Biomaterials Science, King’s College London Dental Institute, UK
| | - E. Bower
- King’s College London Dental Institute, Weston Education Centre, Off 262 Cutcombe Road, Denmark Hill, London SE5 9RJ, UK
- Emeritus Professor of Biostatistics, King’s College London, UK
- Department of Oral Health Services Research, King’s College London Dental Institute, Weston Education Centre, Off 262 Cutcombe Road, Denmark Hill, London SE5 9RJ, UK
- School of Dental Sciences, University of Newcastle, UK
- Department of Dental Biomaterials Science, King’s College London Dental Institute, UK
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Affiliation(s)
- Judith A. Jones
- Boston University Schools of Dental Medicine and Public Health; Department of General Dentistry; Elders’ Oral Health Summit
| | - Carolyn J. Wehler
- Boston University School of Dental Medicine; Department of General Dentistry
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Jones JA. Financing and Reimbursement of Elders’ Oral Health Care: Lessons from the Present, Opportunities for the Future. J Dent Educ 2005. [DOI: 10.1002/j.0022-0337.2005.69.9.tb04000.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Judith A. Jones
- Boston University Schools of Dental Medicine and Public Health; Department of General Dentistry; Elders’ Oral Health Summit
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