Substance-use screening and interventions in dental practices: survey of practice-based research network dentists regarding current practices, policies and barriers

Screening, brief intervention, and referral to treatment in oral health settings: A scoping review

OBJECTIVES

Screening, Brief Intervention, and Referral to Treatment (SBIRT) is an effective evidence-based model to provide early intervention and treatment to people with substance use disorders across diverse health settings. Yet, how SBIRT has been implemented within oral health settings and its associated outcomes has not been explored. This scoping review assessed how SBIRT has been implemented in oral health settings in the U.S. and discusses the implications for SBIRT integration in dentistry and oral health research, education and practice.

METHODS

Five scholarly databases were searched using a scoping review methodology for relevant literature, yielding seven articles that met inclusion criteria.

RESULTS

Findings from seven U.S. studies show that SBIRT has been implemented into oral health settings in three distinct ways: through education/training, as an intervention and in one national survey. Findings of this scoping review support the inclusion of SBIRT education for oral health professionals in both practice and clinical environments and offer examples of existing models for future implementation and study.

CONCLUSIONS

The scant literature on SBIRT intervention effects in dental settings-both within and outside of the U.S.-underscores the need for more empirical work to better understand how SBIRT impacts dental providers' knowledge, practices, referrals and ultimately, patient outcomes.

Patients' comfort with and receipt of health risk assessments during routine dental visits: Results from the South Atlantic region of the US National Dental Practice-Based Research Network

OBJECTIVES

To understand patients' comfort with health risk assessments (HRAs) and patient and dentist factors associated with the provision of HRAs.

METHODS

In this cross-sectional study, 857 patients seen by 30 dental practitioners in the United States National Dental Practice-Based Research Network reported their comfort receiving HRA for six risk factors (tobacco use, alcohol use, dietary sugar intake, human immunodeficiency virus risks, human papillomavirus risks and existing medical conditions) and whether they discussed any of the risk factors during their visits. Multi-level logistic models were used to examine the impacts of patient, practitioner, practice characteristics on the (1) number of risk factors patients were comfortable discussing and (2) number of risk factors assessed in the current dental visit.

RESULTS

Only a small percentage (4%) of patients reported being uncomfortable receiving any HRA during their dental visits. However, over half of the patients (53%) reported that they did not receive any HRAs during the current visit. In the regression analyses, patients who were older, male and from the suburban were more likely to be comfortable with more HRAs. Dentists were more likely to provide HRA if they were younger, not non-Hispanic white, less likely to feel that providing HRAs was beyond their scope of practice, yet more likely to feel occasional discomfort in providing HRA.

CONCLUSIONS

Interventions should focus on reducing dental practitioner perception that conducting HRAs is beyond their scope of practice and standardizing screening assessments for multiple risk factors.

Oral cancer screening knowledge and practices among dental professionals at the University of Toronto

INTRODUCTION

Opportunistic oral cancer screening during visits to the dentist is a non-invasive and accessible option for detection of pre-malignant lesions and early-stage malignancies. The objective of this study was to investigate the knowledge, practices, and attitudes towards oral cancer screening among dentists.

METHODS

A 42-item survey was sent to 650 dental professionals affiliated with the University of Toronto. Data regarding training/practice characteristics, knowledge of oral cavity cancer, current screening practices, attitudes towards screening, and remuneration were collected.

RESULTS

Ninety-one dentists responded. Most obtained their dental degree from Canada (71.4%) and were practicing in large urban centers (87.9%). Most dentists correctly identified the oral tongue (87.8%) and floor of mouth (80%) as the two of most common sites of oral cavity cancer but only 56% correctly identified the most common presentation. 91% performed intra/extra oral examinations at every patient visit. Only 9.9% of dentists discussed the risk factors of oral cancer and 33% were not familiar with resources for smoking cessation and alcohol abuse. International medical graduates were more likely to discuss risk factor management than Canadian medical graduates (p < 0.01). Over 80% of dentists referred to a specialist when a suspected lesion was found. The greatest barrier for oral cancer screening was lack of time. Almost all dentists (98.8%) reported that their screening practices do not differ depending on the patient's insurance status and 63.8% reported compensation would not influence their decision to perform oral examinations.

CONCLUSION

Most dentists have a good knowledge of the presentation and risk factors associated with oral cavity cancer. Most dentists perform screening with every patient, with no influence from compensation and insurance status. Dentists are therefore an excellent first contact for oral cavity cancer screening for the general public and for high-risk populations.

Associations between Oral Health and Cannabis Use among Adolescents and Young Adults: Implications for Orthodontists

Cannabis use is prevalent among adolescents and young adults in the US. Virtually all modes of cannabis consumption involve the oral cavity, and previous studies have linked cannabis use with poorer oral health. We sought to identify associations between cannabis use and various oral health outcomes and behaviors among individuals 12-25 years of age, and to discuss implications for orthodontists who largely interact with this age group over an extended period of treatment time. We examined data from patient electronic health records (N = 14,657) obtained between 2015 and 2021. Associations between lifetime and current self-reported cannabis use and several oral health outcomes or related behaviors that reflect periodontal health, caries status, oral lesions, and physical integrity of tooth structure and restorations were examined in a bivariable and multivariable manner, controlling for patient age, sex, and self-reported tobacco and alcohol use. Reporting lifetime cannabis use was associated with higher risk for having oral lesions (aPR = 1.41, 95% CI: 1.07-1.85), bruxism (aPR = 1.31, 95% CI: 1.09-1.58), and frequent consumption of sugary beverages and snacks (aPR = 1.27, 95% CI: 1.12-1.41). Reporting current cannabis use was associated with higher risk for oral lesions (aPR = 1.45, 95% CI: 1.03-2.06) and frequent consumption of sugary beverages and snacks (aPR = 1.26, 95% CI: 1.07-1.48). Cannabis users aged 12-25 are at increased risk for bruxism, oral lesions, and frequent consumption of sugary beverages and snacks. Orthodontists and other dental professionals should probe for drug use and be cognizant of increased risk for oral health problems in patients that report actively using cannabis.

Effectiveness of online training of first and second year AEGD residents in identifying, referring, and managing patients at-risk for substance use and opioid disorders

BACKGROUND AND OBJECTIVES

Dentists have contributed greatly to the opioid epidemic, dispensing roughly 8.6% of opioids totaling over 18 million prescriptions in a 12-month period from July 2016 to June 2017 and report educational gaps regarding screening techniques for substance misuse and an unfamiliarity with available referral resources. The purpose of this study was to determine the knowledge and comfort level of residents in identifying, referring, and managing patients who are at risk for opioid use or substance use disorder in the dental setting before and after an online case-based training course.

METHODS

Thirty-five first year (PGY1) and 11 second year (PGY2) advanced education in general dentistry (AEGD) residents participated in an online training course that aimed to assess knowledge in the domains of identifying, referring, and managing patients at risk for substance abuse disorder and opioid use in an academic setting. There were nine subdomains within the three major domains that further assessed resident comfort and knowledge. Before and after training, data were collected and analyzed.

RESULTS

Analysis of the results indicated that (1) the training modules increased resident comfort in identifying (p = 0.011), referring (p = 0.032), and managing (p = 0.002) patients at risk for opioid substance use. (2) PGY1 residents benefited more than PGY2 residents in identifying (p = 0.034) and the manage domains (p < 0.001). (3) Residents viewed the module quality, usefulness, and applicability favorably. Further analysis of the nine subdomains is presented.

CONCLUSION

Our study suggests that dental curricula would benefit from incorporating training of residents in identifying, referring, and managing patients at risk for substance use disorder and opioid use.

Leveraging Clinical Decision Support and Integrated Medical-Dental Electronic Health Records to Implementing Precision in Oral Cancer Risk Assessment and Preventive Intervention

INTRODUCTION

Precision medicine is focused on serving the unique needs of individuals. Oral and oropharyngeal cancer risk assessment identifies individual risk factors while providing support to reduce risk. The objective is to examine potential current and future strategies to broadly implement evidence-based oral and oropharyngeal cancer risk assessment and screening in dental practices throughout the United States.

METHODS

Feasible and effective oral cancer risk assessment and risk reduction strategies, ripe for implementation in dental practice, were identified in the published literature.

RESULTS

The Screening, Brief Intervention, Referral for Treatment (SBIRT) model is a feasible approach to assessing individual oral cancer risk and providing risk reducing interventions in the dental setting. HPV is a more recently identified risk factor that dentistry is well positioned to address. Evidence supporting the utilization of specific risk assessment tools and risk reduction strategies is summarized and future opportunities discussed.

DISCUSSION

Current knowledge of risk factors for oral and oropharyngeal cancers support the recommendation for dental providers to routinely assess all patients for risk factors, educate them about their personal level of cancer risk, and recommend actions to reduce relevant risk factors. Individuals ages 9-26 should be asked about their HPV vaccination status, educated about HPV and oropharyngeal cancer and receive a recommendation to get the HPV vaccination.

Dental practitioners' use of health risk assessments for a variety of health conditions: Results from the South Atlantic region of The National Dental Practice-Based Research Network

BACKGROUND

An important step in integrating dental and medical care is improving understanding of the frequency and characteristics of dental practitioners who conduct health risk assessments (HRAs).

METHODS

From September 2017 through July 2018, active dentist and hygienist members of the South Atlantic region of The National Dental Practice-Based Research Network (N = 870) were invited to participate in a survey evaluating their HRA practices (screening, measuring, discussing, referring patients) for 6 health conditions (obesity, hypertension, sexual activities, diabetes, alcohol use, tobacco use). For each health condition, the authors used ordinal logistic regression to measure the associations among the practitioner's HRA practices and the practitioner's characteristics, barriers, and practice characteristics.

RESULTS

Most of the 475 responding practitioners (≥ 72%) reported they at least occasionally complete 1 or more HRA steps for the health conditions except sexual activities. Most practitioners screened (that is, asked about) and gave referral information to affected patients for diabetes (56%) and hypertension (63%). Factors associated with each increased HRA practice for 2 or more outcomes were non-Hispanic white compared with Hispanic practitioner (cumulative odds ratio [COR] obesity, 0.4; 95% confidence interval [CI], 0.2 to 0.8; and COR diabetes, 0.3; 95% CI 0.2 to 0.8), male compared with female practitioner (COR tobacco, 0.3; 95% CI, 0.2 to 0.7; and COR hypertension, 0.4; 95% CI 0.2 to 0.8), and practitioner discomfort (COR, obesity and alcohol use, 0.7; 95% CI, 0.6 to 0.9; and COR, sexual activities 0.6; 95% CI 0.5 to 0.8).

CONCLUSIONS AND PRACTICAL IMPLICATIONS

Dental practitioners are conducting HRA practices for multiple conditions. Interventions should focus on reducing practitioner discomfort and target non-Hispanic white, male practitioners.

Patient Interviewing Strategies to Recognize Substance Use, Misuse, and Abuse in the Dental Setting

Brief and effective clinical interviewing is critical for identifying patient risk factors, including those associated with substance use. Dental practitioners may perceive identifying patient substance misuse and abuse as a complex undertaking or may consider this clinical assessment beyond the scope of their training and practice. This article describes interviewing strategies that will help dental providers communicate effectively and empathically with their patients to collect relevant clinical information related to substance use, misuse, and abuse and provide better care for their patients.

Assessment of knowledge and attitude regarding management of patients with substance usage in dental clinics in Modinagar- A cross-sectional study

Introduction

The consequences of oral issues among drug users necessitate the implementation of a comprehensive dental care program. Integrated oral health-care services should be programmed for the management of drug addiction as a multi-organ disease needs a multi-disciplinary approach.

Aim

The aim of the present study was to assess the knowledge and attitude regarding the management of patients with substance usage at a dental clinic.

Methodology

A cross-sectional study was conducted among 208 dentists working as clinicians. A self-structured 27-item questionnaire consisting of questions related to the management of patients with substance usage at a dental clinic was distributed to them. Data were analyzed using Statistical Package for Social Sciences (SPSS) 20.0 (SPSS Inc., Chicago, IL, USA) and descriptive and analytical tests, including mean, standard deviation, and Chi-square test were used. P < 0.05 was considered statistically significant.

Results

Majority of the dentist irrespective of qualification were unaware of the modalities regarding the management of the patients with substance usage at the dental clinic. Most dental clinicians were having a positive attitude regarding such patients and agreed that abuser should be identified and managed in dental settings.

Conclusion

Educating dental graduates and postgraduates about the oral implications of substance usage and making it a part of the dental curriculum may help us deal with the global issues of substance usage. The dental setting is recognized increasingly as an untapped venue for the delivery of medical screenings, given the long-term nature and frequent contacts associated with the patient-dentist relationship.

Patterns of opioid prescribing by dentists in a pediatric population: a retrospective observational study

BACKGROUND

Dentists are regular prescribers of opioid analgesic medications; however, there are few published data on their prescribing practices for children. The aim of this study was to assess opioid prescribing practices of dentists for pediatric patients.

METHODS

We conducted a retrospective study (2011/12 to 2017/18) using administrative health data of opioid prescribing practices of dentists in Nova Scotia for children and adolescents (age < 18 yr). The main variables of interest were opioid "type" and "load" dentists prescribed (number of dispensed prescriptions/yr, days supplied/prescription and dosage/d per prescription in milligrams of morphine equivalents [MME]).

RESULTS

Dentists accounted for a mean of 18.3% (standard deviation 1.5%) of all opioid prescribers for the pediatric population annually but were responsible for 59.9% of all opioid prescriptions and 48.6% of total MME dispensed during the 7-year study period. Oral and maxillofacial surgeons were responsible for 80.7% of all dental-related opioids dispensed. Codeine was most frequently prescribed (78.6% of total MME), followed by oxycodone (11.1%). There were significant downward trends over the study period in the total amount of opioid analgesics dispensed (r = -0.903, p < 0.01), primarily due to a reduction in the total amount of codeine dispensed and number of days supplied per prescription (r = -0.837, p < 0.05). Few opioids were dispensed to children less than 12 years.

INTERPRETATION

Dentists in Nova Scotia reduced prescriptions of opioids in the pediatric population between 2011/12 and 2017/18, which may indicate that current opioid prescribing principles are influencing dentists' prescribing habits. Nonetheless, patients and parents should receive appropriate counselling as to the proper use, risks, storage and potential for misuse of opioids when prescribed.

Dentist and hygienist smoking cessation counseling and awareness of Medicaid benefits

OBJECTIVES

Integrating smoking cessation interventions into dental care is an efficient way to intervene with smokers. This study of dentists and dental hygienists who provide dental care to Medicaid-insured patients explores awareness of Medicaid smoking cessation benefits, awareness of Quitline resources, beliefs about perceived role in providing tobacco interventions, and behaviors around clinical intervention.

METHODS

In 2015, we conducted a survey of dentists and hygienists who serve Medicaid patients in New York State.

RESULTS

A total of 182 dentists and 92 hygienists completed the survey. Ninety percent reported that helping patients quit smoking is part of their role, while 51.0 percent reported feeling confident in their ability to counsel a patient about quitting. Most respondents (73.4 percent) asked patients about tobacco use, 83.7 percent advised smokers to quit, and 49.1 percent assisted with quit attempts. We found that 26.7 percent were aware that dentist smoking cessation counseling is covered by Medicaid, and 15.5 percent were aware that hygienist smoking cessation counseling is covered. A total of 38.9 percent were aware of any Medicaid coverage for smoking cessation. Awareness of the Medicaid smoking cessation benefit was associated with intervention behaviors of asking and assisting.

CONCLUSIONS

Most dental care providers see smoking cessation as part of their role, but few are aware of the Medicaid benefits available to help patients. Expanding coverage of and promoting Medicaid benefits for smoking cessation have the potential to increase the reach and quality of smoking cessation interventions for Medicaid-insured smokers, a population disproportionately affected by tobacco use.

Opioid prescribing and risk mitigation implementation in the management of acute pain: Results from The National Dental Practice-Based Research Network

BACKGROUND

Minimal information exists regarding the consistency and correlates of dentists' implementation of risk mitigation strategies when prescribing opioids, including risk screening, prescription drug monitoring program (PDMP) use, and patient education.

METHODS

The authors conducted a Web-based, cross-sectional survey among practicing dentist members of The National Dental Practice-Based Research Network. The authors used the survey to assess pain management prescribing practices and risk mitigation implementation. The authors linked survey data with network enrollment questionnaire data to include practitioner demographic and practice characteristics.

RESULTS

A total of 822 dentists completed the survey. A minority of dentists reported prescribing opioids only (11%) or opioids in combination with a recommendation for nonsteroidal anti-inflammatory drugs or acetaminophen (18%) to one-half or more of their patients needing management of acute pain. Higher levels of opioid prescribing were associated significantly with less consistent implementation of PDMP use (r = -0.20) and patient education (r = -0.11).

CONCLUSIONS

Most dentists reported infrequent PDMP use and counseling patients regarding risks, storage, and disposal of opioids. Higher frequency of opioid prescribing was associated with less consistent risk mitigation implementation.

PRACTICAL IMPLICATIONS

When opioid prescribing is indicated, risk of misuse and diversion may be mitigated by consistent PDMP use and provision of patient education. Dental education in this arena is needed.

Intimate partner violence screening in the dental setting: Results of a nationally representative survey

BACKGROUND

The dental setting is a potential venue for identifying patients experiencing intimate partner violence (IPV). The study objective was to assess dentists' current practices and attitudes about IPV screening.

METHODS

A nationally representative survey of US general dentists assessed dentists' use of health history forms that queried about IPV and their acceptance of IPV screening as part of their professional roles. Parsimonious Poisson regression models were used in multivariable analysis to estimate risk ratios for the 2 dependent variables.

RESULTS

Almost all dentists did not include a question to screen for IPV on their patient history forms. More than one-half of dentists also did not know of a referral place for patients experiencing IPV and did not believe that IPV screening should be part of their professional roles.

CONCLUSIONS

Uptake of IPV screening and favorable attitudes toward screening were low among dentists studied. However, prior IPV training and clinical knowledge plus awareness of IPV referral mechanisms were positively associated with greater screening uptake and attitudes.

PRACTICAL IMPLICATIONS

The inclusion of brief, focused IPV interventions in dental education and the establishment of collaborations between dentists and IPV agencies for referral mechanisms, in conjunction with an overall shift in dentists' attitudes about their professional responsibilities, may facilitate IPV screening uptake in the dental setting.

Stage-Based Mobile Intervention for Substance Use Disorders in Primary Care: Development and Test of Acceptability

Background

In 2016, 21 million Americans aged 12 years and older needed treatment for a substance use disorder (SUD). However, only 10% to 11% of individuals requiring SUD treatment received it. Given their access to patients, primary care providers are in a unique position to perform universal Screening, Brief Intervention, and Referral to Treatment (SBIRT) to identify individuals at risk, fill gaps in services, and make referrals to specialty treatment when indicated. Major barriers to SBIRT include limited time among providers and low motivation to change among many patients.

Objective

The objective of this study was to develop and test the acceptability of a prototype of a mobile-delivered substance use risk intervention (SURI) for primary care patients and a clinical dashboard for providers that can address major barriers to SBIRT for risky drug use. The SURI delivers screening and feedback on SUD risk via mobile tools to patients at home or in the waiting room; for patients at risk, it also delivers a brief intervention based on the transtheoretical model of behavior change (TTM) to facilitate progress through the stages of change for quitting the most problematic drug and for seeking treatment if indicated. The prototype also delivers 30 days of stage-matched text messages and 4 Web-based activities addressing key topics. For providers, the clinical dashboard summarizes the patient’s SUD risk scores and stage of change data, and provides stage-matched scripts to guide in-person sessions.

Methods

A total of 4 providers from 2 federally qualified health centers (FQHCs) were recruited for the pilot test, and they in turn recruited 5 patients with a known SUD. Furthermore, 3 providers delivered dashboard-guided SBIRT sessions and completed a brief acceptability survey. A total of 4 patients completed a Web-based SURI session and in-person SBIRT session, accessed other program components, and completed 3 acceptability surveys over 30 days. Questions in the surveys were adapted from the National Cancer Institute’s Education Materials Review Form. Response options ranged from 1=strongly disagree to 5=strongly agree. The criterion for establishing acceptability was an overall rating of 4.0 or higher across items.

Results

For providers, the overall mean acceptability rating was 4.4 (standard deviation [SD] 0.4). Notably, all providers gave a rating of 5.0 for the item, “The program can give me helpful information about my patient.” For patients, the overall mean acceptability rating was 4.5 (SD 0.3) for the mobile- and provider-delivered SBIRT sessions and 4.0 (SD 0.4) for the text messages and Web-based activities. One highly rated item was “The program could help me make some positive changes” (4.5).

Conclusions

The SURI program and clinical dashboard, developed to reduce barriers to SBIRT in primary care, were well received by providers and patients.

[Pay for performance in dental care: A systematic narrative review of quality P4P models in dental care]

BACKGROUND

Pay for performance (P4P) links reimbursement to the achievement of quality objectives. Experiences with P4P instruments and studies on their effects are available for the inpatient sector. A systematic narrative review brings together findings concerning the use and the effects of P4P, especially in dental care.

METHODS

A systematic literature search in PubMed and the Cochrane Library for reimbursement models using quality indicators provided 77 publications. Inclusion criteria were: year of publication not older than 2007, dental sector, models of quality-oriented remuneration, quality of care, quality indicators. 27 publications met the inclusion criteria and were evaluated with regard to the instruments and effects of P4P. The database search was supplemented by a free search on the Internet as well as a search in indicator databases and portals. The results of the included studies were extracted and summarized narratively.

RESULTS

27 studies were included in the review. Performance-oriented remuneration is an instrument of quality competition. In principle, P4P is embedded in an existing remuneration system, i.e., it does not occur in isolation. In the United States, England and Scandinavia, models are currently being tested for quality-oriented remuneration in dental care, based on quality indicators. The studies identified by the literature search are very heterogeneous and do not yield comparable endpoints. Difficulties are seen in the reproducibility of the quality of dental care with regard to certain characteristics which still have to be defined as quality-promoting properties. Risk selection cannot be ruled out, which may have an impact on structural quality (access to care, coordination).

CONCLUSION

There were no long-term effects of P4P on the quality of care. In the short and medium term, adverse effects on the participants' motivation as well as shifting effects towards the private sector are described. A prerequisite for the functioning of P4P is the definition of clear targets and measuring parameters. Furthermore, evidence-based quality indicators have to be developed that validly depict quality differences. It is yet unknown whether P4P will have long-term effects or whether the quality of dental care will increase.

Dental opioid prescribing practices and risk mitigation strategy implementation: Identification of potential targets for provider-level intervention

BACKGROUND

Given the regular use of immediate-release opioids for dental pain management, as well as documented opioid misuse among dental patients, the dental visit may provide a viable point of intervention to screen, identify, and educate patients regarding the risks associated with prescription opioid misuse and diversion. The aims of this statewide survey of dental practitioners were to assess (a) awareness of the scope of prescription opioid misuse and diversion; (b) current opioid prescribing practices; (c) use of and opinions regarding risk mitigation strategies; and (d) use and perceived utility of drug monitoring programs.

METHODS

This cross-sectional study surveyed dentists (N = 87) participating in statewide professional and alumni organizations. Dentists were invited via e-mail and listserv announcement to participate in a one-time, online, 59-item, self-administered survey.

RESULTS

A majority of respondents reported prescribing opioids (n = 66; 75.8%). A minority of respondents (n = 38; 44%) reported regularly screening for current prescription drug abuse. Dentists reported low rates of requesting prior medical records (n = 5; 5.8%). Only 38% (n = 33) of respondents had ever accessed a prescription drug monitoring program (PDMP), and only 4 (4.7%) consistently used a PDMP. Dentists reporting prior training in drug diversion were significantly more likely to have accessed their PDMP, P < .01. Interest in continuing education regarding assessment of prescription drug abuse/diversion and use of drug monitoring programs was high.

CONCLUSIONS

Although most dentists received training related to prescribing opioids, findings identified a gap in existing dental training in the assessment/identification of prescription opioid misuse and diversion. Findings also identified gaps in the implementation of recommended risk mitigation strategies, including screening for prescription drug abuse, consistent provision of patient education, and use of a PDMP prior to prescribing opioids.

Screening for substance misuse in the dental care setting: findings from a nationally representative survey of dentists

AIMS

The dental setting is a potentially valuable venue for screening for substance misuse. Therefore, we assessed dentists' inquiry of substance misuse through their patient medical history forms and their agreement with the compatibility of screening as part of the dentists' professional role.

DESIGN

A nationally representative survey of general dentists using a sampling frame obtained from the American Dental Association Survey Center (November 2010-November 2011).

SETTING

United States of America.

PARTICIPANTS

A total of 1802 general dentists.

MEASUREMENTS

A 38-item survey instrument assessing the relationship between dentists' practice, knowledge, behaviors and attitudes with their query about substance misuse and their belief that such screening is part of their professional role.

FINDINGS

Dentists who accepted substance misuse screening as part of their professional role were more likely to query about misuse with their patients (85.8%) compared with those who did not accept such screening as part of their role (68.2%) (P < 0.001). Prior experience and knowledge about substance misuse were the strongest predictors of dentists' inquiry about patient substance use/misuse and acceptance of screening as part of their role in their clinical practice (P < 0.05).

CONCLUSION

While more than three-quarters of US dentists report that they ask their patients about substance misuse, two-thirds do not agree that such screening is compatible with their professional role.

Screening and Brief Interventions for Alcohol and Other Drug Use Among Pregnant Women Attending Midwife Obstetric Units in Cape Town, South Africa: A Qualitative Study of the Views of Health Care Professionals

INTRODUCTION

Despite the negative consequences of alcohol and other drug use during pregnancy, few interventions for pregnant women are implemented, and little is known about their feasibility and acceptability in primary health care settings in South Africa. As part of the formative phase of screening, brief intervention, and referral to treatment for substance use among women presenting for antenatal care, the present study explored health care workers' attitudes and perceptions about screening, brief intervention, and referral to treatment among this population.

METHODS

Forty-three health care providers at 2 public sector midwife obstetric units in Cape Town, South Africa, were interviewed using an open-ended, semistructured interview schedule designed to identify factors that hinder or support the implementation of screening, brief intervention, and referral to treatment for substance use in these settings. Transcribed interviews were analyzed using the framework approach.

RESULTS

Health care providers agreed that there is a substantial need for screening, brief intervention, and referral to treatment for substance use among pregnant women and believe such services potentially could be integrated into routine care. Several women-, staff-, and clinic-level barriers were identified that could hinder the successful implementation in antenatal services. These barriers included the nondisclosure of alcohol and other drug use, the intervention being considered as an add-on service or additional work, negative staff attitudes toward implementation of an intervention, poor staff communication styles such as berating women for their behavior, lack of interest from staff, time constraints, staff shortages, overburdened workloads, and language barriers.

DISCUSSION

The utility of screening, brief intervention, and referral to treatment for addressing substance use among pregnant women in public health midwife obstetric units was supported, but consideration will need to be given to addressing a variety of barriers that have been identified.

Dentists' self-perceived role in offering tobacco cessation services: results from a nationally representative survey, United States, 2010-2011

Introduction

Dental visits represent an opportunity to identify and help patients quit smoking, yet dental settings remain an untapped venue for treatment of tobacco dependence. The purpose of this analysis was to assess factors that may influence patterns of tobacco-use–related practice among a national sample of dental providers.

Methods

We surveyed a representative sample of general dentists practicing in the United States (N = 1,802). Multivariable analysis was used to assess correlates of adherence to tobacco use treatment guidelines and to analyze factors that influence providers’ willingness to offer tobacco cessation assistance if reimbursed for this service.

Results

More than 90% of dental providers reported that they routinely ask patients about tobacco use, 76% counsel patients, and 45% routinely offer cessation assistance, defined as referring patients for cessation counseling, providing a cessation prescription, or both. Results from multivariable analysis indicated that cessation assistance was associated with having a practice with 1 or more hygienists, having a chart system that includes a tobacco use question, having received training on treating tobacco dependence, and having positive attitudes toward treating tobacco use. Providers who did not offer assistance but who reported that they would change their practice patterns if sufficiently reimbursed were more likely to be in a group practice, treat patients insured through Medicaid, and have positive attitudes toward treating tobacco dependence.

Conclusion

Findings indicate the potential benefit of increasing training opportunities and promoting system changes to increase involvement of dental providers in conducting tobacco use treatment. Reimbursement models should be tested to assess the effect on dental provider practice patterns.

A comparison of cessation counseling received by current smokers at US dentist and physician offices during 2010-2011

OBJECTIVES

We compared patient-reported receipt of smoking cessation counseling from US dentists and physicians.

METHODS

We analyzed the 2010 to 2011 Tobacco Use Supplement of the Current Population Survey to assess receipt of smoking cessation advice and assistance by a current smoker from a dentist or physician in the past 12 months.

RESULTS

Current adult smokers were significantly less likely to be advised to quit smoking during a visit to a dentist (31.2%) than to a physician (64.8%). Among physician patients who were advised to quit, 52.7% received at least 1 form of assistance beyond the simple advice to quit; 24.5% of dental patients received such assistance (P < .05). Approximately 9.4 million smokers who visited a dentist in 2010 to 2011 did not receive any cessation counseling.

CONCLUSIONS

Our results indicate a need for intensified efforts to increase dentist involvement in cessation counseling. System-level changes, coupled with regular training, may enhance self-efficacy of dentists in engaging patients in tobacco cessation counseling.