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Janusz CB, Doan T, Gebremariam A, Rose A, Keels MA, Quinonez RB, Eckert G, Yanca E, Fontana M, Prosser LA. A Cost-Effectiveness Analysis of Population-Level Dental Caries Prevention Strategies in US Children. Acad Pediatr 2024; 24:765-775. [PMID: 38548263 PMCID: PMC11193632 DOI: 10.1016/j.acap.2024.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 01/31/2024] [Accepted: 02/06/2024] [Indexed: 05/12/2024]
Abstract
OBJECTIVE To improve oral health disparities and outcomes among US children impacted by dental caries, there is a need to understand the cost-effectiveness of a targeted, risk-based versus universal-based approach for caries prevention. METHODS Health and economic outcomes were simulated in a cohort of 50,000 US children aged 1-18 years, comparing current practice (CP) to risk-based-prevention (RBP) and prevention-for-all (PFA) strategies using health care sector and limited societal perspectives. Prevention included biannual oral health exams and fluoride varnish application, and one-time dental sealant placement. The primary outcome is the cost-effectiveness ratio (ICER), defined as the additional cost per quality-adjusted life year (QALY) gained when comparing each strategy to the next least costly one. RESULTS For RBP compared to CP, the ICER was US$83,000/QALY from the health care sector perspective; for PFA compared to RBP the ICER was US$154,000/QALY. Using a limited societal perspective that includes caregiver time spent attending dental or medical setting visits, RBP compared to CP yielded a ratio of $119,000/QALY and PFA compared to RBP was $235,000/QALY. Results were most sensitive to changes in the probability of pain from an episode of dental caries, costs for prevention and restoration, and the loss in health-related quality of life due to dental caries pain. Scenario analyses evaluating a reduced intensity of prevention services yielded lower ICERs. CONCLUSION Using a risk-based approach that identifies and targets children at increased risk for dental caries to guide the delivery of prevention services represents an economic value similar to other pediatric prevention programs.
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Affiliation(s)
- Cara B. Janusz
- Susan B. Meister Child Health and Evaluation Research (CHEAR) Center, Department of Pediatrics, University of Michigan, Ann Arbor MI
| | - Tran Doan
- Susan B. Meister Child Health and Evaluation Research (CHEAR) Center, Department of Pediatrics, University of Michigan, Ann Arbor MI
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor MI
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh PA (current)
| | - Acham Gebremariam
- Susan B. Meister Child Health and Evaluation Research (CHEAR) Center, Department of Pediatrics, University of Michigan, Ann Arbor MI
| | - Angela Rose
- Susan B. Meister Child Health and Evaluation Research (CHEAR) Center, Department of Pediatrics, University of Michigan, Ann Arbor MI
| | - Martha Ann Keels
- Department of Pediatrics, Duke University, Durham NC
- Division of Pediatric Dentistry and Public Health, University of North Carolina Adams School of Dentistry, Chapel Hill NC
| | - Rocio B. Quinonez
- Division of Pediatric Dentistry and Public Health, University of North Carolina Adams School of Dentistry, Chapel Hill NC
| | - George Eckert
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine and Richard M. Fairbanks School of Public Health, Bloomington IN
| | - Emily Yanca
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine and Richard M. Fairbanks School of Public Health, Bloomington IN
| | - Margherita Fontana
- Department of Cariology, Restorative Sciences & Endodontics, School of Dentistry, University of Michigan, Ann Arbor MI
| | - Lisa A. Prosser
- Susan B. Meister Child Health and Evaluation Research (CHEAR) Center, Department of Pediatrics, University of Michigan, Ann Arbor MI
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor MI
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Nelson S, Albert JM, Selvaraj D, Curtan S, Momotaz H, Bales G, Ronis S, Koroukian S, Rose J. Multilevel Interventions and Dental Attendance in Pediatric Primary Care: A Cluster Randomized Clinical Trial. JAMA Netw Open 2024; 7:e2418217. [PMID: 38980678 PMCID: PMC11234234 DOI: 10.1001/jamanetworkopen.2024.18217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/10/2024] Open
Abstract
Importance Untreated tooth decay is disproportionately present among low-income young children. While American Academy of Pediatrics (AAP) guidelines require pediatric clinicians to implement oral health care, the effectiveness of these oral health interventions has been inconclusive. Objective To test the effectiveness of multilevel interventions in increasing dental attendance and reducing untreated decay among young children attending well-child visits (WCVs). Design, Setting, and Participants The Pediatric Providers Against Cavities in Children's Teeth study is a cluster randomized clinical trial that was conducted at 18 pediatric primary care practices in northeast Ohio. The trial data were collected between November 2017 and July 2022, with data analyses conducted from August 2022 to March 2023. Eligible participants included Medicaid-enrolled preschoolers aged 3 to 6 years attending WCVs at participating practices who were enrolled at baseline (WCV 1) and followed-up for 2 consecutive examinations (WCV 2 and WCV 3). Interventions Clinicians in the intervention group received both the practice-level (electronic medical record changes to document oral health) and clinician-level (common-sense model of self-regulation theory-based oral health education and skills training) interventions. Control group clinicians received AAP-based standard oral health education alone. Main Outcomes and Measures Dental attendance was determined through clinical dental examinations conducted by hygienists utilizing International Caries Detection and Assessment System criteria and also from Medicaid claims data. Untreated decay was determined through clinical examinations. A generalized estimating equations (GEE) approach was used for both clinical examinations and Medicaid claims data. Results Eighteen practices were randomized to either intervention or control. Participants included 63 clinicians (mean [SD] age, 47.0 [11.3] years; 48 female [76.2%] and 15 male [23.8%]; 28 in the intervention group [44.4%]; 35 in the control group [55.6%]) and 1023 parent-child dyads (mean [SD] child age, 56.1 [14.0] months; 555 male children [54.4%] and 466 female children [45.6%]; 517 in the intervention group [50.5%]; 506 in the control group [49.5%]). Dental attendance from clinical examinations was significantly higher in the intervention group (170 children [52.0%]) vs control group (150 children [43.1%]) with a difference of 8.9% (95% CI, 1.4% to 16.4%; P = .02). The GEE model using clinical examinations showed a significant increase in dental attendance in the intervention group vs control group (adjusted odds ratio, 1.34; 95% CI, 1.07 to 1.69). From Medicaid claims, the control group had significantly higher dental attendance than the intervention group at 2 years (332 children [79.6%] vs 330 children [73.7%]; P = .04) but not at 3 years. A clinically but not statistically significant reduction in mean number of untreated decay was found in the intervention group compared with controls (B = -0.27; 95% CI, -0.56 to 0.02). Conclusions and Relevance In this cluster randomized clinical trial, children in the intervention group had better dental outcomes as was evidenced by increased dental attendance and lower untreated decay. These findings suggest that intervention group clinicians comprehensively integrated oral health services into WCVs. Trial Registration ClinicalTrials.gov Identifier: NCT03385629.
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Affiliation(s)
- Suchitra Nelson
- Department of Community Dentistry, Case Western Reserve University School of Dental Medicine, Cleveland, Ohio
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Jeffrey M Albert
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - David Selvaraj
- Department of Community Dentistry, Case Western Reserve University School of Dental Medicine, Cleveland, Ohio
| | - Shelley Curtan
- Department of Community Dentistry, Case Western Reserve University School of Dental Medicine, Cleveland, Ohio
| | - Hasina Momotaz
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Gloria Bales
- Department of Community Dentistry, Case Western Reserve University School of Dental Medicine, Cleveland, Ohio
| | - Sarah Ronis
- University Hospitals Rainbow Center for Child Health & Policy, Cleveland, Ohio
- Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Siran Koroukian
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Johnie Rose
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, Ohio
- Center for Community Health Integration, Case Western Reserve University School of Medicine, Cleveland, Ohio
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Bales GC, Curtan S, Agarwal N, Ronis SD, Nelson S. Adoption of New Oral Health Interventions in Primary Care: Qualitative Findings. AJPM FOCUS 2024; 3:100214. [PMID: 38586824 PMCID: PMC10997997 DOI: 10.1016/j.focus.2024.100214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Abstract
Introduction This is the first study to use the Common-Sense Model of Self-Regulation theory for oral health interventions in pediatric practices. The objective of this qualitative study was to assess adoption and implementation of theory-based multilevel oral health interventions, by clinicians (pediatricians and nurse practitioners) participating in a cluster randomized clinical trial, to create an oral health toolkit for widespread dissemination into pediatric practices. Methods Semistructured interviews were conducted at the conclusion of the cluster randomized clinical trial with 21 clinicians from 9 practices participating in the intervention arm. Clinicians in this arm received Common-Sense Model of Self-Regulation theory-based education and resources to deliver oral health interventions to parents/caregivers and document in electronic medical record. Semistructured interview questions were based on the Diffusion of Innovations Theory, assessing adoption and implementation. The interviews were coded using NVivo (QRS International) software. Main themes were identified using a thematic analysis approach. Results Five themes identified from the interviews included strengths of theory-based oral health training for clinicians, oral health resources to improve quality of care, considerations for efficient future implementation, financial considerations, and parent benefits and challenges. Clinicians found that the theory-based training and resources increased knowledge and confidence when addressing oral health with parents and required only ≤2 minutes in their workflow with no financial consequences. Clinicians reported an increase in oral health awareness among parents but suggested an overall need for more pediatric dentists. Conclusions The Common-Sense Model of Self-Regulation theory-based education and resources were well received by clinicians and perceived to be beneficial without adverse impact on workflow or practice finances. An online toolkit is planned because these oral health interventions can be successfully implemented and delivered in medical settings.
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Affiliation(s)
- Gloria C. Bales
- Department of Community Dentistry, School of Dental Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Shelley Curtan
- Department of Community Dentistry, School of Dental Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Neel Agarwal
- Department of Community Dentistry, School of Dental Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Sarah D. Ronis
- UH Rainbow Center for Child Health & Policy, Cleveland, Ohio
- Department of Pediatrics, School of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Suchitra Nelson
- Department of Pediatrics, School of Medicine, Case Western Reserve University, Cleveland, Ohio
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Wolf E, Ziesemer K, Van der Hijden E. Policy interventions to improve the accessibility and affordability of Dutch dental care. A scoping review of effective interventions. Heliyon 2024; 10:e28886. [PMID: 38707350 PMCID: PMC11066141 DOI: 10.1016/j.heliyon.2024.e28886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 02/26/2024] [Accepted: 03/26/2024] [Indexed: 05/07/2024] Open
Abstract
Caries and periodontitis remain prevalent in the Netherlands. Given the assumption that increasing the accessibility and affordability of dental care can improve oral health outcomes, policy interventions aimed at improving these aspects may contribute to better oral health. To identify possible solutions, this scoping review firstly identifies policy interventions from around the world that have effectively improved the accessibility or affordability of dental care. Secondly, this review discusses the potential of the policy interventions identified that are applicable to the Dutch healthcare sector specifically. A literature search was performed in four databases. Two reviewers independently screened all potentially relevant titles and abstracts before doing the same for the full texts. Only studies that had quantitatively evaluated the effectiveness of policy interventions aimed at improving the accessibility or affordability of dental care were included. 61 of the 1288 retrieved studies were included. Interventions were grouped into four categories. Capacity interventions (n = 5) mainly focused on task delegation. Coverage interventions (n = 25) involved the expansion of covered dental treatments or the group eligible for coverage. Managed care interventions (n = 20) were frequently implemented in school or community settings. Payment model interventions (n = 11) focused on dental reimbursement rates or capitation. 199 indicators were identified throughout the 61 included studies. Indicators were grouped into three categories: accessibility (n = 137), affordability (n = 21), and oral health status (n = 41). Based on the included studies, increasing managed care interventions for children and adding dental coverage to the basic health insurance plan for adults could improve access to dental care in the Netherlands. Due to possible spillover effects, it is advisable to investigate a combination of these policy interventions. Further research will be necessary for the development of effective policy interventions in practice.
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Affiliation(s)
- E.H. Wolf
- Talma Instituut, Vrije Universiteit Amsterdam, Faculty of Social Sciences, De Boelelaan 1105, 1081, HV Amsterdam, Noord-Holland, the Netherlands
| | - K.A. Ziesemer
- Amsterdam UMC, Vrije Universiteit Amsterdam, Medical Library, De Boelelaan 1117, 1081, HV Amsterdam, Noord-Holland, the Netherlands
| | - E.J.E. Van der Hijden
- Talma Instituut, Vrije Universiteit Amsterdam, Faculty of Social Sciences, De Boelelaan 1105, 1081, HV Amsterdam, Noord-Holland, the Netherlands
- Zilveren Kruis Health Insurance, Handelsweg 2, 3707 NH Zeist, Utrecht, the Netherlands
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Christian B, George A, Veginadu P, Villarosa A, Makino Y, Kim WJ, Masood M, Martin R, Harada Y, Mijares-Majini MC. Strategies to integrate oral health into primary care: a systematic review. BMJ Open 2023; 13:e070622. [PMID: 37407034 PMCID: PMC10367016 DOI: 10.1136/bmjopen-2022-070622] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 05/04/2023] [Indexed: 07/07/2023] Open
Abstract
OBJECTIVES Integration of oral health into primary care has been proposed as a primary healthcare approach for efficient and sustainable delivery of oral health services, and the effective management of oral diseases. This paper aimed to synthesise evidence on the effectiveness of strategies to integrate oral health into primary care. DESIGN Systematic review. DATA SOURCES MEDLINE, CINAHL, Embase, Scopus, ProQuest, Cochrane and Google Scholar were searched without date limits until the third week of June 2022. Reference lists of eligible studies were also searched. Experts in the field and existing professional networks were consulted. ELIGIBILITY CRITERIA Only studies that evaluated integration strategies were included in the review. Eligibility was restricted to English language studies published in academic peer-reviewed journals. DATA EXTRACTION AND SYNTHESIS Two reviewers independently extracted data and performed the risk of bias assessments. A narrative synthesis approach was used to report review findings. Heterogeneity among included studies precluded a meta-analysis. RESULTS The search identified 8731 unique articles, of which 49 were included in the review. Majority of the studies explored provision of oral healthcare by primary care professionals in primary care settings, where integration was primarily via training/education and/or policy changes. Most studies reported results favouring the integration strategy, such as improvements in referral pathways, documentation processes, operating efficiencies, number of available health staff, number of visits to non-dental primary care professionals for oral health issues, proportion of children receiving fluoride varnish applications/other preventive treatment, proportion of visits to an oral health professional and dental caries estimates. CONCLUSION The findings from this review demonstrate that the majority of identified strategies were associated with improved outcomes and can be used to inform decision-making on strategy selection. However, more research and evaluation are required to identify best practice models of service integration. PROSPERO REGISTRATION NUMBER CRD42020203111.
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Affiliation(s)
- Bradley Christian
- Population Oral Health, School of Dentistry, The University of Sydney, Sydney, New South Wales, Australia
- Australian Centre for Integration of Oral Health, School of Nursing & Midwifery, Western Sydney University, Liverpool, New South Wales, Australia
| | - Ajesh George
- Population Oral Health, School of Dentistry, The University of Sydney, Sydney, New South Wales, Australia
- Australian Centre for Integration of Oral Health, School of Nursing & Midwifery, Western Sydney University, Liverpool, New South Wales, Australia
- Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
| | - Prabhakar Veginadu
- Menzies School of Health Research, Alice Springs, Northern Territory, Australia
| | - Amy Villarosa
- Australian Centre for Integration of Oral Health, School of Nursing & Midwifery, Western Sydney University, Liverpool, New South Wales, Australia
- Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
- National Centre for Epidemiology and Population Health, The Australian National University, Canberra, Australian Capital Territory, Australia
| | - Yuka Makino
- Noncommunicable Diseases Team, World Health Organization Regional Office for Africa, Brazzaville, Congo
| | - Warrick Junsuk Kim
- World Health Organization Regional Office for the Western Pacific, Manila, Philippines
| | - Mohd Masood
- Department of Rural Clinical Sciences, La Trobe University - Bendigo Campus, Bendigo, Victoria, Australia
| | - Rachel Martin
- Australian Centre for Integration of Oral Health, School of Nursing & Midwifery, Western Sydney University, Liverpool, New South Wales, Australia
- Melbourne Dental School, The University of Melbourne, Melbourne, Victoria, Australia
| | - Yuriko Harada
- World Health Organization Regional Office for the Western Pacific, Manila, Philippines
- Oral Health Programme, Noncommunicable Diseases Department, World Health Organization, Geneva, Switzerland
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Foote T, Willis L, Lin TK. National Oral Health Policy and Financing and Dental Health Status in 19 Countries. Int Dent J 2023; 73:449-455. [PMID: 36948966 DOI: 10.1016/j.identj.2023.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 01/23/2023] [Accepted: 01/27/2023] [Indexed: 03/24/2023] Open
Abstract
OBJECTIVE Dental caries in permanent teeth is one of the most common health issues-despite being preventable in early stages-due to inadequate regulation of preventive dental services in many countries. This study evaluates the association between regulation of preventive dental services and oral health outcomes. METHODS This mixed-method study analysed data from 19 member countries of the Organisation for Economic Co-operation and Development (OECD). Oral health outcomes were measured using decayed missing and filled teeth (DMFT) indexes for children aged 12 to 18 years. Oral health expenditures were measured as a percentage of each country's gross domestic product (GDP). We conducted web-based research and systematically extracted and coded data on dental policy regarding children's preventive dental services. Preventive care was assessed based on legal policy mandating children receive preventive services, availability of free services for children, and regulation of the services provided. We assessed the relationship amongst oral health policy, outcomes, and expenditure using bivariate regression analysis. RESULTS The most common preventive policy category is the availability of free dental services for children (78.95%), and the least common is policy mandating dental services for children (26.32%). The oral health expenditure is correlated with DMFT index (-4.42, P < 0.05). The legal policy mandating dental services for children is correlated with DMFT index (-1.32, P < 0.05) and correlated with average oral health expenditure (0.16, P < 0.05). CONCLUSIONS A percentage increase in oral health expenditure is associated with a 4.42 reduction in DMFT. The existence of legal policy mandating dental care for children is associated with a 1.32 reduction in mean DMFT score and a 0.16% increase in oral health expenditure. These findings highlight the importance of preventive care and may aid policymaking and health system reforms.
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Affiliation(s)
- Tess Foote
- School of Dentistry, University of California, San Francisco, California, USA.
| | - Lauren Willis
- School of Dentistry, Columbia University, New York, New York, USA
| | - Tracy Kuo Lin
- Institute for Health & Aging, Department of Social and Behavioral Sciences, School of Nursing, University of California, San Francisco, California, USA
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Chen AYA, Opper IM, Dick AW, Stein BD, Kranz AM. Pediatric oral health services in Medicaid managed care and fee for service. THE AMERICAN JOURNAL OF MANAGED CARE 2023; 29:104-108. [PMID: 36811985 PMCID: PMC10100644 DOI: 10.37765/ajmc.2023.89319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
OBJECTIVES In 2008, Florida's Medicaid program began reimbursing medical providers for preventive oral health services (POHS) delivered to children aged 6 months to 42 months. We examine whether Medicaid comprehensive managed care (CMC) and fee for service (FFS) had different rates of POHS during pediatric medical visits. STUDY DESIGN Observational study using claims data (2009-2012). METHODS Using repeated cross-sections of 2009-2012 Florida Medicaid data for children 3.5 years or younger, we examined pediatric medical visits. We estimated a weighted logistic regression model to compare POHS rates among visits reimbursed by CMC and FFS Medicaid. The model controlled for FFS (vs CMC), years Florida had a policy allowing POHS in medical settings, an interaction between these 2 variables, and additional child- and county-level characteristics. Results are presented as regression-adjusted predictions. RESULTS Among 1,765,365 weighted well-child medical visits in Florida, POHS were included in 8.33% of CMC-reimbursed visits and 9.67% of FFS-reimbursed visits. Compared with FFS, CMC-reimbursed visits had a nonsignificant 1.29-percentage-point lower adjusted probability of including POHS (P = .25). When examining differences over time, although the POHS rate was 2.72 percentage points lower for CMC-reimbursed visits after 3 years of policy enactment (P = .03), rates were similar overall and increased over time. CONCLUSIONS POHS rates among pediatric medical visits in Florida were similar for visits paid via FFS and CMC, with low rates that increased modestly over time. Our findings are important because more children continue to be enrolled in Medicaid CMC.
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Affiliation(s)
- Annie Yu-An Chen
- RAND Corporation, 20 Park Plaza, 9th Floor, Ste 920, Boston, MA 02116.
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Kranz AM, Opper IM, Stein BD, Ruder T, Gahlon G, Sorbero M, Dick AW. Medicaid Payment and Fluoride Varnish Application During Pediatric Medical Visits. Med Care Res Rev 2022; 79:834-843. [PMID: 35130771 PMCID: PMC9357861 DOI: 10.1177/10775587221074766] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
All Medicaid programs pay for fluoride varnish applications during medical visits for infants and toddlers, but receipt of care varies considerably across states. Using 2006-2014 Medicaid data from 22 states, this study examined the association between Medicaid payment and receipt of fluoride varnish during pediatric medical visits. Among 3,393,638 medical visits, fewer than one in 10 visits included fluoride varnish. Higher Medicaid payment was positively associated with receipt of fluoride varnish during pediatric medical visits. As policymakers consider strategies for increasing young children's access to preventive oral health services, as well as consider strategies for balancing budgets, attention should be paid to the effects of provider payment on access to pediatric oral health services.
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Kranz AM, Gahlon G, Dick AW, Goff SL, Whaley C, Geissler KH. Variation in prices for an evidence-based pediatric preventive service. Health Serv Res 2022; 57:1175-1181. [PMID: 35467008 PMCID: PMC9441288 DOI: 10.1111/1475-6773.13995] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To examine variation in prices paid by private medical insurers for fluoride varnish applications in medical settings, a newly reimbursed service that few children receive. DATA SOURCES Private-insurance medical claims from Connecticut, Maine, New Hampshire, and Rhode Island (2016-2018). STUDY DESIGN We examined prices paid for fluoride varnish by private insurers and compared these to prices paid by Medicaid. DATA COLLECTION/EXTRACTION METHODS Private claims for fluoride varnish during medical visits for children aged 1-5 years. State Medicaid rates for fluoride varnish were obtained from the American Academy of Pediatrics. PRINCIPAL FINDINGS Prices paid for fluoride varnish by private insurers varied within and across states, ranging from less than $5 to $50. Median prices closely followed Medicaid rates in three of the four states. In states covering a package of fluoride varnish plus additional preventive oral health services during medical visits, combined Medicaid rates were nearly double the median price paid by private insurers. CONCLUSIONS Fluoride varnish is a recommended service, but few children receive it. Price variation may contribute to the low uptake of this service. Ensuring sufficient Medicaid and private insurance rates could increase fluoride varnish applications in medical settings and improve oral health.
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Affiliation(s)
| | | | | | - Sarah L. Goff
- School of Public Health & Health SciencesUniversity of Massachusetts AmherstAmherstMassachusettsUSA
| | | | - Kimberley H. Geissler
- School of Public Health & Health SciencesUniversity of Massachusetts AmherstAmherstMassachusettsUSA
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10
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Kranz AM, Goff SL, Dick AW, Whaley C, Geissler KH. Delivery of fluoride varnish during pediatric medical visits by rurality. J Public Health Dent 2022; 82:271-279. [DOI: 10.1111/jphd.12518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 01/04/2022] [Accepted: 03/22/2022] [Indexed: 12/01/2022]
Affiliation(s)
| | - Sarah L. Goff
- Department of Health Promotion and Policy School of Public Health and Health Sciences, University of Massachusetts Amherst Amherst Massachusetts USA
| | | | | | - Kimberley H. Geissler
- Department of Health Promotion and Policy School of Public Health and Health Sciences, University of Massachusetts Amherst Amherst Massachusetts USA
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11
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Trinh MV, Rhodes AL, Measey MA, Silva M. Dental visits in early life: patterns and barriers among Australian children. Aust N Z J Public Health 2022; 46:281-285. [PMID: 35298078 DOI: 10.1111/1753-6405.13224] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 11/01/2021] [Accepted: 01/01/2022] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVES To determine the early dental service utilisation patterns among Australian children and investigate barriers to care. METHOD Randomly selected adults aged 18 years and older who were parents or caregivers of children under 18 years of age completed an online nationally representative cross-sectional survey which was then analysed using descriptive statistics. RESULTS A total 2,048 parents of 3,660 children, including 1,179 aged between one and six years, completed the survey. Utilisation of professional dental care was low among children under six years of age, with just 118 (27.3%) at one year of age having ever received professional dental care. The most frequently reported reasons for lack of professional dental care were that the child was too young, their teeth were healthy or that the child would be scared. Cost was the fourth most frequently reported reason in young children. Only 459 (22.4%) parents knew that the first dental visit should be at one year of age or earlier. CONCLUSIONS Parents are unaware that children should have their first dental visit at 12 months, and therefore most children miss out on essential early health promotion. IMPLICATIONS FOR PUBLIC HEALTH As many parents are unaware of the importance of early dental visits, integrating and strengthening oral health promotion screening and referral within broader early childhood health services is essential.
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Affiliation(s)
- My-Van Trinh
- Melbourne Dental School, University of Melbourne, Melbourne, Victoria.,The Royal Dental Hospital of Melbourne, Carlton, Victoria.,Murdoch Children's Research Institute, Inflammatory Origins, Royal Children's Hospital Melbourne, Parkville, Victoria
| | - Anthea L Rhodes
- Department of General Medicine, Royal Children's Hospital Melbourne, Parkville, Victoria.,Department of Paediatrics, The University of Melbourne, Melbourne, Victoria.,Health Services Research Unit, Royal Children's Hospital Melbourne, Parkville, Victoria
| | - Mary-Anne Measey
- Health Services Research Unit, Royal Children's Hospital Melbourne, Parkville, Victoria
| | - Mihiri Silva
- Melbourne Dental School, University of Melbourne, Melbourne, Victoria.,Department of Paediatrics, The University of Melbourne, Melbourne, Victoria.,Murdoch Children's Research Institute, Inflammatory Origins, Royal Children's Hospital Melbourne, Parkville, Victoria.,Department of Dentistry, Royal Children's Hospital Melbourne, Parkville, Victoria
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Goff SL, Gahlon G, Geissler KH, Dick AW, Kranz AM. Variation in Current Guidelines for Fluoride Varnish Application for Young Children in Medical Settings in the United States. Front Public Health 2022; 10:785296. [PMID: 35309203 PMCID: PMC8930922 DOI: 10.3389/fpubh.2022.785296] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 01/26/2022] [Indexed: 11/15/2022] Open
Abstract
Background The United States Preventive Services Task Force recommends that medical providers apply fluoride varnish (FV) to the teeth of all children under 6 years of age, but fewer than 10% of eligible children receive FV as recommended. Prior studies suggest that variation in clinical guidelines is associated with low uptake of other evidence-based health-related interventions, but consistency of national guidelines for the delivery of FV in medical settings is unknown. Methods Eligible guidelines for application of FV in medical settings for children under 6 years of age were published in the past 10 years by national pediatric or dental professional organizations or by national public health entities. Guidelines were identified using the search terms fluoride varnish + [application; guidelines, or recommendations; children or pediatric; American Academy of Pediatrics (AAP); American Academy of Pediatric Dentistry] and a search of Guideline Central. Details of the guidelines were extracted and compared. Results Ten guidelines met inclusion criteria. Guidelines differed in terms of periodicity recommendations and whether FV was indicated for children with a dental home or level of risk of dental caries. Conclusion Numerous recommendations about FV delivery in medical settings are available to pediatric medical providers. Further study is warranted to determine whether the variation across current guidelines detected in this study may contribute to low FV application rates in medical settings.
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Affiliation(s)
- Sarah L. Goff
- University of Massachusetts Amherst School of Public Health and Health Sciences, Amherst, MA, United States
- *Correspondence: Sarah L. Goff
| | | | - Kimberley H. Geissler
- University of Massachusetts Amherst School of Public Health and Health Sciences, Amherst, MA, United States
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Goldstein EV, Dick AW, Ross R, Stein BD, Kranz AM. Impact of state-level training requirements for medical providers on receipt of preventive oral health services for young children enrolled in Medicaid. J Public Health Dent 2022; 82:156-165. [PMID: 33410186 PMCID: PMC9288108 DOI: 10.1111/jphd.12442] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 12/02/2020] [Accepted: 12/14/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Young children enrolled in Medicaid make few dental visits and have high rates of tooth decay. To improve access to care, state Medicaid programs have enacted policies encouraging nondental providers to deliver preventive oral health services (POHS) in medical offices. Policies vary by state, with some states requiring medical providers to obtain training prior to delivering POHS. Our objective was to test whether these training requirements were associated with higher rates of POHS for Medicaid-enrolled children <6 years. METHODS This study took advantage of a natural experiment in which policy enactment occurred across states at different times. We used Medicaid Analytic eXtract enrollment and claims data, public policy data, and Area Health Resource Files data. We examined an unweighted sample of 8,711,192 (45,107,240 weighted) Medicaid-enrolled children <6 years in 38 states from 2006 to 2014. Multivariable logistic regression models estimated the odds a child received POHS in a calendar year. Results are presented as adjusted probabilities. RESULTS Five or more years after policy enactment, the probability of a child receiving POHS in medical offices was 10.7 percent in states with training requirements compared to 5.0 percent in states without training requirements (P = 0.01). Findings were similar when receipt of any POHS in medical or dental offices was examined 5 or more years post-policy-enactment (requirement = 42.5 percent, no requirement = 33.6 percent, P < 0.001). CONCLUSIONS Medicaid policies increased young children's receipt of POHS and at higher rates in states that required POHS training. These results suggest that oral health training for nondental practitioners is a key component of policy success.
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Affiliation(s)
- Evan V. Goldstein
- RAND Corporation, Arlington, VA,Ohio State University, College of Public Health, Columbus, OH
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Repercussions of the COVID-19 pandemic on preventive health services in Brazil. Prev Med 2022; 155:106914. [PMID: 34953811 PMCID: PMC8716082 DOI: 10.1016/j.ypmed.2021.106914] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 10/12/2021] [Accepted: 12/12/2021] [Indexed: 12/20/2022]
Abstract
INTRODUCTION The increasing burden of non-communicable diseases and limited public financing are major challenges facing health care systems in Latin America. Although COVID-19 severely impacted the Brazilian health care system, it is crucial to further characterize the degree of disruption caused to public health efforts, in order to address and manage long term effects of this pandemic. We therefore quantified the demand for preventive and treatment services from the Brazilian Unified Health System (Sistema Único de Saúde/SUS) in 2020 to evaluate potential repercussions of COVID-19 in this setting. METHODS Using the SUS database, we compared preventative and treatment services rendered in 2020 to the same services rendered from 2017 to 19. We also evaluated the frequency of respiratory infection (RI) diagnoses during the pandemic, relative to the preceding years. RESULTS Compared to 2017-19, in 2020 non-urgent medical appointments decreased 1.4-fold (p = 0.0017), dental consultations 2.8-fold (p = 0.05), and immunization coverage 1.5 fold (p = 0.0005). The number of RI visits to SUS ambulatory care units in 2020 was 4.2 times higher than in preceding years (p = 0.0014), with a peak of 280,898 diagnoses in July 2020. CONCLUSION The COVID-19 pandemic appears to have led to a dramatic decline in preventative and treatment services provided by SUS to the Brazilian population. Our findings may aid decision-makers in formulating policies to increase the availability of outpatient services in the aftermath of the pandemic. Counter measures will be critical to avoid a resurgence in vaccine-preventable diseases and complications stemming from non-communicable, chronic health conditions.
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Ko A, Banks JT, Hill CM, Chi DL. Fluoride Prescribing Behaviors for Medicaid-Enrolled Children in Oregon. Am J Prev Med 2022; 62:e69-e76. [PMID: 34602339 PMCID: PMC8748272 DOI: 10.1016/j.amepre.2021.06.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 06/04/2021] [Accepted: 06/10/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION This study aims to examine physician and dentist fluoride prescription patterns and identify the factors associated with fluoride prescriptions for Medicaid-enrolled children. The hypothesis is that dentists will be the primary prescribers of fluoride and that caries risk factors will be associated with fluoride prescriptions. METHODS Data were analyzed for Oregon children aged 0-17 years enrolled in Medicaid for ≥300 days in both 2016 and 2017. The outcome variable was receiving a fluoride prescription in 2017. A 2-tailed chi-square test was used to assess fluoride prescribing differences between physicians and dentists. Multivariable logistic regression models were used to examine the likelihood of receiving a fluoride prescription in 2017 and to generate ORs. Model covariates included child's age, sex, race, ethnicity, Medicaid plan type, previous fluoride prescription, previous restorative dental treatment, and water fluoridation status. RESULTS Of 200,169 Medicaid-enrolled children, 6.7% (n=13,337) received fluoride prescriptions. Physicians were >3 times as likely to prescribe fluoride as dentists (73.4% vs 23.0%, p<0.001). Children with a history of fluoride prescriptions (OR=14.30, p<0.001) and any restorative dental treatment (OR=1.58, p<0.001) were significantly more likely to receive a fluoride prescription, whereas children living in areas with water fluoridation were significantly less likely (OR=0.50, p=0.01). CONCLUSIONS Physicians play an important role in prescribing fluoride to Medicaid-enrolled children, especially those at increased dental caries risk. Additional research is needed on strategies to ensure that all high-risk children have an opportunity to benefit from prescription fluoride.
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Affiliation(s)
- Alice Ko
- Department of Oral Health Sciences, University of Washington School of Dentistry, Seattle, Washington
| | - Jordan T Banks
- Department of Oral Health Sciences, University of Washington School of Dentistry, Seattle, Washington
| | - Courtney M Hill
- Department of Oral Health Sciences, University of Washington School of Dentistry, Seattle, Washington
| | - Donald L Chi
- Department of Oral Health Sciences, University of Washington School of Dentistry, Seattle, Washington.
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Clark MB, Braun PA. Promotion of Oral Health and Prevention of Dental Caries Among Children in Primary Care. JAMA 2021; 326:2139-2140. [PMID: 34874439 DOI: 10.1001/jama.2021.20396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Phillips LA, Coan LL, Wijesuriya UA. Oral health in primary care: Integration of enhanced oral health education in a nurse practitioner residency program. J Am Assoc Nurse Pract 2021; 34:624-630. [PMID: 34864784 DOI: 10.1097/jxx.0000000000000677] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 10/28/2021] [Indexed: 11/26/2022]
Abstract
ABSTRACT Access to oral health care is challenging, especially for vulnerable populations and those in rural and underserved areas. The purpose of this brief report is to discuss the implementation strategies of enhanced content in oral health educational materials and share results of acquisition of knowledge and confidence in oral health content by residents in a nurse practitioner residency program. The method included the use of 3 surveys of 34 questions administered at different time points measuring confidence levels and sustainability. Results showed the average level of confidence obtained in Posttest1 and in Posttest 2 after 6 months is greater than the pretest. The paired-sample t-test provides significant evidence of improving mean responses for Questions 10, 11, 16, and 32 in Posttest 1 (p-values: .04 each) and Questions 10, 17, 25, and 31 in Posttest2 (p-values: .04 each) compared with the pretest. In conclusion, the addition of enhanced oral health educational materials in our program resulted in improved knowledge and confidence in the residents to incorporate oral health care in their practices.
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Affiliation(s)
- Lori A Phillips
- College of Nursing and Health Professions, University of Southern Indiana
| | - Lorinda L Coan
- College of Nursing and Health Professions, University of Southern Indiana
| | - Uditha A Wijesuriya
- Pott College of Science, Engineering, and Education, University of Southern Indiana
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18
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Swankoski KE, Fishman PA, Chi DL, Wong ES. Effects of Medicaid expansion on self-reported use of dental services in socioeconomically vulnerable subgroups. J Public Health Dent 2021; 82:395-405. [PMID: 34467538 DOI: 10.1111/jphd.12473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 07/13/2021] [Accepted: 07/29/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Research suggests Medicaid expansion led to modest increases in the use of dental services among low-income adults, especially in states with more generous Medicaid dental benefits. We expand upon this research by examining whether the effect of Medicaid expansion differed across important socioeconomic subgroups. METHODS Using Behavioral Risk Factor Surveillance System data from 2012 to 2016, we employed a difference-in-differences framework to estimate the effect of Medicaid expansion on annual use of dental services overall and by whether states offered more-than-emergency Medicaid dental benefits. We used generalized linear mixed-effects model trees to estimate effects across socioeconomic subgroups (e.g., age, education, race, income). RESULTS The effect of Medicaid expansion varied by state's generosity of Medicaid dental coverage and combinations of socioeconomic subgroups. Overall, there was no significant association between Medicaid expansion and probability of using dental services (-0.1 pp percentage points [pp], p = 0.914). Medicaid expansion was associated with a modest increase in the probability of using dental services in states with more-than-emergency Medicaid dental benefits (2.3 pp, p < 0.001) and with a modest decrease in states with no or emergency-only benefits (-4.3 pp, p < 0.001). Among adults aged 21-35 without a high school diploma, Medicaid expansion was associated with an 8.1 pp (p = 0.003) increase in dental use probability, but there were no associated effects of Medicaid expansion for other subgroups. CONCLUSIONS While Medicaid expansion alone is not sufficient to ensure adults receive recommended dental care, some vulnerable subgroups appear to have benefited. Efforts to mitigate barriers to dental care may be needed to increase uptake of dental services by low-income adults.
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Affiliation(s)
- Kaylyn E Swankoski
- Department of Health Systems and Population Health, University of Washington, Seattle, Washington, USA
| | - Paul A Fishman
- Department of Health Systems and Population Health, University of Washington, Seattle, Washington, USA
| | - Donald L Chi
- Department of Health Systems and Population Health, University of Washington, Seattle, Washington, USA.,Department of Oral Health Sciences, University of Washington, Seattle, Washington, USA
| | - Edwin S Wong
- Department of Health Systems and Population Health, University of Washington, Seattle, Washington, USA
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Kranz AM, Opper IM, Estrada-Darley I, Goldstein E, Stein BD, Dick AW. Outcomes Associated With State Policies Enabling Provision of Oral Health Services in Medical Offices Among Medicaid-enrolled Children. Med Care 2021; 59:513-518. [PMID: 33973938 PMCID: PMC8117116 DOI: 10.1097/mlr.0000000000001532] [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] [Indexed: 11/25/2022]
Abstract
BACKGROUND To increase receipt of preventive oral health services (POHS), all state Medicaid programs have enacted policies to encourage nondental providers to deliver POHS in medical offices. This study examined if these Medicaid policies improved oral health, as measured by reductions in dental visits with treatment and preventable emergency department (ED) visits for nontraumatic dental conditions (NTDC). METHODS Using data on children aged 6 months to up to 6 years from 38 state Medicaid programs during 2006-2014, we used a generalized difference-in-differences estimation approach to examine the probability of a child having, in a year, any dental visits with caries-related treatment and any ED visits for NTDC, conditional on length of policy enactment. Models included additional child-level and county-level characteristics, state and year fixed effects, probability weights, and clustered standard errors. RESULTS Among a weighted sample of 45,107,240 child/year observations, 11.7% had any dental visits with treatment and 0.2% had any ED visits for NTDC annually. Children in states with and without medical POHS policies had similar odds of having any dental visits with treatment, regardless of length of policy enactment. Children in states with medical POHS policies enacted for one or more years had significantly greater odds of having any ED visits for NTDC (P<0.05). CONCLUSIONS State policies making POHS available in medical offices did not affect rates of dental visits with caries-related treatment, but were associated with increased rates of potentially avoidable ED visits for NTDC. Findings suggest that many young Medicaid-enrollees lack access to dentists.
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Affiliation(s)
| | | | | | - Evan Goldstein
- RAND Corporation, 1200 S. Hayes St. Arlington, VA, 22202
- Ohio State University, College of Public Health, 1841 Neil Ave. Columbus, OH, 43210
| | - Bradley D. Stein
- RAND Corporation, 4570 Fifth Ave. Suite 600, Pittsburgh, PA, 15213
| | - Andrew W. Dick
- RAND Corporation, 20 Park Plaza, 9 Floor, Suite 920, Boston, MA, 02116
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Selvaraj D, Curtan S, Copeland T, McNamee E, Debelnogich J, Kula T, Momotaz H, Nelson S. Caries disparities among Medicaid-enrolled young children from pediatric primary care settings. J Public Health Dent 2021; 81:131-142. [PMID: 33135213 PMCID: PMC8756375 DOI: 10.1111/jphd.12423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 09/09/2020] [Accepted: 10/16/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The objectives of this study are to determine the overall and racial differences in the extent of caries experience and to examine the association between child and parent/caregiver characteristics and caries among 3-6-year-old Medicaid-enrolled children. METHODS This study reports baseline cross-sectional data from a larger pragmatic clinical trial in pediatric primary care practices. Child-level clinical dental exams included decayed and filled teeth (dft) using ICDAS criteria and parent/caregiver questionnaire collected information on socio-demographics, child oral health behaviors, oral health related quality of life (OHQoL), and food environment. RESULTS A total of 1,024 parent/caregiver-child dyads participated in the study. The overall caries experience (dft) was 49 percent and untreated decay was 42 percent. Children who were Black had 1.3 and 1.2 times significantly higher frequency of untreated primary decay and caries experience compared to non-Black children. An overall logistic regression model predicted that race, increased age, receiving dental care in the past 12 months for a cavity/toothache, and lower caregiver OHQoL was significantly associated with increased odds of the child having caries. Non-Black caregivers with less education, whose child was older, and lower child OHQoL had increased odds of having a child with caries, but these same variables were not predictive for the Black children. CONCLUSIONS Racial disparities exist with respect to caries experience and untreated decay within a Medicaid-enrolled population of young children attending well-child visits. Pediatric primary care offices are well-positioned to provide dental surveillance and preventive care and could play an important role in decreasing oral health inequities.
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Affiliation(s)
- David Selvaraj
- Community Dentistry, Case Western Reserve University, Cleveland, OH, USA
| | - Shelley Curtan
- Community Dentistry, Case Western Reserve University, Cleveland, OH, USA
| | - Tashyana Copeland
- Community Dentistry, Case Western Reserve University, Cleveland, OH, USA
| | - Erin McNamee
- Community Dentistry, Case Western Reserve University, Cleveland, OH, USA
| | - Jelena Debelnogich
- Community Dentistry, Case Western Reserve University, Cleveland, OH, USA
| | - Taylor Kula
- Community Dentistry, Case Western Reserve University, Cleveland, OH, USA
| | - Hasina Momotaz
- Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, USA
| | - Suchitra Nelson
- Community Dentistry, Case Western Reserve University, Cleveland, OH, USA
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Shanmugavadivel G, Senthil Eagappan AR, Dinesh S, Balatandayoudham A, Sadish M, Kumar PP. Dental caries status of children receiving Highly active antiretroviral therapy (HAART) - A multicentric cross-sectional study in Tamil Nadu, India. J Family Med Prim Care 2020; 9:6147-6152. [PMID: 33681055 PMCID: PMC7928149 DOI: 10.4103/jfmpc.jfmpc_1032_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 09/09/2020] [Accepted: 09/20/2020] [Indexed: 11/21/2022] Open
Abstract
Background: Highly active antiretroviral therapy (HAART) has progressively improved the life expectancies in HIV positive children. These antiretroviral drugs could possibly have an influence on the oral health status. Different age groups of children under HAART with caries had implications in approach to dental treatment, which were attempted to be identified in the study. Aims/Objectives: The aim of the study was to assess the caries status among HIV positive children receiving HAART. To characterize the age group with high caries indices and treatment needs. Methods: A cross-sectional study was conducted among 313 HIV infected children aged 3–14 years receiving HAART from various ART centers Tamil Nadu, India. Dental examinations were performed and caries status of primary and permanent dentition was assessed using Decayed, Missing, and Filled teeth (DMFT)/Decayed, Missing, and Filled surface (DMFS) indices. Statistical Analysis: The one way ANOVA with post-hoc Tukey HSD test. Results: The mean deft/DMFT scores were 3.15 ± 2.72/2.07 ± 1.31 and defs/DMFS scores were 7.42 ± 5.90/4.30 ± 2.58. The caries incidence was significantly different across the three age groups compared. DMFT scores of 13 − 14 years age group were significantly higher than in the 3−6 years (P < 0.0000) and 7−12 years (P < 0.0001). Conclusion: A higher caries experience was present among children on HAART as compared to the general population in Tamil Nadu. A significant association with increasing age and DMFT scores was noted. Age groups of 13−14 had high caries prevalence than age groups of 3−6 and 7−12 years in given study population. The individualized treatment approaches based on the age groups is suggested.
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Affiliation(s)
- G Shanmugavadivel
- Department of Pedodontics, Sri Venkateshwaraa Dental College, Ariyur, Pondicherry, India
| | - A R Senthil Eagappan
- Department of Pedodontics and Preventive Dentistry, Chettinad Dental College and Research Institute, Kelambakkam, Tamil Nadu, India
| | - S Dinesh
- Department of Conservative Dentistry, Sri Venkateshwaraa Dental College, Ariyur, Pondicherry, India
| | - A Balatandayoudham
- Department of Oral Surgery, Sri Venkateshwaraa Dental College, Ariyur, Pondicherry, India
| | - M Sadish
- Department of Prosthodontics, Sri Venkateshwaraa Dental College, Ariyur, Pondicherry, India
| | - P Prasanna Kumar
- Department of Conservative Dentistry, Sri Venkateshwaraa Dental College, Ariyur, Pondicherry, India
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Khouja T, Burgette JM, Donohue JM, Roberts ET. Association between Medicaid expansion, dental coverage policies for adults, and children's receipt of preventive dental services. Health Serv Res 2020; 55:642-650. [PMID: 32700423 PMCID: PMC7518821 DOI: 10.1111/1475-6773.13324] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To examine whether low-income children's use of preventive dental services is linked to variation in state Medicaid policies that affect parents' access to dental care in Medicaid. DATA SOURCES Medical Expenditure Panel Survey (2011-2016), Area Health Resources File, and Medicaid adult dental coverage policies. STUDY DESIGN We conducted a quasi-experimental analysis using linked parent-child dyads in low-income families (≤125 percent of the Federal Poverty Level). We assessed whether expansions of Medicaid to low-income adults under the Affordable Care Act were associated with increases in the use of preventive dental services among low-income children when state Medicaid programs did vs did not cover these services for adults. PRINCIPAL FINDINGS Over the study period, 37.8 percent of low-income children received at least one annual preventive dental visit. We found no change in children's receipt of preventive dental care associated with Medicaid expansions in states that covered (1.26 percentage points; 95% CI: -3.74 to 6.27) vs did not cover preventive dental services for adults (3.03 percentage points; 95% CI: -2.76 to 8.81). (differential change: -1.76 percentage points; 95% CI: -8.09, 4.56). However, our estimates are imprecise, with wide confidential intervals that are unable to rule out sizable effects in either direction. CONCLUSION We did not find an association between Medicaid expansions with concurrent coverage of preventive dental services for adults and children's use of these services. Factors other than parental access to dental benefits through Medicaid may be more salient determinants of preventive dental care use among low-income children.
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Affiliation(s)
- Tumader Khouja
- Department of Health Policy and ManagementUniversity of Pittsburgh Graduate School of Public HealthPittsburghPennsylvania
| | - Jacqueline M. Burgette
- Departments of Dental Public Health and Pediatric Dentistry, School of Dental MedicineUniversity of PittsburghPittsburghPennsylvania
| | - Julie M. Donohue
- Department of Health Policy and ManagementUniversity of Pittsburgh Graduate School of Public HealthPittsburghPennsylvania
| | - Eric T. Roberts
- Department of Health Policy and ManagementUniversity of Pittsburgh Graduate School of Public HealthPittsburghPennsylvania
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Nelson S, Slusar MB, Curtan S, Selvaraj D, Hertz A. Formative and Pilot Study for an Effectiveness-Implementation Hybrid Cluster Randomized Trial to Incorporate Oral Health Activities into Pediatric Well-Child Visits. Dent J (Basel) 2020; 8:E101. [PMID: 32882958 PMCID: PMC7559918 DOI: 10.3390/dj8030101] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 08/05/2020] [Accepted: 08/28/2020] [Indexed: 12/04/2022] Open
Abstract
Background: Dental caries in pediatric patients are noted to have broad impacts on systemic health and well-being. Thus, utilizing an effectiveness-implementation hybrid I design, the Pediatric Providers Against Cavities in Children's Teeth (PACT) trial is investigating multi-level interventions at the practice (incorporation of oral health in electronic medical record [EMR]) and provider levels (theory-based didactic and skills training to communicate oral health facts to parent/caregiver, give a prescription to see a dentist and a list of area dentists) to increase dental utilization among 3 to 6 year old Medicaid-enrolled children attending well-child visits (WCV). The formative and pilot work for the larger main trial are presented. Methods: Formative work-Focus groups with 26 participants (Community leaders, providers, parent/caregivers); and key informant interviews with practice leadership (n = 4). Topics discussed were: core oral health (OH) information to communicate at WCVs and study logistics. Transcripts were coded and analyzed using Atlas.ti; Pilot study was refined using the formative findings and was conducted at two pediatric practices to test the implementation of: the provider didactic and skills training curriculum; EMR incorporation of four OH questions; logistics of incorporating OH activities at a WCV; and parent/caregiver recruitment. Results: Formative work showed that providers and parent/caregivers required knowledge of dental caries, and a list of area Medicaid-accepting dentists. Providers and practice leadership advised on the logistics of incorporating oral health into WCVs. All groups suggested asking parent/caregivers their preferred method of contact and emphasizing importance of OH to motivate participation. Utilizing these findings, the curriculum and protocol was revised. The pilot study in two practices successfully implemented the protocol as follows: all seven providers were trained in two 45 min didactic education and skills session; incorporation of OH questions into practices EMR; recruited 86 child-parent dyads (95% participation) at the WCV; providers delivered the OH intervention to parent/caregivers in <2 min and 90% completed EMR documentation of OH questions. These findings were instrumental in finalizing the main PACT trial in 18 practices. The RE-AIM framework is used in the main trial to collect effectiveness and implementation measures at baseline and follow-up visits. Conclusions: The formative and pilot findings were instrumental in refining the OH intervention and protocol which has resulted in successful implementation of the main trial. Trial Registration: Clinical trials.gov, Registered 9 November 2017, NCT03385629.
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Affiliation(s)
- Suchitra Nelson
- Department of Community Dentistry, Case Western Reserve University School of Dental Medicine, Cleveland, OH 44106-4905, USA; (S.C.); (D.S.)
| | - Mary Beth Slusar
- Department of Sociology, California State University Northridge, Northridge, CA 91330, USA;
| | - Shelley Curtan
- Department of Community Dentistry, Case Western Reserve University School of Dental Medicine, Cleveland, OH 44106-4905, USA; (S.C.); (D.S.)
| | - David Selvaraj
- Department of Community Dentistry, Case Western Reserve University School of Dental Medicine, Cleveland, OH 44106-4905, USA; (S.C.); (D.S.)
| | - Andrew Hertz
- University Hospitals Cleveland Medical Center, Cleveland, OH 44106, USA;
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Kranz A, Rozier R, Stein B, Dick A. Do Oral Health Services in Medical Offices Replace Pediatric Dental Visits? J Dent Res 2020; 99:891-897. [PMID: 32325007 PMCID: PMC7346745 DOI: 10.1177/0022034520916161] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
In the United States, state Medicaid programs pay for medical and dental care for children from low-income families and support nondental primary care providers delivering preventive oral health services (POHS) to young children in medical offices ("medical POHS"). Despite the potential of these policies to expand access to care, there is concern that they may replace dental visits with medical POHS. Using Medicaid claims from 38 states from 2006 to 2014, we conducted a repeated cross-sectional study and used linear probability regression to estimate the association between the annual proportion of children in a county receiving medical POHS and the probability that a child received 1) dental POHS and 2) a dental visit in a given year. Models included county and year fixed effects and controlled for child- and county-level factors, and standard errors were clustered at the state level. In a weighted population of 45.1 million child-years (age, 6 mo to <6 y), we found no significant nor substantively important association between the proportion of children in a county receiving medical POHS and the probability that a child received dental POHS or a dental visit. Additionally, we found an almost zero probability (<0.001) that the reduction in dental POHS was at least as large as the expansion in medical POHS (full substitution) and a 0.50 probability that increased medical POHS was associated with an increase in dental POHS of at least 6.6% of the expansion of medical POHS. Results were similar when receipt of dental visits was examined. This study failed to find evidence that medical POHS replaced dental visits for young children enrolled in Medicaid and, in fact, offers evidence that increased medical POHS was associated with increased utilization of dental care. Given lower-than-desired rates of dental visits for this population, delivery of medical POHS should be expanded.
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Affiliation(s)
| | - R.G. Rozier
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
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Kim P, Daly JM, Berkowitz S, Levy BT. Use of the Fluoride Varnish Billing Code in a Tertiary Care Center Setting. J Prim Care Community Health 2020; 11:2150132720913736. [PMID: 32193976 PMCID: PMC7092652 DOI: 10.1177/2150132720913736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Introduction: Dental caries is the most common chronic disease in children from birth through 5 years of age. Application of fluoride varnish (FV) is recommended for children younger than 6 years every 3 to 6 months by the United States Preventive Services Task Force. The purposes of this study were to (1) assess use and reimbursement of Current Dental Terminology (CDT) D1206 and Current Procedural Terminology (CPT) 99188 codes, which are the billing codes for FV application; (2) determine when and by whom each FV code was used; and (3) summarize the associated clinical notes. Methods: Using the electronic medical record data warehouse from a single tertiary teaching hospital and its affiliated primary care clinics, the dates of service, departments, provider names, and patient identifiers associated with codes CDT D1206 and CPT 99188 were collected. The content of clinical notes was reviewed and summarized. The study period was from May 1, 2009 through May 17, 2019. Results: During the 10-year time period, CDT D1206 was used 5 times and CPT 99188 was used 35 times. FV was applied exclusively during well-child visits. Only pediatricians, and no family physicians, applied FV in this setting. Discussion: A single pediatrician championing for FV application increased both the completion of procedure and the appropriate billing in 2019. Conclusion: FV application has been likely underutilized in this Midwestern tertiary teaching hospital and its affiliated clinics. For both family medicine and pediatric offices, an advocate for caries prevention is likely needed for successful implementation of FV application at well-child visits.
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Affiliation(s)
- Peter Kim
- Genesis Health System, Davenport, IA, USA.,University of Iowa, Iowa City, IA, USA
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Pateman K, Huang J, Ford PJ, Mutch A, Freeman CR, Taing MW. Consumer perspectives on pharmacy staff roles in providing oral health services in Australia. HEALTH & SOCIAL CARE IN THE COMMUNITY 2020; 28:524-532. [PMID: 31659804 DOI: 10.1111/hsc.12885] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Revised: 09/27/2019] [Accepted: 10/14/2019] [Indexed: 06/10/2023]
Abstract
Australian and international findings report pharmacy staff are motivated to expand and undertake new roles in public health and expressed a strong interest in providing oral healthcare services to the community. We sought to describe consumer experiences within primary oral healthcare, and views about pharmacy staff roles and boundaries in providing oral health services as perceived by a sample of consumers living within metropolitan Australia. Sampling occurred purposively to enable diverse perspectives on the topic. Socioeconomic status, as defined by the Socio-Economic Index for Areas, was used as the primary criteria to stratify focus group recruitment. Thematic, in-depth analysis of focus group discussions was carried out. In all, 34 participants took part in six focus groups, held in metropolitan settings in Queensland, Australia. Findings show that consumers supported pharmacy staff performing non-invasive oral health services including providing oral health education and advice, reviewing medications and recommending evidence-based medications. As services became more invasive (i.e., oral screening and fluoride application), questions and concerns were raised around the appropriateness of the community pharmacy setting and the level of training of pharmacy staff to provide these services. This study identifies the need to support greater integration of oral healthcare roles by community pharmacy staff. Future innovative and collaborative research involving additional stakeholder groups are necessary to explore, develop and test the feasibility and effectiveness of pharmacy-led oral healthcare models.
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Affiliation(s)
- Kelsey Pateman
- School of Dentistry, The University of Queensland, Brisbane, Qld, Australia
| | - Jialin Huang
- School of Pharmacy, The University of Queensland, Brisbane, Qld, Australia
| | - Pauline J Ford
- School of Dentistry, The University of Queensland, Brisbane, Qld, Australia
| | - Allyson Mutch
- School of Public Health, The University of Queensland, Brisbane, Qld, Australia
| | - Christopher R Freeman
- School of Pharmacy, The University of Queensland, Brisbane, Qld, Australia
- Centre for Optimising Pharmacy Practice-based Excellence in Research, The University of Queensland, Brisbane, Qld, Australia
| | - Meng-Wong Taing
- School of Pharmacy, The University of Queensland, Brisbane, Qld, Australia
- Centre for Optimising Pharmacy Practice-based Excellence in Research, The University of Queensland, Brisbane, Qld, Australia
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Kranz AM, Ross R, Sorbero M, Kofner A, Stein BD, Dick AW. Impact of a Medicaid policy on preventive oral health services for children with intellectual disabilities, developmental disabilities, or both. J Am Dent Assoc 2020; 151:255-264.e3. [PMID: 32081299 DOI: 10.1016/j.adaj.2019.12.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 11/06/2019] [Accepted: 12/01/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND Integrating preventive oral health services (POHS) into medical offices may ease access to care for children with intellectual and developmental disabilities (IDD). The authors examined the impact of state policies allowing delivery of POHS in medical offices on receipt of POHS among Medicaid enrollees with IDD. METHODS The authors used 2006 through 2014 Medicaid data for children with IDD aged 6 months through 5 years from 38 states. IDD were defined using 14 condition codes from Centers for Medicare & Medicaid Services Chronic Conditions Data Warehouse. The length of the state's medical POHS policy (no policy, < 1 year, 1 year, 2 years, 3 years, or ≥ 4 years) was interacted with an indicator that the child was younger than 3 years. The authors used logistic regression models to estimate the likelihood that a child received POHS in a medical office or in a medical or dental office in a given year. RESULTS Among 447,918 children with IDD, 1.6% received POHS in medical offices. Children younger than 3 years in states with longer-enacted policies had higher rates of receiving POHS. For example, the predicted probability of receiving POHS was 40.6% (95% confidence interval, 36.3% to 44.9%) for children younger than 3 years in states with a medical POHS policy for more than 4 years compared with 30.6% (95% confidence interval, 27.8% to 33.5%) for children in states without a policy. CONCLUSIONS State Medicaid policies allowing delivery of POHS in medical offices increased receipt of POHS among Medicaid-enrolled children with IDD who were younger than 3 years. PRACTICAL IMPLICATIONS Few children with IDD receive POHS in any setting. Efforts are needed to reduce barriers to POHS for publicly insured children with IDD.
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Scherrer CR, Naavaal S. Cost-Savings of Fluoride Varnish Application in Primary Care for Medicaid-Enrolled Children in Virginia. J Pediatr 2019; 212:201-207.e1. [PMID: 31253412 DOI: 10.1016/j.jpeds.2019.05.026] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Revised: 04/23/2019] [Accepted: 05/10/2019] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To determine the cost-benefit of fluoride varnish application during pediatric well-visits for the Medicaid/Children's Health Insurance Program population in Virginia (VA) from a Medicaid payer perspective. To provide initial cost estimates from the primary care provider (PCP) perspective. STUDY DESIGN A systematic search of recent literature was completed to obtain input data for a Monte Carlo cost-benefit simulation and for the fluoride varnish application time, labor, and materials costs for PCPs. The analysis was conducted from a Medicaid perspective; costs and savings related to fluoride varnish application in primary dentition through 7.5 years were calculated for all Medicaid-eligible children up to 3 years of age in VA. Sensitivity analysis was performed to mitigate the effects of parameter uncertainty. RESULTS Delivering fluoride varnish to all children <3 years old in VA who annually receive well-visits through Medicaid but did not receive fluoride varnish at those visits would reduce the percent of 7.5 year olds with decay from 63.2% to 39.8%. Accounting for averted restoration cost, PCP fluoride varnish application would save $75.32 per child, or a total population savings of almost $2 million/year for VA Medicaid. From the PCP perspective, the Medicaid reimbursement rate for fluoride varnish is 3.8-12.0 times the direct fluoride varnish application cost (labor and materials). CONCLUSIONS Application of fluoride varnish by a PCP to children under 3 years of age is cost-saving in this study population. Costs to provide fluoride varnish from the PCP perspective are favorable compared with the Medicaid reimbursement, but additional studies on optimizing fluoride varnish application into the well-visit workflow are needed.
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Affiliation(s)
- Christina R Scherrer
- Department of Systems and Industrial Engineering, Kennesaw State University, Marietta, GA.
| | - Shillpa Naavaal
- Department of Oral Health Promotion and Community Outreach, School of Dentistry, Virginia Commonwealth University, Richmond, VA; Oral Health in Childhood and Adolescence Core, Institute for Inclusion, Inquiry and Innovation, Virginia Commonwealth University, Richmond, VA
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Meyer BD, Wang R, Steiner MJ, Preisser JS. The Effect of Physician Oral Health Services on Dental Use and Expenditures under General Anesthesia. JDR Clin Trans Res 2019; 5:146-155. [PMID: 31434532 DOI: 10.1177/2380084419870128] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Despite early evidence touting the effectiveness of physician-provided oral health services (POHS), recent evidence suggests these services might have little impact on caries-related outcomes in children. General anesthesia (GA) is often used to treat early childhood caries and may be considered the most extreme utilization outcome. We sought to assess the impact of POHS utilization on dental GA utilization and expenditures. METHODS We used the Medicaid claims of a birth cohort of children born in 2008 in North Carolina (N = 32,558) to determine the impact of POHS on dental utilization and expenditures under GA for individual children. Children were followed until their eighth birthday. We analyzed the association of the number of prior POHS visits with visit-specific outcomes of dental treatment under GA using population-averaged models fit with generalized estimating equations with exchangeable working correlation structure. RESULTS Children with 2 or more previous POHS visits had reduced odds of GA (odds ratio [OR] = 0.93; confidence interval [CI], 0.87-0.99; P = 0.029) and expenditures ($114; CI,-$152.61 to -$75.19; P < 0.001) compared to those without physician-provided oral health visits, adjusting for age, sex, race/ethnicity, and geographic residence. Dental expenditures did not differ between POHS and non-POHS subjects at non-GA visits. CONCLUSIONS POHS decreased the odds of having dental GA treatment and dental expenditures at GA visits. The role of physicians in oral health care can reduce the impact on the most severe outcome-treatment under general anesthesia. KNOWLEDGE TRANSFER STATEMENT The results of this study have important financial implications for state Medicaid programs and disease management programs trying to mitigate the costs of treating early childhood caries under general anesthesia. Children who receive physician oral health care are less likely to use and more likely to save money on general anesthesia to complete dental treatment.
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Affiliation(s)
- B D Meyer
- Department of Pediatric Dentistry, School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - R Wang
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - M J Steiner
- Department of Pediatrics, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - J S Preisser
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Olatosi OO, Onyejaka NK, Oyapero A, Ashaolu JF, Abe A. Age and reasons for first dental visit among children in Lagos, Nigeria. Niger Postgrad Med J 2019; 26:158-163. [PMID: 31441453 DOI: 10.4103/npmj.npmj_60_19] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND An early first dental clinic appointment offers the prospect of prompt preventative care and parental education regarding the oral health of the child. The evidence-based recommendation by dental professionals all over the world is that a child should visit a dentist before or by 1 year of age. AIM This study aimed to determine the chronological age at and the purpose for a first dental clinic visit amongst children aged 16 years and below attending the Paediatric Dental Clinic at the Lagos University Teaching Hospital (LUTH). MATERIALS AND METHODS This was a retrospective study conducted amongst children who attended the Paediatric Dental Clinic at the LUTH between January 2017 and December 2018. Data on age at first dental visit, reasons for attending and other information relevant to the study were collected. Descriptive statistics and Chi-square analysis were conducted, and the level of significance was set at P < 0.05. RESULTS A total of 1157 children were studied, comprising 580 (50.5%) males and 577 (49.9%) females. Their mean age on their first dental visit was 7.9 ± 3.7 years. Most of the children (31.4%) had their first dental visits at 7 and 9 years, and 0.8% of the children had their first dental visit below the age of 1 year. The most common reason for visiting the dental clinic was dental pain (33.1%). A higher proportion of the children (911 [79.0%]) had their first dental visit for therapeutic purposes, whereas 246 (21.0%) children visited the dental clinic for preventive care. Sex and age at first dental visit were statistically significantly associated with the reason for attendance (P < 0.001). CONCLUSION Most children had their first dental visit between the ages of 7 and 9 years, mainly because of pain. It is necessary to create more awareness among parents/caregivers and to establish the concept of dental home.
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Affiliation(s)
- Olubukola Olamide Olatosi
- Department of Child Dental Health, Faculty of Dental Sciences, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Nneka Kate Onyejaka
- Department of Child Dental Health, University of Nigeria, Ituku, Enugu, Nigeria
| | - Afolabi Oyapero
- Department of Preventive Dentistry, Faculty of Dentistry, Lagos State University College of Medicine, Lagos, Nigeria
| | - Joseph Femi Ashaolu
- Department of Child Dental Health, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Adesuwa Abe
- Department of Child Dental Health, Lagos University Teaching Hospital, Lagos, Nigeria
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Geiger CK, Kranz AM, Dick AW, Duffy E, Sorbero M, Stein BD. Delivery of Preventive Oral Health Services by Rurality: A Cross-Sectional Analysis. J Rural Health 2019; 35:3-11. [PMID: 30537073 PMCID: PMC6298795 DOI: 10.1111/jrh.12340] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 10/10/2018] [Accepted: 10/30/2018] [Indexed: 12/01/2022]
Abstract
PURPOSE Integrating oral health care into primary care has been promoted as a strategy to increase delivery of preventive oral health services (POHS) to young children, particularly in rural areas where few dentists practice. Using a multistate sample of Medicaid claims, we examined a child's odds of receiving POHS in a medical office by county rurality. METHODS We used 2012-2014 Medicaid Analytic extract claims data for 6,275,456 children younger than 6 years in 39 states that allowed Medicaid payment for POHS in medical offices. We used county-level characteristics from the Area Health Resources Files, including a 3-level measure of county rurality. We used logistic regression to estimate a child's odds of receiving POHS in a medical office by county rurality, while controlling for other patient and county characteristics. FINDINGS POHS in medical offices were received by 7.8% of children. Rates of POHS in medical offices were higher in metropolitan (metro) counties (8.4%) than nonmetro adjacent to metro (5.8%) and nonmetro not adjacent to metro (4.3%). In adjusted analysis, children living in nonmetro not adjacent to metro (OR = 0.79, 95% CI: 0.64-0.99) and adjacent to metro counties (OR = 0.70, 95% CI: 0.59-0.82) were significantly less likely to receive POHS in medical offices than children living in metro counties. CONCLUSIONS In this study of POHS in medical offices among young Medicaid-enrolled children, we found POHS rates were lowest in nonmetro counties. Given barriers to dental care in rural areas, states should take additional steps beyond allowing Medicaid reimbursement to increase delivery of POHS in medical offices.
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Affiliation(s)
- Caroline K. Geiger
- RAND Corporation Pittsburgh, Pittsburgh, Pennsylvania
- Harvard University Graduate School of Arts and Sciences, Cambridge, Massachusetts
| | | | | | - Erin Duffy
- Pardee RAND Graduate School, Santa Monica, California
| | - Mark Sorbero
- RAND Corporation Pittsburgh, Pittsburgh, Pennsylvania
| | - Bradley D. Stein
- RAND Corporation Pittsburgh, Pittsburgh, Pennsylvania
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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Kranz AM, Duffy E, Dick AW, Sorbero M, Rozier RG, Stein BD. Impact of Medicaid Policy on the Oral Health of Publicly Insured Children. Matern Child Health J 2019; 23:100-108. [PMID: 30032444 PMCID: PMC6324972 DOI: 10.1007/s10995-018-2599-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Objective Fluoride varnish (FV) applications among non-dentist primary care providers has increased due to state Medicaid policies. In this study we examine the impact of FV policies on the oral health of publicly insured children aged 2-6 years old. Methods Using three waves of the National Survey of Children's Health (2003, 2007, 2011/12), we used a logistic regression model with state and year fixed effects, adjusting for relevant child characteristics, to examine the association between years since a state implemented a FV policy and the odds of a publicly insured child having very good or excellent teeth. We compared children with public insurance in states with FV policies to children with public insurance in states without FV policies, controlling for the same difference among children with private insurance who were unlikely to be affected by Medicaid FV policies. Results Among 68,890 children aged 2-6 years, 38% had public insurance. Compared to privately insured children, publicly insured children had significantly lower odds of having very good or excellent teeth [odds ratio (OR) 0.70, 95% CI 0.62-0.81]. Publicly insured children in states with FV policies implemented for four or more years had significantly greater odds of having very good or excellent teeth (OR 1.28, 95% CI 1.03-1.60) compared to publicly insured children in states without FV policies. Conclusions for Practice State policies supporting non-dental primary care providers application of FV were associated with improvements in oral health for young children with public insurance.
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Affiliation(s)
| | - Erin Duffy
- Pardee RAND Graduate School, 1776 Main Street, Santa Monica, CA, 90401, USA
| | - Andrew W Dick
- RAND, 20 Park Plaza, 9th Floor, Suite 920, Boston, MA, 02116, USA
| | - Mark Sorbero
- RAND, 4570 Fifth Avenue, Suite 600, Pittsburgh, PA, 15213, USA
| | - Richard Gary Rozier
- University of North Carolina Gillings School of Global Public Health, 135 Dauer Drive, Chapel Hill, NC, 27599, USA
| | - Bradley D Stein
- RAND, 4570 Fifth Avenue, Suite 600, Pittsburgh, PA, 15213, USA
- University of Pittsburgh School of Medicine, 200 Lothrop Street, Pittsburgh, PA, 15213, USA
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Fontana M, Eckert GJ, Keels MA, Jackson R, Katz B, Levy BT, Levy SM. Fluoride Use in Health Care Settings: Association with Children's Caries Risk. Adv Dent Res 2018; 29:24-34. [PMID: 29355412 DOI: 10.1177/0022034517735297] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Expanded partnership with the medical community is an important strategy for reducing dental caries disparities. The purpose of this study was to assess the relationship between fluoride (F) "in office" (drops/tablets and/or varnish), as prescribed or applied by a health care professional by age 1 y, and 1) caries development and 2) presence of other caries risk factors or mediators (e.g., socioeconomic status). Child-primary caregiver (PCG) pairs ( N = 1,325) were recruited in Indiana, Iowa, and North Carolina as part of a longitudinal cohort study to validate a caries risk tool for primary health care settings. PCGs completed a caries risk questionnaire, while children received caries examinations per the criteria of the International Caries Detection and Assessment System at ages 1, 2.5, and 4 y. Baseline responses regarding children's history of F in office were tested for association with other caries risk variables and caries experience at ages 2.5 and 4 y via generalized estimating equation models applied to logistic regression. The sample was 48% female, and many children (61%) were Medicaid enrolled. The prevalence of cavitated caries lesions increased from 7% at age 2.5 y to 25% by age 4 y. Children who received F in office were likely deemed at higher caries risk and indeed were significantly ( P < 0.01) more likely to develop cavitated caries lesions by ages 2.5 and 4 y, even after F application (odds ratios: 3.5 and 2.3, respectively). Factors significantly associated with receiving F included the following: child being Medicaid enrolled, not having an employed adult in the household, child and PCG often consuming sugary drinks and snacks, and PCG having recent caries experience. Increased F in office from a health care provider by age 1 y was associated with known caries risk factors. Most (69%) children had never been to the dentist, suggesting that risk factors could be alerting medical providers and/or parents, thereby affecting in-office F recommendations. Differences among states could also be related to state-specific F-varnish reimbursement policies (ClinicalTrials.gov NCT01707797).
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Affiliation(s)
- M Fontana
- 1 University of Michigan, Ann Arbor, MI, USA
| | - G J Eckert
- 2 Indiana University, Indianapolis, IN, USA
| | | | - R Jackson
- 2 Indiana University, Indianapolis, IN, USA
| | - B Katz
- 2 Indiana University, Indianapolis, IN, USA
| | - B T Levy
- 4 University of Iowa, Iowa City, IA, USA
| | - S M Levy
- 4 University of Iowa, Iowa City, IA, USA
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Atchison KA, Weintraub JA, Rozier RG. Bridging the dental-medical divide: Case studies integrating oral health care and primary health care. J Am Dent Assoc 2018; 149:850-858. [PMID: 30057150 DOI: 10.1016/j.adaj.2018.05.030] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 05/02/2018] [Accepted: 05/17/2018] [Indexed: 01/04/2023]
Abstract
BACKGROUND The National Academies of Sciences, Engineering, and Medicine commissioned an environmental scan describing the status of health care integration of oral health and primary care services. METHODS The authors conducted an environmental scan of US integration activities with publications from January 2000 through August 2017. They categorized services as preventive oral health services (POHS) provided by medical care providers, POHS provided by dental providers in nondental settings, preventive health services provided by dental providers, or care coordination using dedicated personnel and technology. The authors chose 4 programs as case studies and interviewed key personnel in each program. One case study illustrates each category of integrated services; additional examples describe category variation. RESULTS The case study involving Into the Mouth of Babes illustrates medical professionals delivering POHS to children. The case study involving Grace Health presents dental hygienists embedded in the obstetrics-gynecology clinic to provide oral screening, prophylaxis, and education to pregnant women. At HealthPartners, medical care providers refer patients with diabetes to dentists and waive copays for periodontal care. The InterCommunity Health Network Coordinated Care Organization uses dedicated patient coordinators, technology, and coordinated payment and referral mechanisms to facilitate care. CONCLUSIONS Integration of dental and medical care increased access to and coordination of patient care by means of offering health care services traditionally provided by the other profession. PRACTICAL IMPLICATIONS Integration models demonstrate the incorporation of POHS by primary care professionals, the embedding of dental professionals into primary care clinics, and the incorporation of care coordination to increase the delivery of oral health care. Similarly, dentists identify and refer patients with medical needs or preventive gaps to medical homes.
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Association Between Employee Dental Claims, Health Risks, Workplace Productivity, and Preventive Services Compliance. J Occup Environ Med 2017; 59:721-726. [DOI: 10.1097/jom.0000000000001069] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Braun PA, Widmer-Racich K, Sevick C, Starzyk EJ, Mauritson K, Hambidge SJ. Effectiveness on Early Childhood Caries of an Oral Health Promotion Program for Medical Providers. Am J Public Health 2017; 107:S97-S103. [PMID: 28661802 DOI: 10.2105/ajph.2017.303817] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To assess an oral health promotion (OHP) intervention for medical providers' impact on early childhood caries (ECC). METHODS We implemented a quasiexperimental OHP intervention in 8 federally qualified health centers that trained medical providers on ECC risk assessment, oral examination and instruction, dental referral, and fluoride varnish applications (FVAs). We measured OHP delivery by FVA count at medical visits. We measured the intervention's impact on ECC in 3 unique cohorts of children aged 3 to 4 years in 2009 (preintervention; n = 202), 2011 (midintervention; n = 420), and 2015 (≥ 4 FVAs; n = 153). We compared numbers of decayed, missing, and filled tooth surfaces using adjusted zero-inflated negative binomial models. RESULTS Across 3 unique cohorts, the FVA mean (range) count was 0.0 (0), 1.1 (0-7), and 4.5 (4-7) in 2009, 2011, and 2015, respectively. In adjusted zero-inflated negative binomial models analyses, children in the 2015 cohort had significantly fewer decayed, missing, and filled tooth surfaces than did children in previous cohorts. CONCLUSIONS An OHP intervention targeting medical providers reduced ECC when children received 4 or more FVAs at a medical visit by age 3 years.
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Affiliation(s)
- Patricia A Braun
- Patricia A. Braun, Katina Widmer-Racich, and Carter Sevick are with the Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz School of Medicine, Aurora. Erin J. Starzyk and Katya Mauritson are with the Colorado Department of Public Health and Environment, Denver. Patricia A. Braun is also with and Simon J. Hambidge is with Denver Health and Hospital, Denver, CO
| | - Katina Widmer-Racich
- Patricia A. Braun, Katina Widmer-Racich, and Carter Sevick are with the Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz School of Medicine, Aurora. Erin J. Starzyk and Katya Mauritson are with the Colorado Department of Public Health and Environment, Denver. Patricia A. Braun is also with and Simon J. Hambidge is with Denver Health and Hospital, Denver, CO
| | - Carter Sevick
- Patricia A. Braun, Katina Widmer-Racich, and Carter Sevick are with the Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz School of Medicine, Aurora. Erin J. Starzyk and Katya Mauritson are with the Colorado Department of Public Health and Environment, Denver. Patricia A. Braun is also with and Simon J. Hambidge is with Denver Health and Hospital, Denver, CO
| | - Erin J Starzyk
- Patricia A. Braun, Katina Widmer-Racich, and Carter Sevick are with the Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz School of Medicine, Aurora. Erin J. Starzyk and Katya Mauritson are with the Colorado Department of Public Health and Environment, Denver. Patricia A. Braun is also with and Simon J. Hambidge is with Denver Health and Hospital, Denver, CO
| | - Katya Mauritson
- Patricia A. Braun, Katina Widmer-Racich, and Carter Sevick are with the Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz School of Medicine, Aurora. Erin J. Starzyk and Katya Mauritson are with the Colorado Department of Public Health and Environment, Denver. Patricia A. Braun is also with and Simon J. Hambidge is with Denver Health and Hospital, Denver, CO
| | - Simon J Hambidge
- Patricia A. Braun, Katina Widmer-Racich, and Carter Sevick are with the Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz School of Medicine, Aurora. Erin J. Starzyk and Katya Mauritson are with the Colorado Department of Public Health and Environment, Denver. Patricia A. Braun is also with and Simon J. Hambidge is with Denver Health and Hospital, Denver, CO
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Mertz E, Spetz J, Moore J. Pediatric Workforce Issues. Dent Clin North Am 2017; 61:577-588. [PMID: 28577638 DOI: 10.1016/j.cden.2017.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Untreated dental disease remains one of the most prevalent health conditions for children, driven in part by disparities in access to care. This article examines evidence-based workforce strategies being used to facilitate better access to pediatric health services and to improve oral health status and outcomes for children. The workforce strategies described in this article include promising new models in the dental field, with new and existing providers as well as emerging workforce models outside of the dental field. Case studies for some of these workforce strategies are also presented. Future directions and health policy implications are considered.
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Affiliation(s)
- Elizabeth Mertz
- Preventive and Restorative Dental Sciences, Healthforce Center, University of California, San Francisco, 3333 California Street, Suite 410, San Francisco, CA 94143, USA.
| | - Joanne Spetz
- Philip R. Lee Institute for Health Policy Studies, Healthforce Center, University of California, San Francisco, 3333 California Street, Suite 265, San Francisco, CA 94143, USA
| | - Jean Moore
- Center for Health Workforce Studies, School of Public Health, University at Albany, State University of New York, 1 University Place, Suite 220, Rensselaer, NY 12144, USA
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Blackburn J, Morrisey MA, Sen B. Outcomes Associated With Early Preventive Dental Care Among Medicaid-Enrolled Children in Alabama. JAMA Pediatr 2017; 171:335-341. [PMID: 28241184 PMCID: PMC5470412 DOI: 10.1001/jamapediatrics.2016.4514] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 11/14/2016] [Indexed: 11/14/2022]
Abstract
Importance There is a recommendation for children to have a dental home by 6 months of age, but there is limited evidence supporting the effectiveness of early preventive dental care or whether primary care providers (PCPs) can deliver it. Objective To investigate the effectiveness of preventive dental care in reducing caries-related treatment visits among Medicaid enrollees. Design, Setting, and Participants High-dimensional propensity scores were used to address selection bias for a retrospective cohort study of children continuously enrolled in coverage from the Alabama Medicaid Agency from birth between 2008 and 2012, adjusting for demographics, access to care, and general health service use. Exposures Children receiving preventive dental care prior to age 2 years from PCPs or dentists vs no preventive dental care. Main Outcome and Measures Two-part models estimated caries-related treatment and expenditures. Results Among 19 658 eligible children, 25.8% (n = 3658) received early preventive dental care, of whom 44% were black, 37.6% were white, and 16.3% were Hispanic. Compared with matched children without early preventive dental care, children with dentist-delivered preventive dental care more frequently had a subsequent caries-related treatment (20.6% vs 11.3%, P < .001), higher rate of visits (0.29 vs 0.15 per child-year, P < .001), and greater dental expenditures ($168 vs $87 per year, P < .001). Dentist-delivered preventive dental care was associated with an increase in the expected number of caries-related treatment visits by 0.14 per child per year (95% CI, 0.11-0.16) and caries-related treatment expenditures by $40.77 per child per year (95% CI, $30.48-$51.07). Primary care provider-delivered preventive dental care did not significantly affect caries-related treatment use or expenditures. Conclusions and Relevance Children with early preventive care visits from dentists were more likely to have subsequent dental care, including caries-related treatment, and greater expenditures than children without preventive dental care. There was no association with subsequent caries-related treatment and preventive dental care from PCPs. We observed no evidence of a benefit of early preventive dental care, regardless of the provider. Additional research beyond administrative data may be necessary to elucidate any benefits of early preventive dental care.
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Affiliation(s)
- Justin Blackburn
- Department of Health Care Organization and Policy, University of Alabama at Birmingham School of Public Health, Birmingham
| | - Michael A. Morrisey
- Department of Health Policy and Management, Texas A&M School of Public Health, College Station
| | - Bisakha Sen
- Department of Health Care Organization and Policy, University of Alabama at Birmingham School of Public Health, Birmingham
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Matsuo G, Rozier RG, Kranz AM. Dental Caries: Racial and Ethnic Disparities Among North Carolina Kindergarten Students. Am J Public Health 2015; 105:2503-9. [PMID: 26469649 DOI: 10.2105/ajph.2015.302884] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVES We examined racial/ethnic disparities in dental caries among kindergarten students in North Carolina and the cross-level effects between students' race/ethnicity and school poverty status. METHODS We adjusted the analysis of oral health surveillance information (2009-2010) for individual-, school-, and county-level variables. We included a cross-level interaction of student's race/ethnicity (White, Black, Hispanic) and school National School Lunch Program (NSLP) participation (< 75% vs ≥ 75% of students), which we used as a compositional school-level variable measuring poverty among families of enrolled students. RESULTS Among 70,089 students in 1067 schools in 95 counties, the prevalence of dental caries was 30.4% for White, 39.0% for Black, and 51.7% for Hispanic students. The adjusted difference in caries experience between Black and White students was significantly greater in schools with NSLP participation of less than 75%. CONCLUSIONS Racial/ethnic oral health disparities exist among kindergarten students in North Carolina as a whole and regardless of school's poverty status. Furthermore, disparities between White and Black students are larger in nonpoor schools than in poor schools. Further studies are needed to explore causal pathways that might lead to these disparities.
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Affiliation(s)
- Go Matsuo
- At the time of the study, Go Matsuo was with the Oral Health Section, Division of Public Health, North Carolina Department of Health and Human Services, Raleigh. R. Gary Rozier is with the Department of Health Policy and Management, Gillings School of Global Public Health, and Ashley M. Kranz is with the School of Dentistry, University of North Carolina, Chapel Hill
| | - R Gary Rozier
- At the time of the study, Go Matsuo was with the Oral Health Section, Division of Public Health, North Carolina Department of Health and Human Services, Raleigh. R. Gary Rozier is with the Department of Health Policy and Management, Gillings School of Global Public Health, and Ashley M. Kranz is with the School of Dentistry, University of North Carolina, Chapel Hill
| | - Ashley M Kranz
- At the time of the study, Go Matsuo was with the Oral Health Section, Division of Public Health, North Carolina Department of Health and Human Services, Raleigh. R. Gary Rozier is with the Department of Health Policy and Management, Gillings School of Global Public Health, and Ashley M. Kranz is with the School of Dentistry, University of North Carolina, Chapel Hill
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