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Kumar S, Mandal TK, Kumar A, Ahmad M, Naim H, N J. Assessment of Oral Mucosal Lesions (OML), Periodontal Health Conditions, and Unmet Dental Treatment Needs in the Rural Adult Population of Jharkhand, North India. Cureus 2023; 15:e49961. [PMID: 38179366 PMCID: PMC10765760 DOI: 10.7759/cureus.49961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/04/2023] [Indexed: 01/06/2024] Open
Abstract
Background Dental diseases like caries, periodontal diseases, and oral mucosal lesions (OML) are common findings in rural adult populations that greatly impact their quality of life. Aim To assess OML, periodontal health conditions, and unmet dental treatment needs in the rural adult population in Jharkhand. Methodology A total of 700 permanent residents of Bero Block, Jharkhand, North India, in the age group of 35-44 years, participated in this cross-sectional study. Both men and women were equally represented. Their socio-demographic characteristics and previous dental visits were collected using standardized proforma. An assessment of periodontal health conditions, OML, and unmet dental treatment needs was done using the World Health Organization (WHO) Oral Health Assessment Proforma of 1997. Results It was found that over half (54.3%) of the study population had the adverse habit of smoking and chewing paan. Males were more likely to experience leukoplakia (18.87%), whereas females were more likely to experience abscesses (9.43%). The majority of males and females had a community periodontal index (CPI) score and loss of attachment (LOA) score greater than two, which indicated poor periodontal health as assessed by the periodontal index. Both males and females needed extraction of the diseased teeth as their primary treatment. Conclusion The rural adult population residing in the Bero block of Jharkhand showed poor periodontal health and high unmet dental treatment needs. These people need effective oral health promotion policies and dental health education to improve their oral health.
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Affiliation(s)
- Sandeep Kumar
- Public Health Dentistry, Rajendra Institute of Medical Sciences, Ranchi, IND
| | - Tapan K Mandal
- Conservative Dentistry and Endodontics, Rajendra Institute of Medical Sciences, Ranchi, IND
| | - Arunoday Kumar
- Prosthodontics and Crown & Bridge, Regional Institute of Medical Sciences, Imphal, IND
| | - Manawar Ahmad
- Prosthetic Dental Sciences, College of Dentistry, Jazan University, Jazan, SAU
| | - Hina Naim
- Prosthetic Dental Sciences, College of Dentistry, Jazan University, Jazan, SAU
| | - Jagadesaan N
- Prosthodontics and Crown & Bridge, JKK Nattraja Dental College and Hospital, Komarapalayam, IND
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Kim NH, Elani HW, Kawachi I. Did Dental Insurance Expansion Improve Dental Care Needs Among Korean Adults? Difference in Difference Analysis. J Epidemiol 2023; 33:101-108. [PMID: 34121050 PMCID: PMC9794449 DOI: 10.2188/jea.je20200596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND In 2012, the Korean government expanded dental insurance for the elderly to promote improved access to dental care. We examined the causal effect of this policy on dental care needs, focusing on low-income older adults. METHODS We compared data before and after policy implementation using double difference (DD) and triple difference (DDD) analyses. We used the nationally representative data from the Korea National Health and Nutrition Examination Survey from 2010 and 2016-2018. Individuals aged ≥65 years were included in the treatment group, and individuals aged <65 years were included in the control group. RESULTS Dental insurance expansion was associated with a paradoxical increase in perceived unmet dental needs among elderly individuals (8.8 percentage points increase, 95% CI: 4.7 to 13.0). However, there were improvements in dental prosthetics outcomes (denture wearing [4.0 percentage points, 95% CI: 0.2 to 7.9] and dental implants [5.0 percentage points, 95% CI: 2.1 to 7.9]; P < 0.01). Upon analyzing low-income elderly individuals using DDD analysis, we found that the insurance expansion led to a 21.6% smaller increase in unmet dental needs among low-income adults, compared to high-income adults (95% CI, -35.0 to -8.5; P < 0.01). CONCLUSION Dental insurance expansion in South Korea resulted in improvements in access to dental prosthetic services overall. It also led to a smaller increase in unmet dental needs among low-income older adults, compared to high-income adults.
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Affiliation(s)
- Nam-Hee Kim
- Department of Dental Hygiene, Wonju College of Medicine, Yonsei University, Wonju, Republic of Korea,Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA,Department of Dental Hygiene, College of Software and Digital Healthcare Convergence, Yonsei University, Wonju, Republic of Korea
| | - Hawazin W. Elani
- Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, MA, USA
| | - Ichiro Kawachi
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Reinhardt JW, Moncrief KQ, Koch JEJ, Samson KK, Yu F. Maintaining a strong rural dental workforce. J Dent Educ 2023; 87:86-92. [PMID: 36050836 DOI: 10.1002/jdd.13093] [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: 03/26/2022] [Revised: 06/23/2022] [Accepted: 08/06/2022] [Indexed: 01/11/2023]
Abstract
AIMS This study was designed to examine demographics of University of Nebraska Medical Center College of Dentistry graduates over a recent 10-year period and factors related to their choice of rural or urban practice. Findings were compared to similar previous studies to analyze trends. METHODS Using data from the annual Health Professions Tracking Service 2019 Dentistry Profile survey, we examined the demographic information of 169 graduates from 2009 to 2018 practicing in Nebraska at the end of 2018. We analyzed factors such as rural or urban high school graduation, gender, and other background information to explore associations with their 2018 practice location (urban vs. rural) using chi-square tests and logistic regression. RESULTS This study found that some demographic variables were associated with future practice location. Specifically, a higher proportion of graduates of rural high schools chose to work in a rural location (60%) relative to those who graduated from an urban high school (18%) (p < 0.0001). A higher proportion of men (50%) selected rural practice compared to women (33%) (p = 0.02). Only 17 graduates who attended high school outside of Nebraska stayed to practice in Nebraska, and there was a lower proportion of these graduates working in rural locations (18%) relative to in-state high school graduates (45%) (p = 0.03). CONCLUSION We found significant positive associations between dentists who chose rural practice and demographic factors such as being rural high school graduates, male, and in-state predental residents. Our findings differ from descriptive results of similar previous studies.
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Affiliation(s)
- John W Reinhardt
- Department of Adult Restorative Dentistry, UNMC College of Dentistry, Lincoln, Nebraska, USA
| | - Kathryn Q Moncrief
- Division of Orthodontics, University of Kentucky College of Dentistry, Lexington, Kentucky, USA
| | - Jade E J Koch
- Private Dental Practice, Redfield, South Dakota, USA
| | - Kaeli K Samson
- Department of Biostatistics, UNMC College of Public Health, Omaha, Nebraska, USA
| | - Fang Yu
- Department of Biostatistics, UNMC College of Public Health, Omaha, Nebraska, USA.,Center for Collaboration on Research Design and Analysis, UNMC College of Public Health, Omaha, Nebraska, USA
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4
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Abstract
BACKGROUND Vulnerable populations are more likely to present to non-dental healthcare locations with dental issues. Oral health screening in those settings, such as primary care, is an effective way to identify individuals with unmet oral health needs and facilitate dental referrals. OBJECTIVE To implement and evaluate the integration of oral health screening at an outpatient transitional primary care clinic in Maryland. METHODS The quality improvement project occurred over 12 weeks. The project leader obtained support from institutional stakeholders, collaborated with dentistry, provided evidence-based resources, and developed referral strategies. Patients received a pre-screen at registration. Primary care providers used an oral health assessment tool (OHAT) for further screening and/or gave a dental referral. RESULTS Approximately 108 patients completed pre-screen: 73% had not seen dentist in the past 12 months; 12% had current oral problem or pain; 53% had no established dentist; <5% had a completed OHAT; 20% referred to existing dentist; 56% received dental resource listing. CONCLUSIONS Oral health disparity continues to exist among vulnerable populations. IMPLICATIONS FOR NURSING Oral screening by advanced practice nurses is an effective way to identify patients with unmet oral health needs and to promote dental referral.
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5
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Lutfiyya MN, Gross AJ, Soffe B, Lipsky MS. Dental care utilization: examining the associations between health services deficits and not having a dental visit in past 12 months. BMC Public Health 2019; 19:265. [PMID: 30836954 PMCID: PMC6402128 DOI: 10.1186/s12889-019-6590-y] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 02/25/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND A growing literature supports the contention that closing the divide between dental and medical care can improve access to and coordination of patient care. Health service deficits (HSDs) entail: no routine medical exam, no personal healthcare provider (HCP), no health insurance, and/or delaying medical care because of cost all within the last 12 months. Examining the associations between HSDs and dental care utilization could inform strategies and interventions aimed at narrowing the gap between the medical and dental professions. This study explored whether HSDs are associated with not having a dental care visit within the last 12 months. In addition, the study sought to provide an updated analysis of the characteristics and factors associated with dental care utilization. METHODS Two thousand sixteen Behavioral Risk Factor Surveillance System survey data were analyzed using bivariate and multivariable techniques. The outcome variable for this study was: last dental visit was longer than 12 months ago. RESULTS US adults without healthcare insurance, without a personal HCP, who had delayed medical care because of cost, and who had their last routine medical visit longer than 12 months ago had greater odds of not having a dental visit within the last 12 months. Further, this study identified disparities in dental care utilization among males, rural residents, those earning less than $50,000 per year, Non-Hispanic Blacks and Non-Hispanic other races. Individuals with six or more and/or all of their permanent teeth removed and current smokers also had greater odds of not having had a dental care visit in the past 12 months. CONCLUSIONS Findings suggest that a stronger integration of medical and dental care might increase dental care utilization. In addition, persistent disparities in dental care utilization remain for several demographic groups. Targeted interventions offer the promise of helping achieve HP 2020 goals for improved oral health.
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Affiliation(s)
- M. Nawal Lutfiyya
- Department of Pharmacy Practice and Pharmaceutical Sciences, College of Pharmacy, University of Minnesota, Minneapolis, MN USA
- College of Dental Medicine, Roseman University of Health Sciences, 10920 S. River Front Parkway, South Jordan, Utah 84095 USA
| | - Andrew J. Gross
- College of Dental Medicine, Roseman University of Health Sciences, 10920 S. River Front Parkway, South Jordan, Utah 84095 USA
| | - Burke Soffe
- College of Dental Medicine, Roseman University of Health Sciences, 10920 S. River Front Parkway, South Jordan, Utah 84095 USA
| | - Martin S. Lipsky
- College of Dental Medicine, Roseman University of Health Sciences, 10920 S. River Front Parkway, South Jordan, Utah 84095 USA
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Khan A, Thapa JR, Zhang D. Preventive Dental Checkups and Their Association With Access to Usual Source of Care Among Rural and Urban Adult Residents. J Rural Health 2017; 33:419-426. [PMID: 28905468 DOI: 10.1111/jrh.12271] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Revised: 07/18/2017] [Accepted: 08/10/2017] [Indexed: 11/27/2022]
Abstract
PURPOSE This study aimed to assess the relationship between rural or urban residence and having a usual source of care (USC), and the utilization of preventive dental checkups among adults. METHODS Cross-sectional analysis was conducted using data from the Medical Expenditure Panel Survey 2012. We performed a logit regression on the relationship between rural and urban residence, having a USC, and having at least 1 dental checkup in the past year, adjusting for sociodemographic characteristics and health status. FINDINGS After controlling for covariates, rural adult residents had significantly lower odds of having at least 1 dental checkup per year compared to their urban counterparts (odds ratio [OR] = 0.73, 95% confidence interval [CI]: 0.62-0.86, P < .001). Additionally, individuals with a USC had higher odds of having at least 1 dental checkup per year (OR = 1.76, 95% CI: 1.59-1.95, P < .001). Among both rural and urban residents, having a USC was significantly associated with an 11% (95% CI = 9%-13%) increase in the probability of having a preventive dental checkup within a year. CONCLUSIONS Individuals with a USC were more likely to obtain a preventive dental visit, with similar effects in rural and urban settings. We attributed the lower odds of having a checkup in rural regions to the lower density of oral health care providers in these areas. Integration of rural oral health care into primary care may help mitigate the challenges due to a shortage of oral health care providers in rural areas.
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Affiliation(s)
- Aishah Khan
- Department of Health Policy and Management, College of Public Health, University of Georgia, Athens, Georgia
| | - Janani R Thapa
- Department of Health Policy and Management, College of Public Health, University of Georgia, Athens, Georgia
| | - Donglan Zhang
- Department of Health Policy and Management, College of Public Health, University of Georgia, Athens, Georgia
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Cruz S, Chi DL. Research Evidence Use in Early and Periodic Screening, Diagnostic, and Treatment Dental Medicaid Class Action Lawsuits. Dent Clin North Am 2017; 61:627-644. [PMID: 28577642 DOI: 10.1016/j.cden.2017.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Little is known about research evidence use in dental Medicaid class action lawsuits. This qualitative study develops a conceptual model to understand the role of dentists and how research evidence was used. Archival analyses were conducted and 15 key informants interviewed. Dentists had key roles requiring scientific expertise or clinical experience serving vulnerable populations. Most evidence was newly generated, not based on existing sources. Dentists were involved in all phases of the lawsuits. Future research should identify conditions fostering research evidence use in dental Medicaid lawsuits and whether high-quality research evidence use improves child health outcomes.
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Affiliation(s)
- Stephanie Cruz
- Department of Oral Health Sciences, School of Dentistry, University of Washington, Box 357475, B509 Health Sciences Building, Seattle, WA 98195-7475, USA.
| | - Donald L Chi
- Department of Oral Health Sciences, School of Dentistry, University of Washington, Box 357475, B509 Health Sciences Building, Seattle, WA 98195-7475, USA
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Rastenienė R, Aleksejūnienė J, Pūrienė A. Dental treatment needs and health care-seeking behaviours of patients with acute odontogenic infections in Lithuania. Int Dent J 2015; 65:188-95. [PMID: 25980821 DOI: 10.1111/idj.12168] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
AIMS To assess patients with acute odontogenic maxillofacial infections (AOMIs), regarding their functional dentition and dental treatment needs, and identify factors explaining these outcomes. METHODS During a 1-year period, 160 patients with AOMIs were treated at the specialised dental care centre of Vilnius University. Both oral status and specific dental treatment needs were evaluated for each patient. For the restorative dental treatment need, we examined if patients needed fillings, crowns or bridges. Periodontal dental treatment needs were based only on the most severe cases, and patients were allocated either to a group for which periodontal treatment was recommended or to a group that did not need periodontal treatment. Based on these clinical assessments, four ratios for specific dental treatment needs (restorations, extractions, endodontic treatment and periodontal treatment) and two summative ratios (total dental treatment needs and presence of a functional dentition) were calculated. The questionnaire included variables from various domains. RESULTS Patients with AOMIs retained one-third of their functional dentition and the mean ± standard deviation of their total dental treatment needs was 46.0 ± 29.7%, of which 32.4 ± 17.1% related to the need for restorations. Higher dental treatment needs were associated with a low level of education, low income, irregular oral self-care, systemic diseases and self-treatment of acute dental conditions before seeking professional help. CONCLUSIONS Patients with AOMIs retained one-third of their functional dentition, and almost half of their dentition were in need of dental treatment.
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Affiliation(s)
- Rūta Rastenienė
- Institute of Odontology, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Jolanta Aleksejūnienė
- Division of Preventive and Community Dentistry, Faculty of Dentistry, University of British Columbia, Vancouver, BC, Canada
| | - Alina Pūrienė
- Institute of Odontology, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
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Sun BC, Chi DL, Schwarz E, Milgrom P, Yagapen A, Malveau S, Chen Z, Chan B, Danner S, Owen E, Morton V, Lowe RA. Emergency department visits for nontraumatic dental problems: a mixed-methods study. Am J Public Health 2015; 105:947-55. [PMID: 25790415 DOI: 10.2105/ajph.2014.302398] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We documented emergency department (ED) visits for nontraumatic dental problems and identified strategies to reduce ED dental visits. METHODS We used mixed methods to analyze claims in 2010 from a purposive sample of 25 Oregon hospitals and Oregon's All Payer All Claims data set and interviewed 51 ED dental visitors and stakeholders from 6 communities. RESULTS Dental visits accounted for 2.5% of ED visits and represented the second-most-common discharge diagnosis in adults aged 20 to 39 years, were associated with being uninsured (odds ratio [OR] = 5.2 [reference: commercial insurance]; 95% confidence interval [CI] = 4.8, 5.5) or having Medicaid insurance (OR = 4.0; 95% CI = 3.7, 4.2), resulted in opioid (56%) and antibiotic (56%) prescriptions, and generated $402 (95% CI = $396, $408) in hospital costs per visit. Interviews revealed health system, community, provider, and patient contributors to ED dental visits. Potential solutions provided by interviewees included Medicaid benefit expansion, care coordination, water fluoridation, and patient education. CONCLUSIONS Emergency department dental visits are a significant and costly public health problem for vulnerable individuals. Future efforts should focus on implementing multilevel interventions to reduce ED dental visits.
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Affiliation(s)
- Benjamin C Sun
- Benjamin C. Sun, Annick Yagapen, Susan Malveau, and Ben Chan are with Department of Emergency Medicine, Oregon Health and Science University (OHSU), Portland. Robert A. Lowe is with the Department of Medical Informatics and Clinical Epidemiology, OHSU. Donald L. Chi and Peter Milgrom are with Department of Oral Health Sciences, University of Washington, Seattle. Eli Schwarz is with School of Dentistry, OHSU. Zunqui Chen is with Department of Public Health and Preventive Medicine, OHSU. Sankirtana Danner is with Oregon Rural Practice-Based Research Network, OHSU. Erin Owen is with Slocum Research and Education Foundation, Eugene, OR. Vickie Morton is with Financial Services, OHSU
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Zilversmit L, Kane DJ, Rochat R, Rodgers T, Russell B. Factors associated with receiving treatment for dental decay among Medicaid-enrolled children younger than 12 years of age in Iowa, 2010. J Public Health Dent 2014; 75:17-23. [PMID: 25131658 DOI: 10.1111/jphd.12066] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Revised: 06/13/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The Iowa Department of Public Health I-Smile program provides dental screening and care coordination to over 23,000 low-income and Medicaid-enrolled children per year. The purposes of this study were to evaluate I-Smile program effectiveness to ensure that Medicaid-enrolled children obtained dental treatment after having been screened and to determine the factors associated with failure to receive dental care after screening through the I-Smile program. METHODS Based on I-Smile program priorities, we limited our sample to children younger than 12 years of age who screened positive for decay and who linked to a paid Medicaid claim for dental treatment (n = 1,816). We conducted bivariate analyses to examine associations between children's characteristics who screened positive for decay and received treatment within 6 months of their initial screening. We also performed multivariate logistic regression to assess the association of sociodemographic characteristics with receipt of treatment among children who screened positive for decay. RESULTS Eleven percent of children screened positive for decay. Nearly 24 percent of children with decay received treatment based on a Medicaid-paid claim. Being 5 years or older [adjusted odds ratio (aOR): 1.48, confidence interval (CI): 1.17, 1.88] and not having a dental home (aOR: 1.90, CI: 1.41, 2.58) were associated with higher odds of not receiving dental treatment. CONCLUSIONS Children 5 years and older and without a dental home were less likely to obtain dental treatment. Opportunities exist for the I-Smile program to increase the numbers of at-risk children with dental homes and who obtain dental care after screening.
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Affiliation(s)
- Leah Zilversmit
- Centers for Disease Control and Prevention, Maputo, Mozambique; Associations of Schools and Programs of Public Health, Maputo, Mozambique; Rollins School of Public Health, Emory University, Atlanta, GA, USA
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Davis MM, Aromaa S, McGinnis PB, Ramsey K, Rollins N, Smith J, Beamer BA, Buckley DI, Stange KC, Fagnan LJ. Engaging the underserved: a process model to mobilize rural community health coalitions as partners in translational research. Clin Transl Sci 2014; 7:300-6. [PMID: 24837826 PMCID: PMC4134739 DOI: 10.1111/cts.12168] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
PURPOSE Community engagement (CE) and community-engaged research (CEnR) are increasingly recognized as critical elements in research translation. Process models to develop CEnR partnerships in rural and underserved communities are needed. METHOD Academic partners transformed four established Community Health Improvement Partnerships (CHIPs) into Community Health Improvement and Research Partnerships (CHIRPs). The intervention consisted of three elements: an academic-community kickoff/orientation meeting, delivery of eight research training modules to CHIRP members, and local community-based participatory research (CBPR) pilot studies addressing childhood obesity. We conducted a mixed methods analysis of pre-/postsurveys, interviews, session evaluations, observational field notes, and attendance logs to evaluate intervention effectiveness and acceptability. RESULTS Forty-nine community members participated; most (78.7%) attended five or more research training sessions. Session quality and usefulness was high. Community members reported significant increases in their confidence for participating in all phases of research (e.g., formulating research questions, selecting research methods, writing manuscripts). All CHIRP groups successfully conducted CBPR pilot studies. CONCLUSIONS The CHIRP process builds on existing infrastructure in academic and community settings to foster CEnR. Brief research training and pilot studies around community-identified health needs can enhance individual and organizational capacity to address health disparities in rural and underserved communities.
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Affiliation(s)
- Melinda M. Davis
- Oregon Rural Practice‐Based Research Network and Department of Family MedicineOregon Health & Science UniversityPortlandOregonUSA
| | - Susan Aromaa
- Oregon Clinical & Translational Research Institute Community Engagement ProgramOregon Health & Science UniversityPortlandOregonUSA
| | | | - Katrina Ramsey
- Department of Public Health and Preventive MedicineOregon Health & Science UniversityPortlandOregonUSA
| | - Nancy Rollins
- Oregon Rural Practice‐Based Research NetworkOregon Health & Science UniversityPortlandOregonUSA
| | | | | | - David I. Buckley
- Departments of Family Medicine, Medical Informatics and Clinical Epidemiology, Public Health and Preventive MedicineOregon Health & Science UniversityPortlandOregonUSA
| | - Kurt C. Stange
- Case Western Reserve University Clinical and Translational Science Collaborative and Departments of Family Medicine & Community Health, Epidemiology & Biostatistics, Sociology, and OncologyCase Western Reserve UniversityClevelandOhioUSA
| | - Lyle J. Fagnan
- Oregon Rural Practice‐Based Research Network, Oregon Clinical & Translational Research Institute Community Engagement Program, and Department of Family MedicineOregon Health & Science UniversityPortlandOregonUSA
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12
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Hardie TL, Polek C, Wheeler E, McCamant K, Dixson M, Gailey R, Lafrak K. Characterising emergency department high-frequency users in a rural hospital. Emerg Med J 2013; 32:21-5. [PMID: 24351523 DOI: 10.1136/emermed-2013-202369] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Patients who are frequent users (≥4 visits/year) comprise ∼10% of patients, but account for ∼34% of total yearly emergency department (ED) visits. Non-emergent care provided to frequent ED users affects operating costs and usage. The majority of reports characterising frequent ED use are from urban teaching centres. This study describes frequent users of ED services in a rural community setting and the association between counts of patient's visits and discrete diagnoses. DESIGN Retrospective study of 1652 frequent ED adult patients from a rural US hospital over a one-year period. Descriptive statistics and Poisson regression were used to explore the characteristics of frequent users and their patterns of diagnoses. RESULTS Frequent user visits ranged from 4 to 66 per patient. Frequent users were 9.41% of patient volume accounting for 33.94% of the total visits and were younger compared with patients with <4 visits. Approximately 36% of frequent user visits were generated by 20 diagnoses when the diagnoses were concatenated into domains which covered ∼76% of the visits. There was a high correlation between the number of visits and discrete diagnoses in frequent users. CONCLUSIONS These findings suggest a more complex picture of rural ED services and their relationship with primary care and dental services, which needs to be defined before policy development to reduce ED use.
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Affiliation(s)
- Thomas L Hardie
- College of Nursing and Health Professions, Drexel University, Philadelphia, Pennsylvania, USA
| | - Carolee Polek
- School of Nursing, University of Delaware, Newark, Delaware, USA
| | - Erlinda Wheeler
- School of Nursing, University of Delaware, Newark, Delaware, USA
| | - Karen McCamant
- American Nurses Credentialing Center, Silver Springs, Maryland, USA
| | - Melinda Dixson
- Emergency Services, Union Hospital of Cecil County, Elkton, Maryland, USA
| | | | - Karen Lafrak
- Department of Emergency Medicine, Union Hospital of Cecil County, Elkton, Maryland, USA
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13
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Walker A, Probst JC, Martin AB, Bellinger JD, Merchant A. Analysis of hospital-based emergency department visits for dental caries in the United States in 2008. J Public Health Dent 2013; 74:188-94. [DOI: 10.1111/jphd.12045] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2013] [Accepted: 10/18/2013] [Indexed: 11/29/2022]
Affiliation(s)
- Andre Walker
- Institute for Partnerships to Eliminate Health Disparities; Arnold School of Public Health; University of South Carolina; Columbia SC USA
| | - Janice C. Probst
- Department of Health Services Policy and Management; Arnold School of Public Health; University of South Carolina; Columbia SC USA
- South Carolina Rural Health Research Center; Columbia SC USA
| | - Amy B. Martin
- Department of Health Services Policy and Management; Arnold School of Public Health; University of South Carolina; Columbia SC USA
- South Carolina Rural Health Research Center; Columbia SC USA
| | - Jessica D. Bellinger
- Department of Health Services Policy and Management; Arnold School of Public Health; University of South Carolina; Columbia SC USA
- South Carolina Rural Health Research Center; Columbia SC USA
| | - Anwar Merchant
- Department of Epidemiology and Biostatistics; Arnold School of Public Health; University of South Carolina; Columbia SC USA
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Cohen LA. Expanding the physician's role in addressing the oral health of adults. Am J Public Health 2013; 103:408-12. [PMID: 23327256 PMCID: PMC3673507 DOI: 10.2105/ajph.2012.300990] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2012] [Indexed: 12/30/2022]
Abstract
Many disadvantaged adults visit physicians or hospital emergency departments to receive relief from dental pain. Physicians also see patients with general questions or concerns about their oral health. Unfortunately, because physicians generally have received little oral health training, patients often do not receive comprehensive emergency services or appropriate counseling. This situation has begun to change, as there has been a growing sentiment among the dental and medical communities that better integration and coordination between medicine and dentistry would be beneficial. Reports from the Institute of Medicine and professional associations and foundations reflect the need for better integration. I have outlined the rationale for and progress toward expanding the physician's role in addressing the oral health of adults.
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Affiliation(s)
- Leonard A Cohen
- Division of Dental Public Health, University of Maryland Dental School, Baltimore, MD 21201, USA.
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Miyamoto S, Henderson S, Young H, Ward D, Santillan V. Recruiting rural participants for a telehealth intervention on diabetes self-management. J Rural Health 2012; 29:69-77. [PMID: 23289657 DOI: 10.1111/j.1748-0361.2012.00443.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Recruiting rural and underserved participants in behavioral health interventions is challenging. Community-based recruitment approaches are effective, but they are not always feasible in multisite, diverse community interventions. This study evaluates the feasibility of a rapid, multisite approach that uses rural clinic site coordinators to recruit study participants. The approach allows for rural recruitment in areas where researchers may not have developed long-term collaborative relationships. METHODS Adults with diabetes were recruited from rural Federally Qualified Health Center (FQHC) clinics. Recruitment feasibility was assessed by analyzing field notes by the project manager and health coaches, and 8 in-depth, semistructured interviews with clinic site coordinators and champions, followed by thematic analysis of field notes and interviews. FINDINGS Forty-seven rural sites were contacted to obtain the 6 sites that participated in the study. On average, sites took 14 days to commit to study participation. One hundred and twenty-one participants were acquired from letters mailed to eligible participants and, in some sites, by follow-up phone calls from site coordinators. Facilitators and deterrents affecting study recruitment fell into 4 broad categories--study design, site, site coordinator, and participant factors. CONCLUSION The rapid multisite approach led to quick and efficient recruitment of clinic sites and participants. Recruitment success was achieved in some, but not all, rural sites. The study highlights the opportunities and challenges of recruiting rural clinics and rural, underserved participants in multisite research. Suggestions are provided for improving recruitment for future interventions.
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Affiliation(s)
- Sheridan Miyamoto
- Betty Irene Moore School of Nursing at University of California Davis, Sacramento, CA, USA.
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16
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Wallace BB, MacEntee MI, Harrison R, Hole R, Mitton C. Community dental clinics: providers' perspectives. Community Dent Oral Epidemiol 2012; 41:193-203. [DOI: 10.1111/cdoe.12012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2012] [Accepted: 09/06/2012] [Indexed: 11/30/2022]
Affiliation(s)
- Bruce B. Wallace
- Faculty of Dentistry; University of British Columbia; Vancouver; BC; Canada
| | | | - Rosamund Harrison
- Faculty of Dentistry; University of British Columbia; Vancouver; BC; Canada
| | - Rachelle Hole
- School of Social Work; University of British Columbia - Okanagan; Kelowna, BC; Canada
| | - Craig Mitton
- Centre for Clinical Epidemiology and Evaluation; Vancouver Coastal Health; Research Institute School of Population and Public Health; University of British Columbia; Vancouver; BC; Canada
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17
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Davis MM, Keller S, DeVoe JE, Cohen DJ. Characteristics and lessons learned from practice-based research networks (PBRNs) in the United States. J Healthc Leadersh 2012. [PMID: 26213481 PMCID: PMC4512302 DOI: 10.2147/jhl.s16441,] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023] Open
Abstract
Practice-based research networks (PBRNs) are organizations that involve practicing clinicians in asking and answering clinically relevant research questions. This review explores the origins, characteristics, funding, and lessons learned through practice-based research in the United States. Primary care PBRNs emerged in the USA in the 1970s. Early studies explored the etiology of common problems encountered in primary care practices (eg, headache, miscarriage), demonstrating the gap between research conducted in controlled specialty settings and real-world practices. Over time, national initiatives and an evolving funding climate have shaped PBRN development, contributing to larger networks, a push for shared electronic health records, and the use of a broad range of research methodologies (eg, observational studies, pragmatic randomized controlled trials, continuous quality improvement, participatory methods). Today, there are over 160 active networks registered with the Agency for Healthcare Research and Quality's PBRN Resource Center that engage primary care clinicians, pharmacists, dentists, and other health care professionals in research and quality-improvement initiatives. PBRNs provide an important laboratory for encouraging collaborative research partnerships between academicians and practices or communities to improve population health, conduct comparative effectiveness and patient-centered outcomes research, and study health policy reform. PBRNs continue to face critical challenges that include: (1) adapting to a changing landscape; (2) recruiting and retaining membership; (3) securing infrastructure support; (4) straddling two worlds (academia and community) and managing expectations; and (5) preparing for workforce transitions.
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Affiliation(s)
- Melinda M Davis
- Department of Family Medicine, Oregon Health & Science University, Portland, OR, USA ; Oregon Rural Practice-based Research Network, Oregon Health & Science University, Portland, OR, USA
| | - Sara Keller
- Department of Family Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Jennifer E DeVoe
- Department of Family Medicine, Oregon Health & Science University, Portland, OR, USA ; OCHIN Practice-based Research Network, Portland, OR, USA
| | - Deborah J Cohen
- Department of Family Medicine, Oregon Health & Science University, Portland, OR, USA
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18
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Davis MM, Keller S, DeVoe JE, Cohen DJ. Characteristics and lessons learned from practice-based research networks (PBRNs) in the United States. J Healthc Leadersh 2012; 4:107-116. [PMID: 26213481 PMCID: PMC4512302 DOI: 10.2147/jhl.s16441] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Practice-based research networks (PBRNs) are organizations that involve practicing clinicians in asking and answering clinically relevant research questions. This review explores the origins, characteristics, funding, and lessons learned through practice-based research in the United States. Primary care PBRNs emerged in the USA in the 1970s. Early studies explored the etiology of common problems encountered in primary care practices (eg, headache, miscarriage), demonstrating the gap between research conducted in controlled specialty settings and real-world practices. Over time, national initiatives and an evolving funding climate have shaped PBRN development, contributing to larger networks, a push for shared electronic health records, and the use of a broad range of research methodologies (eg, observational studies, pragmatic randomized controlled trials, continuous quality improvement, participatory methods). Today, there are over 160 active networks registered with the Agency for Healthcare Research and Quality's PBRN Resource Center that engage primary care clinicians, pharmacists, dentists, and other health care professionals in research and quality-improvement initiatives. PBRNs provide an important laboratory for encouraging collaborative research partnerships between academicians and practices or communities to improve population health, conduct comparative effectiveness and patient-centered outcomes research, and study health policy reform. PBRNs continue to face critical challenges that include: (1) adapting to a changing landscape; (2) recruiting and retaining membership; (3) securing infrastructure support; (4) straddling two worlds (academia and community) and managing expectations; and (5) preparing for workforce transitions.
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Affiliation(s)
- Melinda M Davis
- Department of Family Medicine, Oregon Health & Science University, Portland, OR, USA ; Oregon Rural Practice-based Research Network, Oregon Health & Science University, Portland, OR, USA
| | - Sara Keller
- Department of Family Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Jennifer E DeVoe
- Department of Family Medicine, Oregon Health & Science University, Portland, OR, USA ; OCHIN Practice-based Research Network, Portland, OR, USA
| | - Deborah J Cohen
- Department of Family Medicine, Oregon Health & Science University, Portland, OR, USA
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Kruger E, Perera I, Tennant M. Primary oral health service provision in Aboriginal Medical Services-based dental clinics in Western Australia. Aust J Prim Health 2011; 16:291-5. [PMID: 21138696 DOI: 10.1071/py10028] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2010] [Accepted: 10/21/2010] [Indexed: 11/23/2022]
Abstract
Australians living in rural and remote areas have poorer access to dental care. This situation is attributed to workforce shortages, limited facilities and large distances to care centres. Against this backdrop, rural and remote Indigenous (Aboriginal) communities in Western Australia seem to be more disadvantaged because evidence suggests they have poorer oral health than non-Indigenous people. Hence, provision of dental care for Aboriginal populations in culturally appropriate settings in rural and remote Western Australia is an important public health issue. The aim of this research was to compare services between the Aboriginal Medical Services (AMS)-based clinics and a typical rural community clinic. A retrospective analysis of patient demographics and clinical treatment data was undertaken among patients who attended the dental clinics over a period of 6 years from 1999 to 2004. The majority of patients who received dental care at AMS dental clinics were Aboriginal (95.3%), compared with 8% at the non-AMS clinic. The rate of emergency at the non-AMS clinic was 33.5%, compared with 79.2% at the AMS clinics. The present study confirmed that more Indigenous patients were treated in AMS dental clinics and the mix of dental care provided was dominated by emergency care and oral surgery. This indicated a higher burden of oral disease and late utilisation of dental care services (more focus on tooth extraction) among rural and remote Indigenous people in Western Australia.
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Affiliation(s)
- Estie Kruger
- The Centre for Rural and Remote Oral Health, The University of Western Australia, 35 Stirling Highway, Crawley, WA 6009, Australia.
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