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Access to preventive services after the integration of oral health care into early childhood education and medical care.

ABSTRACT: BACKGROUND:The effect of Early Head Start (EHS) on receipt of preventive oral health services (POHS) from both oral and medical health care providers is not known. METHODS:The authors compared children enrolled in North Carolina EHS programs with similar children enrolled in Medicaid but not EHS on the use of POHS. They analyzed 4 dependent variables (oral assessment by medical health care provider, oral assessment by oral health care provider, fluoride application by medical health care provider, fluoride application by oral health care provider) by using multivariate logistic regression that controlled for covariates. RESULTS:Primary caregivers of children enrolled in EHS (n = 479) and Medicaid (n = 699) were interviewed when children were approximately 10 and 36 months of age. An average of 81% of EHS and non-EHS children received POHS from an oral or medical health care provider at follow-up. EHS children had greater odds of receiving an oral health assessment (odds ratio [OR], 2.33; 95% confidence interval [CI], 1.74 to 3.13) and fluoride (OR, 1.53; 95% CI, 1.16 to 2.03) from an oral health care provider than children not enrolled. EHS children had decreased odds (OR, 0.73; 95% CI, 0.54 to 0.99) of receiving fluoride from a medical health care provider. CONCLUSIONS:Both children enrolled in EHS and community control participants had high rates of POHS, but the source of services differed. EHS children had greater odds of receiving POHS from oral health care providers than non-EHS children. EHS and non-EHS children had equal rates for fluoride overall because of the greater percentage of non-EHS children with medical fluoride visits. PRACTICAL IMPLICATIONS:The integration of POHS in early education and Medicaid medical benefits combined with existing dental resources in the community greatly improves access to POHS.

SUBMITTER: Burgette JM

PROVIDER: S-EPMC7239644 | biostudies-literature | 2018 Dec

REPOSITORIES: biostudies-literature

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Access to preventive services after the integration of oral health care into early childhood education and medical care.

Burgette Jacqueline M JM Preisser John S JS Rozier R Gary RG

Journal of the American Dental Association (1939) 20180920 12

<h4>Background</h4>The effect of Early Head Start (EHS) on receipt of preventive oral health services (POHS) from both oral and medical health care providers is not known.<h4>Methods</h4>The authors compared children enrolled in North Carolina EHS programs with similar children enrolled in Medicaid but not EHS on the use of POHS. They analyzed 4 dependent variables (oral assessment by medical health care provider, oral assessment by oral health care provider, fluoride application by medical heal ...[more]

PMID: 30243426

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Project description:BackgroundMany adolescents are at risk of dental caries and periodontal disease, which may be controlled through health education and clinical preventive interventions provided by oral health and dental therapists (therapists). Senior clinicians (SCs) can influence the focus of dental care in the New South Wales (NSW) Public Oral Health Services as their role is to provide clinical support and advice to therapists, advocate for their communities, and inform Local Health District (LHD) managers of areas for clinical quality improvement. The objective of this study was to record facilitating factors and strategies that are used by SCs to encourage therapists to provide preventive care and advice to adolescent patients.MethodsIn-depth, semistructured interviews were undertaken with 16 SCs from all of the 15 NSW LHDs (nine rural and six metropolitan). A framework matrix was used to systematically code data and enable key themes to be identified for analysis.ResultsAll SCs from the 15 NSW Health LHDs participated in the study. Factors influencing SCs' ability to integrate preventive care into clinical practice were: 1) clinical leadership and administrative support, 2) professional support network, 3) clinical and educational resources, 4) the clinician's patient management aptitude, and 5) clinical governance processes. Clinical quality improvement and continuing professional development strategies equipped clinicians to manage and enhance adolescents' confidence toward self-care.ConclusionThis study shows that SCs have a clear understanding of strategies to enhance the therapist's offer of scientific-based preventive care to adolescents. The problem they face is that currently, success is measured in terms of relief of pain activities, restorations placed, and extraction of teeth, which is an outdated concept. However, to improve clinical models of care will require the overarching administrative authority, NSW Health, to accept that the scientific evidence relating to dental care has changed and that management monitoring information should be incorporated into NSW Health reforms.

Project description:IntroductionAdapting clinical care decisions for patient-reported social risks is essential to social health integration and patient-centered care. Most research in this area focuses on awareness and assistance (social-needs-targeted care), such as screening and referral to food, financial, and other resources. Limited evidence for adjustment strategies (social risk-informed care) or adapting care for social risks made it difficult for Kaiser Permanente to implement new initiatives. This article describes a codesign process to build a novel, adjustment-focused continuing medical education course.MethodsThe authors codeveloped the online continuing medical education course with patients and clinicians using user-centered design. Transcripts from codesign activities were coded and analyzed by thematic analysis to identify major themes, including perceptions of social risk-informed care and barriers to care adjustment.ResultsPractical hurdles for implementing social risk-informed care emerged, including clinicians' concerns about the ethics of adjustment as substandard care, particularly without robust assistance activities. However, patients expressed a desire for their care to be adapted to their social circumstances, to allow for more realistic care plans.DiscussionImplementation barriers identified from the codesign were addressed through an interactive, case-study approach. Existing evidence on contextualized care and shared decision making informed a general framework for primary care providers to engage in awareness and adjustment activities, paired with 3 interactive case studies based on real-world, clinician-supplied scenarios.ConclusionThe authors recommend that multiple stakeholder perspectives be incorporated during the development of social health integration initiatives, particularly adjustment. Education complemented by active, nuanced, flexible implementation strategies may be necessary for the successful uptake of care-delivery-based social health integration activities.

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Access to preventive services after the integration of oral health care into early childhood education and medical care.

Publications

Access to preventive services after the integration of oral health care into early childhood education and medical care.

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