Implementation of Oral Health Screening and Referral Guidelines in Primary Health Care

2018 ◽  
Vol 4 (2) ◽  
pp. 167-177 ◽  
Author(s):  
Y. Zhu ◽  
K. Close ◽  
L.P. Zeldin ◽  
B.A. White ◽  
R.G. Rozier
Keyword(s):  
Primary Care ◽  
Oral Health ◽  
Health Services ◽  
American Academy ◽  
Dental Care ◽  
Health Screening ◽  
Referral Process ◽  
American Academy Of Pediatrics ◽  
Referral Practices ◽  
Oral Health Services

Objectives: To determine the oral health screening and referral practices of pediatric providers, their adherence to American Academy of Pediatrics oral health guidelines, and barriers to adherence. Methods: Providers in 10 pediatric practices participating in the North Carolina Quality Improvement Initiative, funded by the Child Health Insurance Program Reauthorization Act of 2009, were asked to complete a 91-item questionnaire. Questions on risk assessment and referral practices were based on those recommended by the American Academy of Pediatrics. Adherence to oral health guidelines was assessed by practitioners’ evaluation of 4 vignettes presenting screening results for an 18-mo-old child with different levels of risk and caries status. Respondents chose referral recommendations assuming adequate and inadequate dentist workforces. Logit models determined the association between barriers specified in Cabana’s framework and adherence (count of 6 to 8 adherent vignettes vs. 0 to 5). Results: Of 72 eligible providers, 53 (74%) responded. Almost everyone (98.1%) screened for dental problems; 45.2% referred in at least half of well-child visits. Respondents were aware of oral health guidelines, expressed strong agreement with them, and reported confidence in providing preventive oral health services. Yet they underreferred by an average of 42% per vignette for the 7 clinical vignette-workforce scenarios requiring an immediate referral. Frequently cited barriers were providers’ beliefs that 1) parents are poorly motivated to seek dental care, 2) oral health counseling has a small effect on parent behaviors, 3) there is a shortage of dentists in their community who will see infants and toddlers, and 4) information systems to support referrals are insufficient. Conclusion: Pediatric clinicians’ beliefs lead to a conscious decision not to refer many patients, even when children should be referred. Knowledge Transfer Statement: Evidence suggests that the primary care–dental referral process needs improvement. This study identifies barriers to delivering recommended preventive oral health services in pediatrics. The information can be used to improve the screening and referral process and, thus, the quality of preventive oral health services provided in primary care. Results also can guide researchers on the selection of interventions that need testing and might close gaps in the referral process and improve access to dental care.

scholarly journals Delivering Preventive Oral Health Services In Pediatric Primary Care: A Case Study

2008 ◽  
Vol 27 (6) ◽  
pp. 1728-1732 ◽  
Author(s):  
Dianne Riter ◽  
Russell Maier ◽  
David C. Grossman
Keyword(s):  
Primary Care ◽  
Oral Health ◽  
Health Services ◽  
Pediatric Primary Care ◽  
Oral Health Services

scholarly journals Influence of Public Oral Health Services and Socioeconomic Indicators on the Frequency of Hospitalization and Deaths due to Oral Cancer in Brazil, between 2002–2017

2020 ◽  
Vol 18 (1) ◽  
pp. 238
Author(s):  
Aldelany R. Freire ◽  
Deborah E. W. G. Freire ◽  
Elza C. F. de Araújo ◽  
Edson H. G. de Lucena ◽  
Yuri W. Cavalcanti
Keyword(s):  
Primary Care ◽  
Oral Health ◽  
Oral Cancer ◽  
Health Services ◽  
Population Size ◽  
Cox Regression ◽  
Health Coverage ◽  
Socioeconomic Indicators ◽  
Access To Health Services ◽  
Oral Health Services

Background: Oral cancer is a frequent neoplasm worldwide, and socioeconomic factors and access to health services may be associated with its risk. Aim: To analyze effect of socioeconomic variables and the influence of public oral health services availability on the frequency of new hospitalized cases and mortality of oral cancer in Brazil. Materials and Methods: This observational study analyzed all Brazilian cities with at least one hospitalized case of oral cancer in the National Cancer Institute database (2002–2017). For each city were collected: population size, Municipal Human Development Index (MHDI), Gini Coefficient, oral health coverage in primary care, number of Dental Specialized Centers (DSC) and absolute frequency of deaths after one year of the first treatment. The risk ratio was determined by COX regression, and the effect of the predictor variables on the incidence of cases was verified by the Hazard Ratio measure. Poisson regression was used to determine factors associated with higher mortality frequency. Results: Cities above 50,000 inhabitants, with high or very high MHDI, more unequal (Gini > 0.4), with less oral health coverage in primary care (<50%) and without DSC had a greater accumulated risk of having 1 or more cases (p < 0.001). Higher frequency of deaths was also associated with higher population size, higher MHDI, higher Gini and lower oral health coverage in primary care (p < 0.001). Conclusions: The number hospitalization and deaths due to oral cancer in Brazil was influenced by the cities’ population size, the population’s socioeconomic status and the availability of public dental services.

Public Oral Health Services Coverage and Socioeconomic Indicators’ Effect on The Number of Hospitalized Cases of Oral Cancer in Brazil

2020 ◽  
Author(s):  
Aldelany Ramalho Freire ◽  
Deborah Ellen Wanderley Gomes Freire ◽  
Elza Cristina Farias de Araújo ◽  
Edson Hilan Gomes de Lucena ◽  
Yuri Wanderley Cavalcanti
Keyword(s):  
Primary Care ◽  
Oral Health ◽  
Oral Cancer ◽  
Health Services ◽  
Population Size ◽  
Cox Regression ◽  
Predictor Variables ◽  
Health Coverage ◽  
Socioeconomic Indicators ◽  
Oral Health Services

Abstract Background: Oral cancer still representing one of the most frequent neoplasms worldwide, especially in developing countries. Socioeconomic factors and access to health services may be associated with the risk of oral cancer. This study analyzed the frequency of new hospitalized cases of oral cancer in Brazil, according to socioeconomic variables and data on oral health coverage in its public health system. Methods: Observational study, with a retrospective cohort design, whose sampling units was composed of all Brazilian cities that registered at least one hospitalized case of oral cancer in the National Cancer Institute database, between 2002-2017. For each city included, were collected the population size, Municipal Human Development Index (M-HDI), Gini Coefficient, as well as data regarding oral health coverage in primary care and the number of Dental Specialized Center (DSC). The COX regression was used to determine the risk ratio for a city to present a new hospitalized case of oral cancer, and the effect of the predictor variables on the incidence of cases was verified by the Hazard Ratio measure. Accumulated risk curves were obtained for the adjusted model, and for each variable. Results: All predictor variables were considered significant in the regression model (p<0.05). Cities above 50 thousand inhabitants, with high or very high M-HDI, more unequal (Gini>0.4), with less oral health coverage in primary care (<50%) and without the presence of DSC demonstrated a greater accumulated risk of having 1 or more hospitalized cases of oral cancer. Conclusions: The risk of hospitalization for oral cancer in Brazil is greater in cities with a larger population size, more developed, with greater inequality of income distribution and with less availability of public oral health services.

scholarly journals Dental and Oral Problem Patterns and Treatment Seeking Behavior of Geriatric Population

2017 ◽  
Vol 11 (1) ◽  
pp. 230-236 ◽  
Author(s):  
Bader K. AlZarea
Keyword(s):  
Health Care ◽  
Oral Health ◽  
Health Services ◽  
Dental Care ◽  
Elderly Persons ◽  
Health Seeking ◽  
Geriatric Population ◽  
Cross Sectional ◽  
Dental Practitioners ◽  
Oral Health Services

Background:The manifestations of oral changes and disorders affecting the geriatric population are different from the rest of the population. Inaccessibility to dental care is a compelling impediment to avail oral health services.Objective:The aims were to assess the dental and oral problems and to find out the determinants of oral health seeking behaviour among elderly population of Al-Jouf province, Saudi Arabia.Methods:The present cross sectional study included geriatric patients of 60 years and above, who visited the College of Dentistry, Al-Jouf University. A simple pre-structured questionnaire was filled by the patients, which comprised of demographic details and the different oral complaints of elderly and the type of health care utilized for those complaints.Results:Out of total 892 elderly persons included, 51.79% were males and 48.21 were females. The most common oral problem was missing tooth (78.69%) followed by gum problems (74.21%). 39.5% males and 28.0% females visited general dental practitioners for oral health care. Majority of the participants (32.8%) suggested accessibility as a basic factor in determining the health care source. The difference in the distribution of male and females or association between the type of care and gender and distribution for choosing a health care source was found to be statistically significant (p< 0.05).Conclusion:Inaccessibility to dental care emerged as an important barrier to avail oral health services. Adequate access to medical and dental care can reduce premature morbidity and mortality, preserve function, and enhance overall quality of life.

scholarly journals Progress and challenges in potential access to oral health primary care services in Brazil: A population-based panel study with latent transition analysis

PLoS ONE ◽  
2021 ◽  
Vol 16 (3) ◽  
pp. e0247101
Author(s):  
Ana Graziela Araujo Ribeiro ◽  
Rafiza Félix Marão Martins ◽  
João Ricardo Nickenig Vissoci ◽  
Núbia Cristina da Silva ◽  
Thiago Augusto Hernandes Rocha ◽  
...  
Keyword(s):  
Primary Care ◽  
Oral Health ◽  
Health Services ◽  
Panel Study ◽  
Home Visits ◽  
Work Process ◽  
Transition Analysis ◽  
Dental Office ◽  
Day Of The Week ◽  
Oral Health Services

Objective Compared indicators of potential access to oral health services sought in two cycles of the Program for Improvement of Access and Quality of Primary Care (PMAQ-AB), verifying whether the program generated changes in access to oral health services. Methods Transitional analysis of latent classes was used to analyze two cross-sections of the external evaluation of the PMAQ-AB (Cycle I: 2011–2012 and Cycle II: 2013–2014), identifying completeness classes for a structure and work process related to oral health. Consider three indicators of structure (presence of a dental surgeon, existence of a dental office and operating at minimum hours) and five of the work process (scheduling every day of the week, home visits, basic dental procedures, scheduling for spontaneous demand and continuation of treatment). Choropleth maps and hotspots were made. Results The proportion of elements that had one or more dentist (CD), dental office and operated at minimum hours varied from 65.56% to 67.13 between the two cycles of the PMAQ-AB. The number of teams that made appointments every day of the week increased 8.7% and those that made home visits varied from 44.51% to 52.88%. The reduction in the number of teams that reported guaranteeing the agenda for accommodating spontaneous demand, varying from 62.41% to 60.11% and in the continuity of treatment, varying from 63.41% to 61.11%. For the structure of health requirements, the predominant completeness profile was "Best completeness" in both cycles, comprising 71.0% of the sets at time 1 and 67.0% at time 2. The proportion of teams with "Best completeness" increased by 89.1%, the one with "Worst completeness" increased by 20%, while those with "Average completeness" decreased by 66.3%. Conclusion We identified positive changes in the indicators of potential access to oral health services, expanding the users’ ability to use them. However, some access attributes remain unsatisfactory, with organizational barriers persisting.

scholarly journals Do Oral Health Services in Medical Offices Replace Pediatric Dental Visits?

2020 ◽  
Vol 99 (8) ◽  
pp. 891-897 ◽  
Author(s):  
A.M. Kranz ◽  
R.G. Rozier ◽  
B.D. Stein ◽  
A.W. Dick
Keyword(s):  
Oral Health ◽  
Health Services ◽  
Young Children ◽  
Dental Care ◽  
Primary Care Providers ◽  
The United States ◽  
Dental Visit ◽  
Dental Visits ◽  
Oral Health Services ◽  
Linear Probability

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.

scholarly journals Construction and Validation of a Tool for the Assessment of the Oral Health in Primary Health Care Through the Perspective of Patients

2020 ◽  
Vol 12 (4) ◽  
pp. 37
Author(s):  
Heriberto Fiuza Sanchez ◽  
Raquel Conceição Ferreira ◽  
Andrea Maria Duarte Vargas ◽  
Marcos Azeredo Furquim Werneck ◽  
Efigênia Ferreira e Ferreira
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Factor Analysis ◽  
Primary Health Care ◽  
Oral Health ◽  
Focus Group ◽  
Health Services ◽  
Health Unit ◽  
Primary Health ◽  
Oral Health Services

OBJECTIVE: To construct and validate a questionnaire to evaluate the quality of oral health services in primary health care, from patients. METHODS: Initially a theoretical model of evaluation of Primary Health Care was elaborated, based on the evaluation of primary care and integrality in primary care. This model served as the basis for the script of a focus group with patients, aiming to verify the attributes perceived as important for such evaluation. The focus group results substantiated the first version of the questionnaire. Content validation was performed through a committee of experts (five teachers/researchers) and face validation in two pre-tests (37 patients each pre-test). For construct validation, factor analysis was performed and reliability (Kappa coefficient) and internal consistency (Cronbach&#39;s alpha) were verified. RESULTS: Thirty questions were considered for exploratory factor analysis. The anti-image matrix of covariances showed the need to exclude fourteen questions (values &lt;0.5). After this initial analysis, 16 questions remained in the questionnaire. The KMO test, considering the 16 questions, presented a value of 0.84. Cronbach&#39;s alpha was 0.919. The final version contains 16 questions divided into two dimensions: my health unit and the care in my health unit. CONCLUSIONS: The questionnaire allows a strategy that easily evaluates oral health services in primary care, based on the perception of patients.

Sign in / Sign up

Export Citation Format

Share Document