Rozier R Gary, Sutton Betty King, Bawden James W, Haupt Kelly, Slade Gary D, King Rebecca S
Department of Health Policy and Administration, School of Public Health, University of North Carolina at Chapel Hill, 27599-7411, USA.
J Dent Educ. 2003 Aug;67(8):876-85.
Early childhood caries is a significant public health problem in low-income children, with important negative consequences for the child and the family. The purpose of this paper is to describe the development, implementation, and preliminary outcomes of preventive dentistry programs in North Carolina that target low-income children from birth to thirty-five months of age. The focus is on Into the Mouths of Babes, a statewide program in which pediatricians, family physicians, and providers in community health clinics are reimbursed by Medicaid to provide preventive dental services for children (risk assessment, screening, referral, fluoride varnish application) and caregivers (counseling). The provider intervention includes continuing medical education lectures and interactive sessions, practice guidelines for the patient interventions, case-based problems, practical strategies for implementation, a toolkit with resource materials, and follow-up training. In the first two years of the statewide program, 1,595 medical providers have been trained. The number of providers billing for these services has steadily increased, and by the last quarter of 2002, the number of visits in which preventive dental services were provided in medical offices reached 10,875. A total of 38,056 preventive dental visits occurred in medical offices in 2002. By the end of 2002, only sixteen of the state's one hundred counties had no pediatrician, family physician, or local health department participating. The preliminary results from this program demonstrate that nondental professionals can integrate preventive dental services into their practices. The program has increased access to preventive dental services for young Medicaid children whose access to dentists is restricted. Assessments of effectiveness and cost-effectiveness of both the provider and patient interventions are under way.
幼儿龋齿是低收入家庭儿童面临的一个重大公共卫生问题，会给儿童及其家庭带来严重的负面后果。本文旨在描述北卡罗来纳州针对出生至35个月大的低收入儿童的预防牙科项目的开展、实施情况及初步成果。重点介绍“关爱婴幼儿口腔健康”项目，这是一个全州性的项目，儿科医生、家庭医生以及社区健康诊所的医护人员可获得医疗补助，为儿童（进行风险评估、筛查、转诊、涂抹氟化物漆）和护理人员（提供咨询）提供预防性牙科服务。医护人员干预措施包括继续医学教育讲座和互动课程、患者干预的实践指南、基于案例的问题、实施的实用策略、配有参考资料的工具包以及后续培训。在该全州性项目的头两年里，已有1595名医疗服务提供者接受了培训。开具这些服务账单的提供者数量稳步增加，到2002年最后一个季度，在医疗机构提供预防性牙科服务的就诊次数达到10875次。2002年医疗机构共进行了38056次预防性牙科就诊。到2002年底，该州100个县中只有16个县没有儿科医生、家庭医生或当地卫生部门参与。该项目的初步结果表明，非牙科专业人员可以将预防性牙科服务纳入他们的业务范围。该项目增加了那些看牙医受限的低收入医疗补助儿童获得预防性牙科服务的机会。目前正在对医护人员和患者干预措施的有效性及成本效益进行评估。
