Kressin Nancy R, Nunn Martha E, Singh Harpreet, Orner Michelle B, Pbert Lori, Hayes Catherine, Culler Corinna, Glicken Stephan R, Palfrey Sean, Geltman Paul L, Cadoret Cynthia, Henshaw Michelle M
Northeast Center for Research to Evaluate and Eliminate Dental Disparities, Boston, MA, USA.
Med Care. 2009 Nov;47(11):1121-8. doi: 10.1097/MLR.0b013e3181b58867.
Early childhood caries (ECC) is a serious and preventable disease which pediatric clinicians can help address by counseling to reduce risk.
We implemented a multifaceted practice-based intervention in a pediatric outpatient clinic treating children vulnerable to ECC (N = 635), comparing results to those from a similar nearby clinic providing usual care (N = 452).
We provided communication skills training using the approach of patient centered counseling, edited the electronic medical record to prompt counseling, and provided parents/caregivers with an educational brochure.
We assessed changes in provider knowledge about ECC after the intervention, and examined providers' counseling practices and incidence of ECC over time by site, controlling for baseline ECC, patient sociodemographics and parents'/caregivers' practice of risk factors (diet, oral hygiene, tooth-monitoring), among 1045 children with complete data.
Provider knowledge about ECC increased after the intervention training (percentage correct answers improved from 66% to 79%). Providers at the intervention site used more counseling strategies, which persisted after adjustment for sociodemographic characteristics. Children at the intervention site had a 77% reduction in risk for developing ECC at follow up, after controlling for age and race/ethnicity, sociodemographics and ECC risk factors; P <or= 0.004.
The multifaceted intervention was associated with increased provider knowledge and counseling, and significantly attenuated incidence of ECC. If validated by additional studies, similar interventions could have the potential to make a significant public health impact on reducing ECC among young children.
幼儿龋齿（ECC）是一种严重但可预防的疾病，儿科临床医生可通过咨询以降低风险来帮助解决该问题。
我们在一家儿科门诊对易患ECC的儿童（N = 635）实施了多方面的基于实践的干预措施，并将结果与附近一家提供常规护理的类似诊所（N = 452）的结果进行比较。
我们采用以患者为中心的咨询方法提供沟通技能培训，编辑电子病历以促使进行咨询，并为家长/照顾者提供一份教育手册。
我们评估了干预后提供者对ECC知识的变化，并在1045名有完整数据的儿童中，按地点检查提供者的咨询实践以及ECC随时间的发生率，同时控制基线ECC、患者社会人口统计学特征以及家长/照顾者的风险因素（饮食、口腔卫生、牙齿监测）实践情况。
干预培训后，提供者对ECC的知识有所增加（正确答案的百分比从66%提高到79%）。干预地点的提供者使用了更多的咨询策略，在对社会人口统计学特征进行调整后，这种情况仍然存在。在控制年龄、种族/民族、社会人口统计学特征和ECC风险因素后，干预地点的儿童在随访时患ECC的风险降低了77%；P≤0.004。
多方面干预与提供者知识和咨询的增加相关，并显著降低了ECC的发生率。如果通过其他研究得到验证，类似的干预措施可能有潜力对减少幼儿ECC产生重大的公共卫生影响。
