Braun Patricia A, Racich Katina Widmer, Ling Sarah B, Ellison Misoo C, Savoie Karen, Reiner Linda, Westfall John M
University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
Department of Family Medicine, Broadlawns Medical Center, Des Moines, IA, USA.
Pediatric Health Med Ther. 2015 Jul 10;6:101-109. doi: 10.2147/PHMT.S79826. eCollection 2015.
Early childhood caries is the most common chronic childhood condition and largely preventable. Access to oral health preventive services (OHPS) for children at risk for caries is suboptimal and could be expanded if they were provided by non-dental professionals. Many state Medicaid programs in the USA now reimburse non-dental professionals for OHPS but require that they receive oral health education (OHE) to be reimbursed. Few OHE programs have been evaluated.
We evaluated the impact of Colorado's OHE program on professional- and practice-level behaviors regarding the provision of OHPS to children by measuring its reach, effectiveness, adoption, implementation, and maintenance (ie, using the Reach Effectiveness Adoption Implementation Maintenance [RE-AIM] framework) with Medicaid claims data, online surveys, and key informant interviews.
From 2009 to 2012, the proportion of young, low-income children receiving OHPS from a medical professional increased 16-fold. We surveyed 703 OHE participants; post-OHE response rates were 61% at 12 months, 34% at 24 months (2009 participants), and 39% at 12 months (2011 participants). Respondents reported confidence in providing OHPS; favorable oral health knowledge, attitudes, and beliefs; and were providing OHPS to most eligible children. Approximately half of the practices had initiated practice-level changes to support program implementation and maintenance. Few barriers were reported to care. Eighteen interviewees reported factors facilitating program diffusion, which included quality materials, community need, and reimbursement; barriers included lack of time to provide services, resources to purchase supplies, and referral dentists.
This evaluation of a state interprofessional OHE program shows evidence of program diffusion and identifies facilitating factors and barriers to having medical professionals provide OHPS.
幼儿龋齿是儿童中最常见的慢性疾病，在很大程度上是可以预防的。有龋齿风险的儿童获得口腔健康预防服务（OHPS）的情况并不理想，如果由非牙科专业人员提供这些服务，服务范围可能会扩大。美国许多州的医疗补助计划现在为非牙科专业人员提供的OHPS报销费用，但要求他们接受口腔健康教育（OHE）才能获得报销。很少有OHE项目得到评估。
我们通过使用医疗补助报销数据、在线调查和关键信息访谈，衡量科罗拉多州OHE项目在向儿童提供OHPS方面对专业人员和实践层面行为的影响，即通过测量其覆盖范围、有效性、采用情况、实施情况和维持情况（即使用覆盖范围、有效性、采用情况、实施情况、维持情况[RE-AIM]框架）。
2009年至2012年，从医疗专业人员处接受OHPS的低收入幼儿比例增加了16倍。我们对703名OHE参与者进行了调查；OHE后12个月的回复率为61%，24个月时为34%（2009年参与者），12个月时为39%（2011年参与者）。受访者表示有信心提供OHPS；具备良好的口腔健康知识、态度和信念；并为大多数符合条件的儿童提供OHPS。大约一半的医疗机构已经开始在实践层面做出改变，以支持项目的实施和维持。很少有护理方面的障碍被报告。18名受访者报告了促进项目传播的因素，包括高质量的材料、社区需求和报销；障碍包括缺乏提供服务的时间、购买用品的资源以及转诊牙医。
对一个州跨专业OHE项目的评估显示了项目传播的证据，并确定了医疗专业人员提供OHPS的促进因素和障碍。
