McKernan S C, Reynolds J C, Ingleshwar A, Pooley M, Kuthy R A, Damiano P C
1 Department of Preventive & Community Dentistry, University of Iowa College of Dentistry, Iowa City, Iowa, USA.
2 University of Iowa Public Policy Center, Iowa City, Iowa, USA.
JDR Clin Trans Res. 2018 Jan;3(1):101-108. doi: 10.1177/2380084417714795. Epub 2017 Jun 9.
This study explores how travel distance and other transportation barriers are associated with dental utilization in a Medicaid expansion population. We analyzed data from the Iowa Dental Wellness Plan (DWP), which provides comprehensive dental benefits for low-income adults aged 19 to 64 y as part of Iowa's Medicaid expansion. Transportation and geographical characteristics were evaluated as enabling factors within the framework of Andersen's behavioral model of health services use. In March 2015, a random sample of DWP members ( n = 4,800) was surveyed; adjusted survey response rate was 30% ( n = 1,258).The questionnaire was based on the Consumer Assessment of Healthcare Providers and Systems (CAHPS) Dental Plan Survey and assessed need for dental care, use of dental services and transportation to visits, and self-perceived oral health status. Respondent and dentist addresses were geocoded and used to calculate distance to the nearest DWP general dentist. A logistic regression model predicting utilization of dental care was developed using variables representing each domain of the behavioral model. Most respondents (57%) reported a dental visit since enrolling. Overall, 11% of respondents reported unmet dental need due to transportation problems. Median distance to the nearest general dentist was 1.5 miles. In the adjusted model, travel distance was not significantly associated with the likelihood of dental utilization. However, other transportation-related issues were significantly associated with utilization, including concern about cost of transportation and driver/passenger status. As concern about transportation cost increased, likelihood of having a dental visit decreased. Targeted approaches to assisting low-income populations with transportation barriers should be considered in designing policies and interventions to improve access to dental care. Knowledge Transfer Statement: The results of this study can be used by policy makers and public health planners when designing programs and interventions to improve access to dental care. Consideration of transportation availability and costs could improve utilization of routine dental care, especially among low-income populations.
本研究探讨了旅行距离和其他交通障碍如何与医疗补助扩大人群的牙科服务利用相关联。我们分析了爱荷华州牙科健康计划（DWP）的数据，该计划为爱荷华州医疗补助扩大计划中19至64岁的低收入成年人提供全面的牙科福利。在安德森健康服务使用行为模型的框架内，交通和地理特征被评估为促成因素。2015年3月，对DWP成员进行了随机抽样调查（n = 4800）；调整后的调查回复率为30%（n = 1258）。问卷基于医疗服务提供者和系统消费者评估（CAHPS）牙科计划调查，评估了牙科护理需求、牙科服务使用情况、就诊交通情况以及自我感知的口腔健康状况。对受访者和牙医的地址进行了地理编码，并用于计算到最近的DWP普通牙医的距离。使用代表行为模型各领域的变量建立了预测牙科护理利用情况的逻辑回归模型。大多数受访者（57%）报告自注册以来进行过牙科就诊。总体而言，11%的受访者报告因交通问题未满足牙科需求。到最近普通牙医的中位距离为1.5英里。在调整后的模型中，旅行距离与牙科服务利用的可能性无显著关联。然而，其他与交通相关的问题与服务利用显著相关，包括对交通成本的担忧以及司机/乘客身份。随着对交通成本担忧的增加，进行牙科就诊的可能性降低。在设计改善牙科护理可及性的政策和干预措施时，应考虑针对有交通障碍的低收入人群的有针对性方法。知识转移声明：政策制定者和公共卫生规划者在设计改善牙科护理可及性的项目和干预措施时可使用本研究结果。考虑交通便利性和成本可提高常规牙科护理的利用率，尤其是在低收入人群中。
