University of Massachusetts Amherst School of Public Health and Health Sciences (SL Goff, CF Gilson, and E DeCou), Health Promotion and Policy, Amherst, Mass.
University of Massachusetts Amherst School of Public Health and Health Sciences (SL Goff, CF Gilson, and E DeCou), Health Promotion and Policy, Amherst, Mass.
Acad Pediatr. 2024 Jul;24(5):755-764. doi: 10.1016/j.acap.2023.09.018. Epub 2023 Oct 5.
National guidelines recommend that all children under age six receive fluoride varnish (FV) in medical settings. However, application rates remain low. This study aimed to update understanding of barriers and facilitators to guideline concordant FV application.
We conducted virtual semi-structured interviews with a purposive sample (eg, FV application rates, geographic location, practice size and type) of pediatric primary care clinicians and medical assistants in Massachusetts between February 1 and June 30, 2022. The Consolidated Framework for Implementation Research (CFIR) served as the study's theoretical framework and data were analyzed using a modified grounded theory approach.
Of the 31 participants, 90% identified as White and 81% as female. Major themes, which linked to four CFIR domains, included: variation in perceived adequacy of reimbursement; differences in FV application across practice types; variation in processes, protocols, and priorities; external accountability for quality of care; and potential levers for change. Important subthemes included challenges for small practices; role of quality measures in delivering guideline-concordant preventive oral health care; and desire for preventive care coordination with dentists.
This study suggests that potential barriers and facilitators to guideline concordant FV application exist at multiple levels that may warrant further study. Examples include testing the effectiveness of quality measures for FV application and testing strategies for implementing consistent processes and protocols for improving FV application rates.
国家指南建议所有 6 岁以下儿童在医疗场所接受氟化物涂料（FV）。然而，应用率仍然很低。本研究旨在更新对符合指南的 FV 应用障碍和促进因素的理解。
我们于 2022 年 2 月 1 日至 6 月 30 日在马萨诸塞州对儿科初级保健临床医生和医疗助理进行了虚拟半结构化访谈，采用了有目的的样本（例如，FV 应用率、地理位置、实践规模和类型）。实施研究综合框架（CFIR）作为研究的理论框架，使用改进的扎根理论方法进行数据分析。
31 名参与者中，90%认为自己是白人，81%是女性。主要主题与 CFIR 的四个领域相关，包括：报销充足性感知的差异；不同实践类型的 FV 应用差异；流程、协议和优先级的差异；护理质量的外部问责制；以及潜在的变革杠杆。重要的子主题包括小型实践的挑战；质量措施在提供符合指南的预防性口腔保健中的作用；以及与牙医协调预防性保健的愿望。
本研究表明，符合指南的 FV 应用存在多个层面的潜在障碍和促进因素，这可能需要进一步研究。例如，测试 FV 应用质量措施的有效性，并测试实施一致流程和协议以提高 FV 应用率的策略。
