204685 Translating tobacco treatment guidelines into dental settings

Tuesday, November 10, 2009

Margaret M. Walsh, MS, EdD , Department of Preventive and Restorative Dental Sciences; Center to Address Disparities in Chidren's Oral Health (CAN DO), University of California, San Francisco, San Francisco, CA
Marilynn Belek, DMD , Delta Dental of California, San Francisco, CA
Preeti Prakash, BDS, MSc , Center to Address Disparities in Children's Oral Health, UCSF, University of California San Francisco, San Francisco, CA
Barbara Heckman, RDH, MS , Department of Preventive and Restorative Dental Sciences, University of California, San Francisco, San Francisco, CA
Richard Meckstroth, DDS , Department of Dental Practice and Rural Health, West Virginia University School of Dentistry, Morgantown, WV
Jane A. Weintraub, DDS, MPH , Center to Address Disparities in Children's Oral Health, University of California, San Francisco, San Francisco, CA
Steven J. Silverstein, DMD, MPH , Department of Preventive and Restorative Dental Sciences, University of California, San Francisco, San Francisco, CA
Barbara Grimes, Phd, MS , Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA
Stuart A. Gansky, MS, DrPH , Center to Address Disparities in Children's Oral Health, University of California, San Francisco, San Francisco, CA
Objective: To determine the efficacy of training intensity and third party reimbursement on general dentists' attitudes, and assessment/treatment behaviors related to patients' tobacco use. Methods: Dental practices (N=265) were randomly selected (stratified by state) from a master Delta Dental provider list. Initially, 20% of the sample was randomly assigned to the Usual Care (UC) Arm of the study for recruitment and baseline assessment; the remaining 80% were assigned to the Intervention Arm for recruitment, baseline assessment and randomization to one of 4 groups: low-intensity training (LIT), high intensity training (HIT), low-intensity training plus reimbursement (LITR); and high-intensity training plus reimbursement (HITR). Dentist and patient-reported outcomes were questionnaire-assessed 12 months post intervention by mail. Positive change scores in dentists' attitudes and behaviors were compared between UC vs. any intervention group; and reimbursement (R) vs. no-R. Results: Advise, Assist, and Arrange behaviors of all intervention group dentists improved from baseline to follow-up compared to UC (all P< 0.03). Attitudes and behaviors in the HIT group had more positive change compared to the LIT group (e.g., OR 2.4 95% CI: 1.2-4.7). There were no significant differences between R no-R groups. Patients reported greater assessment and treatment scores in all intervention groups compared to the UC group (OR1.7 95% CI: 1.1-2.6). Conclusion. Both high and low intensity training significantly improved dentists attitudes and behaviors relating to treatment of tobacco use and dependence in dental settings. Reimbursement at the level offered provided no additional effect. Funded by NIDCR/NIDA #1R01DE015691 and Delta Dental of California.

Learning Objectives:
List the five tobacco assessment/treatment behaviors associated with translating U.S. Department of Health and Human Services Public Health Service tobacco treatment guidelines into dental settings. Discuss the efficacy of training, intensity and third party reimbursement on general dentists' attitudes and behaviors related to treatment of tobacco use and dependence.

Keywords: Tobacco, Training

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am the Principal Investigator of the NIDCR/NIH-funded research study (1 R01 DE015691) on translating the U.S. Department of Health and Human Services Public Health Service guidelines for treating tobacco use and dependence in dental settings.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

See more of: Health care professionals’ roles in tobacco cessation
See more of: Alcohol, Tobacco, and Other Drugs