Primary caries prevention in primary care medical and nurse practitioner clinics in Minnesota: Barriers and facilitators to adoption and implementation

Objectives: To describe the extent to which primary care medical and nurse practitioner clinics implemented caries prevention services for high-risk children. Describe barriers and facilitators to the adoption and implementation of caries prevention services. Methods: Clinic nurse managers who participated in a Primary Caries Prevention intervention in Minnesota completed questionnaires reporting their experiences with providing caries prevention services for high-risk children in their practices. To estimate the degree to which PCP was adopted and integrated into clinical processes, we asked a direct adoption question followed by a series of questions about the nature of the CPS in their clinic, including service eligibility and frequency policies, and how the services are provided. Fourteen issues were identified as possible obstacles to program adoption and implementation. Results: Clinics reported being at various stages of adoption: 51.2% offering CPS as an integrated routine service; 17.1% offering CPS but not yet a clinic-wide routine; 14.6% preparing to implement CPS; 4.9% intending to implement CPS in the future; 4.9% piloted CPS but stopped; and 7.3% have no plans to implement CPS. We will provide data to illustrate that CPS is not fully infused within clinics and discuss where more work needs to be done to ensure high-risk children receive periodic fluoride varnish applications according to their risk status. Obstacles: 21.7% reported colleagues think CPS is dentists' responsibility; 18.2% identified other services being implemented; 17.4% reported resistance among staff; 13% reported difficulty integrating the services into their practice routine; and 4.3% reported referral difficulty as an obstacle.