Online Program

Randomized controlled trial of an oral health promotion program in a large, urban safety-net health care system effectively expands access to preventive dental care

Wednesday, November 6, 2013 : 10:30 a.m. - 10:50 a.m.

Patricia Braun, MD, MPH, Children's Outcomes Research, University of Colorado Anchutz Medical Campus, Aurora, CO
Katina Widmer, MA, Children's Outcomes Research, University of Colorado, Aurora, CO
Misoo Ellison, PhD, Biostatistics & Informatics, Colorado School of Public Health, Aurora, CO
Simon Hambidge, MD, PhD, Community Health Services, Pediatrics, Denver Health, University of Colorado School of Medicine, Denver
Background: Caries, a common childhood disease, is preventable, yet access to preventive dental care (PDC) is limited for disadvantaged children. Objective: To examine the provision of PDC by medical providers after participation in an oral health promotion program (OHPP). Design/Methods: We implemented a staged intervention in an urban safety-net health system with 8 federally-qualified health centers (FQHCs). Four FQHCs received the OHPP in 2009 (intervention) and 4 in 2011 (controls). OHPP consisted of an oral health training regarding PDC (including fluoride varnish application (FVA)) and quarterly practice coaching. We measured OHPP adoption by 1) comparing FVA in children receiving care in the intervention vs. control FQHCs in 2011 and 2) FVA in children 18-, 30- and 42-months of age in 2013. Descriptive statistics, Wilcoxon rank-sum and Chi-square tests were used. Results: 1) A random sample of 421 children receiving care in the 4 intervention/4 control FQHCs were recruited. They were 40.6 months old, Hispanic (91.2% intervention/86.4% control, p=0.14) and insured by Medicaid/SCHIP (90.2% intervention/85.6% control, p=0.17). Children from intervention FQHCs were more likely to have received a FVA (mean=1.4 FVA (N=296, Range=0 to 7) than children from control FQHCs (mean= 0.4 FVA (N=124, Range=0 to 4)) (p<0.0001). 2) 79% of 18-month old children receiving care in any FQHCs had received at ≥ 1 FVA; 62% of 30-month old children had received ≥ 2; and 38% of 42-month old children had received ≥ 3. Conclusions: A structured OHPP program effectively engaged medical providers in the provision of PDC to children.

Learning Areas:

Chronic disease management and prevention
Implementation of health education strategies, interventions and programs
Other professions or practice related to public health
Planning of health education strategies, interventions, and programs

Learning Objectives:
Design an effective oral health promotion program for medical providers that is effective at increasing access to preventive dental care for young, disadvantaged children.

Keyword(s): Oral Health, Primary Prevention

Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: off-label use of fluoride varnish is discussed

Qualified on the content I am responsible for because: I designed, implemented and managed all aspects of this research.
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.