Care coordination among pediatricians and dentists: a cross-sectional study of opinions of North Carolina dentists

BMC Oral Health

R Gary Rozier⁴  Marshall Long²  Ashley M Kranz¹  Rocio B Quinonez³ 

[1] Department of Dental Research, School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA;Private Practice, Charlotte, NC, USA;Department of Pediatric Dentistry and Pediatrics, Schools of Medicine and Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA;Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

关键词: Preventive dental services;    Early childhood caries;    Dental workforce;    Infant oral health care;    Guidelines;    Care coordination;   

Others  :  1109910
DOI  :  10.1186/1472-6831-14-33

 received in 2013-12-17, accepted in 2014-04-02,  发布年份 2014

【 摘 要 】

Background

Care coordination between physicians and dentists remains a challenge. This study of dentists providing pediatric dental care examined their opinions about physicians’ role in oral health and identified factors associated with these opinions.

Methods

North Carolina general and pediatric dentists were surveyed on their opinions of how physicians should proceed after caries risk assessment and evaluation of an 18-month-old, low risk child. We estimated two multinomial logistic regression models to examine dentists’ responses to the scenario under the circumstances of an adequate and a limited dental workforce.

Results

Among 376 dentists, 52% of dentists indicated physicians should immediately refer this child to a dental home with an adequate dental workforce. With a limited workforce, 34% recommended immediate referral. Regression analysis indicated that with an adequate workforce guideline awareness was associated with a significantly lower relative risk of dentists’ recommending the child remain in the medical home than immediate referral.

Conclusions

Dentists’ opinions and professional guidelines on how physicians should promote early childhood oral health differ and warrant strategies to address such inconsistencies. Without consistent guidelines and their application, there is a missed opportunity to influence provider opinions to improve access to dental care.

【 授权许可】

   
2014 Quinonez et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Al-Habashneh R, Barghout N, Humbert L, Khader Y, Alwaeli H: Diabetes and oral health: doctors’ knowledge, perception and practice. J Eval Clin Pract 2010, 16(5):976-980.
• [2]Sumi Y, Ozawa N, Miura H, Miura H, Toba K: Community coordination of dental care needs in a home medical care support ward and at home. Nihon Ronen Igakkai Zasshi 2011, 48(4):391-396.
• [3]Sabbagh HJ, El-Kateb M, Al Nowaiser A, Hanno AG, Alamoudi NH: Assessment of pediatricians dental knowledge, attitude and behavior in Jeddah, Saudi Arabia. J Clin Pediatr Dent 2011, 35(4):371-376.
• [4]Ismail AI, Nainar SM, Sohn W: Children’s first dental visit: attitudes and practices of US pediatricians and family physicians. Pediatr Dent 2003, 25(5):425-430.
• [5]AlYousef Y, Damiano P, Weber-Gasparoni K, Qian F, Murph J, Nothwehr F: Medical students’ child oral-health-related knowledge, practices and attitudes. Eur J Dent Educ 2013, 17(4):218-224.
• [6]American Academic of Pediatric Dentistry Council on Clinical Affairs: Definition of Dental Home. Pediatr Dent 2012, 13:35. (6 Suppl Reference Manual):12
• [7]Hale KJ: American Academy of Pediatrics Section on Pediatric Dentistry, Oral health risk assessment timing and establishment of the dental home. Pediatrics 2003, 111(5 pt 1):1113-1116.
• [8]Section on Pediatric Dentistry and Oral Health: American Academy of Pediatrics. Preventive oral health intervention for pediatricians. Pediatrics 2008, 122(6):1387-1393.
• [9]American Academy of Pediatric Dentistry Council on Clinical Affairs: Guideline on infant oral health care care. Clin Guidel Ref Man 2010, 32:114-118.
• [10]American Academy of Pediatric Dentistry Council on Clinical Affairs: Guideline on infant oral health care care. Clin Guidel Ref Man 2012, 35(6):137-141.
• [11]Lewis CW, Grossman DC, Domoto PK, Deyo RA: The role of pediatrician in the oral health of children. A national survey. Pediatrics 2000, 106(6):E84.
• [12]Lewis CW, Boutler S, Keels MA, Krol DM, Mouradian WE, O’Connor KG, Quinonez RB: Oral health and pediatricians: results of a national survey. Acad Pediatr 2009, 9(6):457-461.
• [13]American Academy of Pediatrics: Fluoride varnish reimbursement table. Available at: http://www2.aap.org/oralhealth/State.html webcite. Accessed on June 7, 2013
• [14]Deinard A: State Medicaid payment for caries prevention services by non-dental professionals. 2013. Available at: http://www2.aap.org/oralhealth/docs/OHReimbursementChart.pdf webcite. Accessed March 12, 2014
• [15]Close K, Rozier RG, Zeldin LP, Gilbert AR: Barriers to the adoption and implementation of preventive dental services in primary medical care. Pediatrics 2010, 125(3):509-517.
• [16]Beil HA, Rozier RG: Primary health care providers’ advice for a dental checkup and dental use in children. Pediatrics 2010, 126(2):e435-e441.
• [17]Pahel BT, Rozier RG, Stearns SC, Quinonez RB: Effectiveness of preventive dental treatments by physicians for young Medicaid enrollees. Pediatrics 2011, 127(3):e682-e689.
• [18]Rubio-Valera M, Jove AM, Hughes CM, Guillen-Sola M, Rovira M, Fernandez A: Factors affecting collaboration between general practitioners and community pharmacists: a qualitative study. BMC Health Serv Res 2012, 12:188. Available at: http://www.biomedcentral.com/1472-6963/12/188 webcite. Accessed on April 17, 2013 BioMed Central Full Text
• [19]O’Daniel M, Rosenstein A: Professional communication and team collaboration. In Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Chapter 33. Edited by Hughes RG. Rockville (MD): Agency for Healthcare Research and Quality (US); 2008. Available from: http://www.ncbi.nlm.nih.gov/books/NBK2651/ webcite. Accessed on April 17, 2013
• [20]dela Cruz GG, Rozier RG, Slade G: Dental screening and referral of young children by pediatric primary care providers. Pediatrics 2004, 114(5):e642-e652.
• [21]Garg S, Rubin T, Jasek J, Weinstein J, Helburn L, Kaye K: How willing are dentists to treat young children?: A survey of dentists affiliated with Medicaid managed care in New York City, 2010. J Am Dent Assoc 2013, 144(4):416-425.
• [22]Santos CL, Douglass JM: Practices and opinions of pediatric and general dentists in Connecticut regarding the age 1 dental visit and dental care for children younger than 3 years old. Pediatr Dent 2008, 30(4):348-351.
• [23]Wolfe JD, Weber-Gasparoni K, Kanellis MJ, Qian F: Survey of Iowa general dentists regarding the age 1 dental visit. Pediatr Dent 2005, 28(4):325-331.
• [24]Shulman ER, Ngan P, Wearden S: Survey of treatment provided for young children by West Virginia general dentists. Pediatr Dent 2008, 30(4):352-357.
• [25]United States General Accounting Office (GAO): Efforts Underway to Improve Children’s Access to Dental Services But Sustained Attention Needed to Address Ongoing Concerns, GAO-11-96. Washington, D.C.: GAO, November; 2010.
• [26]Rozier RG, Slade GD, Zeldin LP, Wang H: Parents' satisfaction with preventive dental care for young children provided by non-dental primary care providers. Pediatr Dent 2005, 27:313-322.
• [27]North Carolina CMS 416 report December, 2012. Accessed on March 11, 2013. Available at: http://www.ncdhhs.gov/dma/healthcheck/hmlr5901sfy2012_416.pdf webcite
• [28]Fraher E, McGee V, Hom J, Lyons J, Gaul K: We’re not keeping up with the Joneses: North Carolina has fewer dentists per capita than neighboring (and most other) states. NC Med J 2012, 73(2):111-114.
• [29]Long CM, Quinonez RB, Rozier RG, Kranz A, Lee JY: The first dental visit: Knowledge, attitudes, and behaviors of North Carolina dentists regarding physician referral guidelines. Pediatr Dent 2012, 34:162. (Abstract)- Manuscript accepted for publication to Pediatr Dent
• [30]Cabana MD, Rand CS, Powe NR: Why don’t physicians follow clinical practice guidelines?: A framework for improvement. J Am Med Assoc 1999, 282(15):1458-1465.
• [31]Dillman DA: Mail and telephone surveys: The total design method. New York: Wiley-Interscience; 1978:375pp.
• [32]Tunis SR, Hayward RS, Wilson MC, Rubin HR, Bass EB, Johnston M, Steinberg EP: Internists' attitudes about clinical practice guidelines. Ann Intern Med 1994, 120:956-963.
• [33]Farquhar CM, Kofa EW, Slutsky JR: Clinicians’ attitudes to clinical practice guidelines: a systematic review. MJA 2002, 177:502-506.
• [34]StataCorp: Stata Statistical Software: Release 12. College Station, TX: StataCorp LP; 2011.
• [35]American Dental Association Council on Scientific Affairs: Professionally applied topical fluoride: Executive summary of evidence-based clinical recommendations. Chicago, IL: Special JADA insert; 2006. Available at: http://www.ada.org/sections/scienceAndResearch/pdfs/report_fluoride_exec.pdf webcite
• [36]Hagan JF, Shaw JS, Duncan PM (Eds): Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents. 3rd edition. Elk Grove Village, IL: American Academy of Pediatrics; 2008.
• [37]Long CM, Quinonez RB, Beil HA, Close K, Myers L, Vann WF Jr, Rozier RG: Pediatricians' assessments of caries risk and need for a dental evaluation in preschool aged children. BMC Pediatr 2012, 12:49. doi:10.1186/1471-2431-12-49 BioMed Central Full Text
• [38]Malcheff S, Pink T, Sohn W, Inglehar MR, Habil P, Briskie D: Infant oral health examinations: pediatric dentists’ professional behavior and attitudes. Pediatr Dent 2009, 31(3):202-209.
• [39]Seale NS, Casamassimo PS: Access to dental care for children in the United States: a survey of general practitioners. J Am Dent Assoc 2003, 134(12):1630-1640.
• [40]Meskin LH: Look who’s practicing dentistry. J Am Dent Assoc 2001, 132(10):1352-1354. passim
• [41]Bubna S, Perez-Spiess S, Cernigliaro J, Julliard K: Infant oral health care: beliefs and practices of American Academy of Pediatric Dentistry Members. Pediatr Dent 2012, 34(3):203-209.
• [42]Sohn W, Ismail AI, Tellez M: Efficacy of educational interventions targeting primary care providers’ practice behaviors: an overview of published systematic reviews. J Public Health Dent 2004, 64(3):164-172.
• [43]Lewis CW, Barone L, Quinonez RB, Boulter S, Mouradian WE: Chapter Oral Health Advocates: A nationwide model for pediatrician peer education and advocacy about oral health. Int J Dent 2013. doi:10.1155/2013/498906. Epub 2013 Oct 21
• [44]Close K, Myers L, Casey M, Quinonez R, Hom J, Rozier G: Adherence of Primary Care Medical Providers to Oral Health Screening and Referral Guidelines. Abstract No. 14 of Oral Presentations. Madison, WI: Thirteenth National Oral Health Conference; 2012.
• [45]Accreditation standards for dental education programs: Accreditation standards for dental education programs. Available at: http://www.ada.org/sections/educationAndCareers/pdfs/predoc_2013.pdf webcite. Accessed on July, 2003
• [46]Chung M, Kaste LM, Koerber A, Fadavi S, Punwani I: Dental and medical students’ knowledge and opinions of infant oral health. J Dent Educ 2006, 70(5):511-517.
• [47]McFarland TB, Quinonez RB, Phillips C, Lee J, Chung Y: Provision of preventive oral health services to infant and toddlers: North Carolina general dentists’ readiness. J Oral Health Comm Dent 2013, 7(3):140-147.
• [48]Quinonez RB, Pahel BT, Rozier RG, Stearns SC: Follow-up preventive dental visits for Medicaid-enrolled children in the medical office. J Public Health Dent 2008, 68(3):131-138.
• [49]Sams LD, Rozier RG, Wilder RS, Quinonez RB: Adoption and implementation of policies to support preventive dentistry initiatives for physicians: a national survey of Medicaid programs. Am J Pub Health 2013, 103(8):e83-e90.
• [50]Fisher-Owens SA, Gansky SA, Platt LJ, Weintraub JA, Soobader MJ, Bramlett MD, Newacheck PW: Influences on children’s oral health: a conceptual model. Pediatrics 2007, 120(3):e510-e520.