Elevating Oral Health Interprofessional Practice Among Pediatricians Through a Statewide Quality Improvement Learning Collaborative.

Authors:
Joni D Nelson
Joni D Nelson
University of South Carolina
Christine E Blake
Christine E Blake
University of South Carolina
United States
Dr. Justin B Moore, PhD, MS
Dr. Justin B Moore, PhD, MS
Wake Forest School of Medicine
Associate Professor
Implementation Science, Epidemiology
Winston-Salem, NC | United States
Amy B Martin
Amy B Martin
Arnold School of Public Health
United States

J Public Health Manag Pract 2018 May/Jun;24(3):e19-e24

Department of Stomatology, Division of Population Oral Health, Medical University of South Carolina, Charleston, South Carolina (Drs Nelson and Martin); Department of Health Promotion, Education, & Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina (Drs Spencer and Blake); and Department of Family & Community Medicine, and Department of Epidemiology & Prevention, Wake Forest School of Medicine, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina (Dr Moore).

Context: Because of persistent effects of early childhood caries and impacts of dental health professional shortages areas, the integration of oral health in primary care settings is a public health priority. In this study, we explored oral health interprofessional practice (OHIP) as an integrative pathway to reduce oral health disparities. OHIP can include performing oral health risk assessments, describing the importance of fluoride in the drinking water, implementing fluoride varnish application, and referring patients to a dental home.

Objective: To conduct a formative evaluation of how 15 pediatric primary care practices implemented the adoption of OHIP in their clinical settings.

Design: Using an ecological framework, we conducted a qualitative process evaluation to measure the factors that inhibited and facilitated OHIP adoption into pediatric settings. Document review analysis and qualitative interviews were conducted with pediatric practices to contextualize challenges and facilitators to OHIP adoption.

Setting And Participants: A total of 15 Children's Health Insurance Program Reauthorization Act pediatric practices located in 13 South Carolina counties participated in this study.

Main Outcome Measures: Outcomes of interest were the facilitators and challenges of OHIP adoption into pediatric primary care practices.

Results: Thematic analysis revealed challenges for OHIP adoption including limited resources and capacity, role delineation for clinical and administrative staff, communication, and family receptiveness. OHIP training for clinical practitioners and staff and responsiveness from clinical staff and local dentists were facilitators of OHIP adoption. Twelve key recommendations emerged on the basis of participant experiences within OHIP, with developing an active dental referral network and encouraging buy-in from clinical staff for OHIP adoption as primary recommendations.

Conclusion: We demonstrated the effectiveness of a learning collaborative meeting among pediatric primary care providers to adopt OHIPs. This work reveals an actionable pathway to support oral health equity advancement for children through an additional access point of preventive oral care, reinforcement of positive oral health behaviors, and interaction between parent and child for overall health and wellness of the family.

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http://dx.doi.org/10.1097/PHH.0000000000000622DOI Listing

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August 2017
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