Delivery of Preventive Oral Health Services by Rurality: A Cross-Sectional Analysis
Delivery of Preventive Oral Health Services by Rurality: A Cross-Sectional Analysis
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DOI：
10.1111/jrh.12340
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发表时间：
2019-01-01
影响因子：
4.9
通讯作者：
Stein, Bradley D.
中科院分区：
文献类型：
--
作者：
Geiger, Caroline K.;Kranz, Ashley M.;Stein, Bradley D.
目的将口腔保健纳入初级保健，作为增加向幼儿提供预防性口腔保健服务(POHS)的一项战略，特别是在很少有牙医执业的农村地区。使用多个州的医疗补助申请样本，我们按县乡村检查了儿童在医疗办公室接受POH的几率。方法我们使用了2012-2014年的医疗补助分析摘录数据，涉及39个州的6,275,456名6岁以下儿童，这些州允许在医疗办公室为POH支付医疗补助。我们使用了地区卫生资源档案中的县级特征，包括县乡村的3级衡量标准。我们使用Logistic回归来估计儿童在县乡村医疗机构接受POH的几率，同时控制其他患者和县的特征。结果7.8%的儿童接受了医务室的POH服务。大都(都市)县卫生室POHs发生率(8.4%)高于非都市(5.8%)和非都市(4.3%)。在校正分析中，居住在不毗邻大都市区(OR=0.79，95%CI：0.64~0.99)和毗邻大都市区(OR=0.70，95%CI：0.59~0.82)的非大都市区儿童在卫生室接受POH的可能性显著低于大都市区(OR=0.79，95%CI：0.64~0.99)。结论：在这项研究中，我们发现在非大城市的县，医务室的POHS发生率是最低的。鉴于农村地区的牙科护理存在障碍，各州应该采取更多措施，不仅仅是允许医疗补助报销，以增加医疗办公室提供的POH。
Purpose Integrating oral health care into primary care has been promoted as a strategy to increase delivery of preventive oral health services (POHS) to young children, particularly in rural areas where few dentists practice. Using a multistate sample of Medicaid claims, we examined a child's odds of receiving POHS in a medical office by county rurality. Methods We used 2012-2014 Medicaid Analytic extract claims data for 6,275,456 children younger than 6 years in 39 states that allowed Medicaid payment for POHS in medical offices. We used county-level characteristics from the Area Health Resources Files, including a 3-level measure of county rurality. We used logistic regression to estimate a child's odds of receiving POHS in a medical office by county rurality, while controlling for other patient and county characteristics. Findings POHS in medical offices were received by 7.8% of children. Rates of POHS in medical offices were higher in metropolitan (metro) counties (8.4%) than nonmetro adjacent to metro (5.8%) and nonmetro not adjacent to metro (4.3%). In adjusted analysis, children living in nonmetro not adjacent to metro (OR = 0.79, 95% CI: 0.64-0.99) and adjacent to metro counties (OR = 0.70, 95% CI: 0.59-0.82) were significantly less likely to receive POHS in medical offices than children living in metro counties. Conclusions In this study of POHS in medical offices among young Medicaid-enrolled children, we found POHS rates were lowest in nonmetro counties. Given barriers to dental care in rural areas, states should take additional steps beyond allowing Medicaid reimbursement to increase delivery of POHS in medical offices.