Formative and Pilot Study for an Effectiveness-Implementation Hybrid Cluster Randomized Trial to Incorporate Oral Health Activities into Pediatric Well-Child Visits.
Formative and Pilot Study for an Effectiveness-Implementation Hybrid Cluster Randomized Trial to Incorporate Oral Health Activities into Pediatric Well-Child Visits.
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DOI：
10.3390/dj8030101
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发表时间：
2020-09-01
影响因子：
2.6
通讯作者：
Hertz A
中科院分区：
文献类型：
--
作者：
Nelson S;Slusar MB;Curtan S;Selvaraj D;Hertz A
背景：儿童龋齿对全身健康和幸福有广泛的影响。因此，利用有效性-实施混合I设计，儿科提供者对儿童牙齿龋洞（PACT）试验正在调查实践中的多层次干预（将口腔健康纳入电子病历[EMR]）和提供者层面（以理论为基础的教学和技能培训，向父母/护理人员传达口腔健康事实，提供看牙医的处方和地区牙医名单），以增加参加健康儿童访问（WCV）的3至6岁医疗补助登记儿童的牙科利用率。较大的主要试验的形成和试点工作。研究方法：形成性工作-焦点小组，26名参与者（社区领导人，供应商，父母/照顾者）;和关键线人采访实践领导（n = 4）。讨论的主题是：核心口腔健康（OH）信息在WCV和学习后勤沟通。使用Atlas.ti对成绩单进行编码和分析;使用形成性研究结果对试点研究进行了改进，并在两个儿科实践中进行，以测试以下内容的实施：提供者教学和技能培训课程; EMR纳入四个OH问题;在WCV纳入OH活动的物流;以及父母/护理人员招募。结果如下：形成性工作表明，提供者和父母/照顾者需要龋齿的知识，并列出地区接受医疗补助的牙医。提供者和实践领导就将口腔健康纳入WCV的物流提供建议。所有小组都建议询问父母/照顾者他们喜欢的联系方式，并强调OH的重要性，以激励参与。利用这些发现，课程和协议进行了修订。在两个实践中的试点研究成功地实施了该方案，如下所示：所有7名提供者都接受了两次45分钟的教学教育和技能培训;将OH问题纳入EMR实践;在WCV招募了86名儿童-父母配对（95%参与）;提供者在<2分钟内向父母/照顾者提供OH干预，90%完成了OH问题的EMR文件。这些调查结果有助于完成18个实践中的主要PACT试验。RE-AIM框架用于主试验，以收集基线和随访访视时的有效性和实施措施。结论：形成性和试点结果有助于完善OH干预和协议，导致成功实施的主要试验。试验注册：Clinical trials.gov，2017年11月9日注册，NCT 03385629。
Background: Dental caries in pediatric patients are noted to have broad impacts on systemic health and well-being. Thus, utilizing an effectiveness-implementation hybrid I design, the Pediatric Providers Against Cavities in Children’s Teeth (PACT) trial is investigating multi-level interventions at the practice (incorporation of oral health in electronic medical record [EMR]) and provider levels (theory-based didactic and skills training to communicate oral health facts to parent/caregiver, give a prescription to see a dentist and a list of area dentists) to increase dental utilization among 3 to 6 year old Medicaid-enrolled children attending well-child visits (WCV). The formative and pilot work for the larger main trial are presented. Methods: Formative work—Focus groups with 26 participants (Community leaders, providers, parent/caregivers); and key informant interviews with practice leadership (n = 4). Topics discussed were: core oral health (OH) information to communicate at WCVs and study logistics. Transcripts were coded and analyzed using Atlas.ti; Pilot study was refined using the formative findings and was conducted at two pediatric practices to test the implementation of: the provider didactic and skills training curriculum; EMR incorporation of four OH questions; logistics of incorporating OH activities at a WCV; and parent/caregiver recruitment. Results: Formative work showed that providers and parent/caregivers required knowledge of dental caries, and a list of area Medicaid-accepting dentists. Providers and practice leadership advised on the logistics of incorporating oral health into WCVs. All groups suggested asking parent/caregivers their preferred method of contact and emphasizing importance of OH to motivate participation. Utilizing these findings, the curriculum and protocol was revised. The pilot study in two practices successfully implemented the protocol as follows: all seven providers were trained in two 45 min didactic education and skills session; incorporation of OH questions into practices EMR; recruited 86 child-parent dyads (95% participation) at the WCV; providers delivered the OH intervention to parent/caregivers in <2 min and 90% completed EMR documentation of OH questions. These findings were instrumental in finalizing the main PACT trial in 18 practices. The RE-AIM framework is used in the main trial to collect effectiveness and implementation measures at baseline and follow-up visits. Conclusions: The formative and pilot findings were instrumental in refining the OH intervention and protocol which has resulted in successful implementation of the main trial. Trial Registration: Clinical trials.gov, Registered 9 November 2017, NCT03385629.
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影响因子：
12.7
作者：
Glasgow, RE;Vogt, TM;Boles, SM
通讯作者：
Boles, SM
影响因子：
1.9
作者：
Duijster, Denise;van Loveren, Cor;Verrips, Gijsbert H. W.
通讯作者：
Verrips, Gijsbert H. W.
影响因子：
2.9
作者：
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通讯作者：
Raklios NA
影响因子：
2.8
作者：
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通讯作者：
Naik, Aanand D.
影响因子：
5.1
作者：
Cristina Guarnizo-Herreno, Carol;Wehby, George L.
通讯作者：
Wehby, George L.