Preventive dental care use for children with special health care needs in Washington's Access to Baby and Child Dentistry program
Preventive dental care use for children with special health care needs in Washington's Access to Baby and Child Dentistry program
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DOI：
10.1016/j.adaj.2018.08.026
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发表时间：
2019-01-01
影响因子：
3.9
通讯作者：
Chi, Donald L.
中科院分区：
文献类型：
--
作者：
Craig, Maureen H.;Scott, JoAnna M.;Chi, Donald L.
背景资料。来自低收入家庭的有特殊卫生保健需求(CSHCN)的学龄前儿童患口腔健康不良的风险增加。这项研究的目标是评估在华盛顿州获得婴儿和儿童牙科(ABCD)计划范围内加入医疗补助的CSHCN的预防性牙科护理使用情况。作者分析了ABCD计划(N=206,488)中6岁以下儿童的2012年医疗补助资格和索赔文件。作者使用医疗诊断和资格数据来确定每个儿童的特殊需要状态(否或是)。结果是预防性使用牙科护理(否或是)。作者使用改进的泊松回归模型估计粗患病率和协变量调整患病率。在206,488名参与研究的儿童中，2.1%是CSHCN，114,570名儿童使用预防性牙科护理(55.5%)。CSHCN使用预防保健的比率与没有特殊卫生保健需求的儿童(SHCN)相似(分别为54.7%和55.5%；P=.32)。在调整混杂变量后，CSHCN儿童使用预防性牙科护理的可能性显著低于非SHCN儿童(患病率比，0.91；95%可信区间，0.88至0.94；P<；.001)。年龄较大的学龄前儿童比年龄较小的学龄前儿童更有可能使用预防性牙科护理。预防性医疗服务使用者也使用预防性牙科护理服务的比例明显较高。与没有参加医疗补助的儿童相比，参加华盛顿ABCD计划的CSHCN儿童使用预防性牙科护理的可能性更小。未来的干预研究调查人员应评估改善CSHCN患者获得预防性牙科护理的途径。可能需要额外的策略来改善接受医疗补助的学龄前CSHCN的口腔健康行为。
Background. Preschool-aged children with special health care needs (CSHCN) from low-income households are at increased risk of developing poor oral health. The study goal was to assess preventive dental care use for CSHCN enrolled in Medicaid within Washington state's Access to Baby and Child Dentistry (ABCD) program.Methods. The authors analyzed 2012 Medicaid eligibility and claims files for children younger than 6 years in the ABCD program (N = 206,488). The authors used medical diagnosis and eligibility data to identify each child's special needs status (no or yes). The outcome was preventive dental care use (no or yes). The authors used modified Poisson regression models to estimate crude and covariate-adjusted prevalence rate ratios.Results. Of the 206,488 children in the study, 2.1% were CSHCN, and 114,570 used preventive dental care (55.5%). CSHCN used preventive care at rates similar to those of children without special health care needs (SHCN) (54.7% and 55.5%, respectively; P = .32). After adjustment for confounding variables, CSHCN were significantly less likely to use preventive dental care than were children without SHCN (prevalence rate ratio, 0.91; 95% confidence interval, 0.88 to 0.94; P < .001). Older preschool-aged children were significantly more likely to use preventive dental care than were younger preschool-aged children. A significantly higher proportion of preventive medical care users also used preventive dental care.Conclusions. CSHCN who were enrolled in Medicaid in Washington's ABCD program were less likely to use preventive dental care than were children without SHCN who were enrolled in Medicaid.Practical Implications. Future intervention research investigators should evaluate ways to improve access to preventive dental care for CSHCN. Additional strategies may be needed to improve oral health behaviors for preschool-aged CSHCN receiving Medicaid.