Removing Barriers to Fluoride Varnish Application in Primary Care Settings

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Removing Barriers to Fluoride Varnish Application in Primary Care Settings Project Summary/Abstract: Dental decay is an important, ongoing public health concern that impacts children from low-income households and from racial and ethnic minorities at higher rates than the general population. Because young children are much more likely to visit a primary care provider than a dentist, including appropriate and effective preventive oral health services (POHS) at pediatric well-child visits has the potential to dramatically improve children’s oral health. Fluoride varnish (FV) application is one such POHS that is reimbursed by insurance programs in the primary care setting for younger children, yet only a small proportion of physicians apply FV. The objective of this project is to assess and reduce barriers currently dissuading PCPs from providing FV during well-child visits. The first aim is to collect and analyze detailed data on time, costs and workflow associated with FV delivery in primary care settings. Key components to achieve this aim will include time study and bottleneck analysis of data from partner clinics with a variety of practice characteristics. The second aim is to assess barriers and facilitators to POHS delivery in primary care settings. Applying the Consolidated Framework for Implementation Research (CFIR) to the collection and analysis of data from key informant interviews, stakeholders’ perspectives on intervention climates will be analyzed to better understand the rationale underlying apparent barriers to POHS delivery, with a focus on process flow barrier elimination. The final aim is to optimize FV application in the well-child visit workflow. Statistical analysis, simulation, and mathematical modeling will be utilized to establish how to minimize time and costs under the influence of variability for different combinations of environmental factors. Best practices for implementation will be collated and disseminated. While FV application does not operate in isolation of other activities, these models can also help determine whether reimbursements would fund additional resources to add FV application without sacrificing other preventive care. The research contribution will be specific workflow suggestions and resulting resource and cost data, as well as a better understanding of barriers and facilitators to implementation, that will allow physicians’ offices to make decisions on how to integrate FV in their pediatric well- child visits based on their own unique practice characteristics. These improved frameworks, widely disseminated, will faciliate more widespread delivery of POHS during well-child visits.