Partnering with Community Health Centers to Prevent ECC

与社区卫生中心合作预防ECC 摘要 《2010年健康人民》所述的国家公共卫生议程。包括减少 儿童乳牙龋齿患病率降至11%或更低（目标21-1 a）。不幸的是， 为预防儿童早期龋齿（ECC）而采取的饮食和卫生行为改变 特别是在最易受幼儿保育影响的儿童中， 不可接受的高。然而，最近为解决医疗护理环境中的ECC问题所做的努力， 这表明这是一个富有成效的方向。考虑到大约95%的美国人 6岁以下的儿童参加定期的健康儿童访问，儿科医生是潜在的盟友，以减少风险， 疾病因此，美国儿科学会通过了一项政策，支持儿科医生使用 龋齿风险评估和转介到牙科之家。 最近的研究记录了两种有效的策略，以减少ECC的发病率。一是 来自几项随机对照试验的令人信服的证据表明，氟化物清漆（FV）可显著降低 ECC的发生率。考虑到这一点，由于氟化物清漆的应用是安全的，廉价的，易于 即使在非牙科环境中，氟化物保护漆的应用也应该在预防 ECC。其次，我们的团队最近发现，培训儿科临床医生，以患者为中心， 咨询（PCC），以减少ECC的风险因素（咨询方法，旨在提高临床医生和患者 关于行为改变的自我效能）导致ECC发生率降低40%以上， 在年轻的白色，非裔美国人，亚洲和拉丁美洲儿童中，然而，这种方法的有效性 尚未在随机临床试验中进行测试。此外，尽管先前的研究表明， 多方面的干预措施，包括改善对推荐健康行为的坚持的策略， 可能是最成功的改变个人和卫生保健提供者的行为，这并没有 在预防幼儿保育方面进行了全面评价。 重要的是，以前的努力没有评估广泛实施的必要因素， 传播这些战略，包括在相关环境中适用公平价值和预防性消费。但这种 迫切需要知识，以便在全国范围内向儿童广泛传播有效的干预措施， 未来 我们假设，在健康儿童就诊期间，儿科临床医生以患者为中心的咨询将 有效降低1至3岁儿童的ECC发生率，超过ECC的任何降低 通过定期使用氟化物清漆实现的发病率。为了验证这一假设，我们提出了一个集群， 随机社区干预研究。我们将培训儿科临床医生（包括医生和护士） 使用氟化物保护漆并使用以患者为中心的咨询来减少ECC危险因素（干预组） 或仅涂氟涂膜（对照组）。该研究将在8个社区卫生 三个州（马萨诸塞州、马里兰州和俄亥俄州）的中心（CHC），将随机分配至 干预组或对照组。这些社区卫生中心共同为一系列贫穷的白色，非裔美国人， 加勒比移民和拉丁美洲儿童是最易受幼儿保育伤害的群体。 因此，我们提出的研究将评估儿科培训计划的有效性和有效性。 临床医生给予氟化物保护漆和以患者为中心的咨询与单独使用氟化物保护漆相比， 2-一岁儿童ECC的年发病率，以改善这些儿童口腔健康相关的生活质量， 儿童，增加临床医生对ECC的知识，增加临床医生提供的氟化物保护漆， 咨询，以减少ECC，并减少儿童暴露于ECC的危险因素。作为次要目标，我们将 还收集了研究基线时3岁儿童ECC患病率的数据， 比较组来估计多方面干预的总体有效性（即，包括影响 的氟化物清漆应用），以减少ECC。此外，我们将确定和解决障碍， 以及在干预和控制地点传播和实施方案的促进者。 该项目是与社区密切合作开发的，详见项目 叙事项目合作伙伴保罗·格尔特曼博士将承担项目特定的社区联络员 责任他的长期社区参与经验，以及他多年来直接服务于 他在社区卫生中心的工作满足了社区的需求，使他非常适合这一角色。他将 我还与俄亥俄州和马里兰州的项目人员密切合作，以确保这些项目的社区合作伙伴 项目绩效现场全力投入研究。 这项拟议中的研究采用了一种创新的方法，以针对弱势群体的幼儿， 不成比例地受到幼儿龋齿的影响，并已证明有效的干预措施。的 从拟议项目中获得的知识将对公共卫生产生重大影响，因为 进一步强调确定和解决既可能抑制又可能促进未来发展的因素， 广泛实施并向全国儿童传播。

Partnering with Community Health Centers to prevent ECC Abstract The national public health agenda, as stated in Healthy People 2010. includes the goal to reduce the prevalence of children with dental caries in their primary teeth to 11% or less (goal 21-1 a). Unfortunately, uptake of the dietary and hygiene behavioral changes needed to prevent early childhood caries (ECC) has been limited, especially among the children most vulnerable to ECC, so that prevalence of the disease remains unacceptably high. However, recent efforts to address the problem of ECC in the medical care setting have been successful suggesting that this is a fruitful direction to pursue. Considering that about 95% of American children under age 6 attend regular well-child visits, pediatricians are potential allies to reduce risk for the disease. Accordingly, the American Academy of Pediatrics has adopted a policy supporting pediatricians' use of caries risk assessment and referral to a dental home. Recent research has documented two efficacious strategies for reducing ECC incidence. First, there is compelling evidence from several randomized controlled trials that fluoride varnish (FV) significantly reduces the incidence of ECC. Given this, and because fluoride varnish applications are safe, cheap and easy to administer even in non-dental settings, fluoride varnish applications should play a key role in the prevention of ECC. Second, our group recently found that training of pediatric clinicians to provide patient centered counseling (PCC) to reduce ECC risk factors (a counseling approach designed to enhance clinician and patient self-efficacy regarding behavioral change) resulted in a greater than 40% reduction in ECC incidence over 2 years among young White, African American, Asian and Latino children. However, the efficacy of this approach has not been tested in a randomized clinical trial. Furthermore, although prior studies have shown that multifaceted interventions including strategies to improve adherence to recommended health behaviors are likely to be the most successful in both changing individual and health care provider behavior, this has not been comprehensively evaluated in the context of ECC prevention. Importantly, prior efforts did not evaluate the factors necessary for widespread implementation and dissemination of such strategies, including FV application and PCC in relevant settings. However, such knowledge is urgently needed to widely disseminate efficacious interventions to children nationwide in the future. We hypothesize that patient centered counseling by pediatric clinicians during well-child visits will be effective in reducing the incidence of ECC in children aged 1 to 3 years over and above any reduction in ECC incidence achieved by regular fluoride varnish applications. To test this hypothesis, we propose a cluster randomized community-based intervention study. We will train pediatric clinicians (both physicians and nurses) to apply fluoride varnish and to use patient centered counseling to reduce ECC risk factors (intervention group) or only to apply fluoride varnish (control group). The study will be conducted in eight Community Health Centers (CHCs) in three states (Massachusetts, Maryland and Ohio), which will be randomized to either the intervention or control groups. These CHCs together serve a range of poor White, African American, Caribbean immigrant and Latino children, groups which are most vulnerable to ECC. Our proposed research will therefore evaluate the efficacy and effectiveness of a training program for pediatric clinicians to administer fluoride varnish and patient centered counseling vs. fluoride varnish alone to reduce the 2-year incidence of ECC among one-year old children, to improve oral health related quality of life in these children, to increase clinician knowledge about ECC, to increase clinician provision of fluoride varnish and counseling to reduce ECC, and to reduce children's exposure to ECC risk factors. As a secondary aim, we will also collect data on the prevalence of ECC among children 3 years old at study baseline, in order to have a comparison group to estimate the overall effectiveness of the multifaceted intervention (i.e., including the effect of the fluoride varnish application) in reducing ECC. Furthermore, we will identify and address the barriers to and facilitators of program dissemination and implementation in both intervention and control sites. This project was developed in close collaboration with the community, as detailed in the project narrative. The project Co-Pi Dr. Paul Geltman will take on the project-specific community liaison responsibility. His long-term community engagement experience, and his many years of directly serving the needs of communities by his work in community health centers, make him ideally suited for that role. He will also work closely with project personnel in Ohio and Maryland to ensure that community partners at those project performance sites are fully engaged in the research. This proposed study uses an innovative approach to target vulnerable populations of young children that are disproportionately affected by early childhood caries with an intervention of proven efficacy. The knowledge garnered from the proposed project will have major public health implications because of its additional emphasis on identifying and addressing the factors that can both inhibit and facilitate future widespread implementation and dissemination to children nationwide.