THE SCOPE OF ORAL HEALTH PRACTICE

AND NEEDS OF CHILD HEALTH CARE

MEDICAL PROVIDERS IN FLORIDA

Michelle Valdes, Hilma Benjamin, M.D., Maja Marinkovic, M.D., and Rani S Gereige, M.D., MPH. Department of Pediatrics, University of South Florida, Tampa, Florida, United States.

Partially supported by a resident’s planning CATCH Grant from the American Academy of Pediatrics

APA School and Community Health SIG

Disclosures

Rani Gereige and the co-authors of the abstract have documented that they have no relevant financial relationships to disclose or conflict of interests to resolve

Background Dental caries are the most common infectious disease in

the U.S. (CDC) The AAP adopted Oral Health as one of its focus areas for

2006-2007 The AAP goal is to train child health professionals to

incorporate oral health risk assessment (OHRA) as part of well visits especially for children 0-3y

There is a great deal of variability in the oral health training and scope of practice of child health care professionals

No study has previously described how much Oral Health care child providers routinely perform (particularly in the State of Florida) .

Objectives Provide an indepth look at the pediatric

oral health scope of practice of primary care providers (PCP) (Pediatrics, Med-Peds and Family Practice) and residents in the State of Florida

Assess current practice barriers and training issues

Design/Methods Web-based survey was sent to the AAP Florida

Chapter listserv and resident section The survey link was placed in the Florida

Academy of Family Physicians (FAFP) electronic newsletter

Over the span of three months, four reminder e-mails we sent

The survey collected demographic data, oral health training data and practice patterns

Results

Fig 1. Field of Practice of Survey Respondents (n=92)

14%1%

35%

50%

Pediatrics Family Medicine

Med-Peds Resident

Results

Fig 2. Work Setting of Practicing Physicians Respondents

13%

48%

17%

11%

8% 3%

Solo Group

Academic Pub Hlth/Comm Hlth Cntr

Hospital-Based Other

Results

Fig 3. Years of Practice of Practicing Physicians Respondents

20%

23%

13%

44%

< 5 years 5-9 years 10-15 years > 15 years

Results

Characteristics of Respondents %

GenderMaleFemale

EthnicityCaucasianHispanicAfrican-AmericanAsian/Pacific IslanderOther

Geographic setting of Practice/ ResidencyRuralUrbanSuburban

Training institution has an affiliated dental schoolYesNo

Oral Health curriculum in residencyNoYes

Didactics

38%62%

64%12%11%7%6%

2%63%35%

40%60%

71%29%

(79%)

Results

Fig 4.

Results

Fig 5.

Results

Fig 6.

Results

Fig 7.

Results

Fig 8.

Results

Fig 9.

Results

Fig 10.

Results

Fig 11.

Results

Limitations and Challenges Limitations inherent to the study design

Survey: Reporter bias Small sample size did not allow

stratification by specialty, year of practice, or training exposure

Residents sample limited by the number of residents in the State of Florida

Future Directions Use the pilot data to design a larger scale

study Chart audits rather than reporting as a

measure of practice pattern More efforts to include Family Medicine

residents Will be used by Florida DOH

Conclusions Overall, most PCPs and residents, despite

inadequate oral health training, include OHRA as part of health maintenance visits

The oral health scope of practice could be improved with more needed training, Fluoride varnish application, and increased awareness of the role parent/caregiver oral health plays among others

References Florida Health Insurance Study, Insurance Coverage Updates, Fact

Sheet No. 2, August 2005. U.S. Department of Health and Human Services. A National Call to Action

to Promote Oral Health. Rockville, MD: U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention and the National Institutes of Public Health, National Institute of Dental and Craniofacial Research. NIH Publication No. 03-0503, May 2003.

U.S. Department of Health and Human Services, A National Call to Action to Promote Oral Health, Rockville, MD: U.S. Department of Health and Human Services, Public Health Service, Center for Disease Control and Craniofacial Research. NIH Publication NO, 03-5303, May 2003.

Oral Health Resources, http://www.cdc.gov/oralhealth/topics/child.htm

Florida Department of Health, floridacharts.com, Access to Dental Care by Low Income Persons

Florida Department of Health, floridacharts.com, Percent of Access to Dental Care at 200% below the Federal Poverty Level by county

Oral Disease: A Crisis Amount Children of Poverty, National Maternal and Child Oral Health Resource Center, May 1998.

Thank You!!!