Barriers to dental utilization among Medicaid-enrolled young children from primary care practices in Northeast Ohio

IF 1.8 3区医学 Q2 DENTISTRY, ORAL SURGERY & MEDICINE

Community dentistry and oral epidemiology Pub Date : 2024-04-22 DOI:10.1111/cdoe.12964

David Selvaraj, Neel Agarwal, Jeffrey M. Albert, Suchitra Nelson

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Abstract

Objectives

To evaluate the individual and community factors that contribute to dental utilization among young children on Medicaid utilizing the Anderson Model and the Socio-Ecological Framework.

Methods

This observational cross-sectional study was conducted using baseline data (socio-demographics, clinical dental need) from a cluster-randomized hybrid effectiveness-implementation trial among 1021 child–parent dyads recruited from primary care practices across northeast Ohio. The baseline data were then linked to dental Medicaid claims data (categorized as any dental visit, volume, and type in the past 12 months) and ICD-10 codes from the child's EHR data (individual-level) together with Dental Health Provider Shortage Area (HPSA) status and Area Deprivation Index (ADI) which were obtained at the neighbourhood-level using home address of each dyad (community-level). Multivariable analyses using generalized estimating equations (GEE) accounted for clustering by practice, and models included individual-level alone, and individual + community-level factors to evaluate their effects on dental utilization.

Results

Medicaid claims data indicated that among the 1021 children (mean age: 4.3 ± 1.1 years; 54.4% males; 43.8% Black, Non-Hispanic), a majority of children were seeing the dentist at least once a year by the age of 4 (56.1%). The mean ADI of their neighbourhoods was 109.22 (20.2) and 27.5% lived in a HPSA area. The GEE analyses revealed that individual factors such as older children, parents being married, and continuous Medicaid enrollment were associated with significantly higher dental utilization. Among community factors, being in a HPSA had an OR = 1.53 (CI: 1.03, 2.27) associated with higher dental utilization.

Conclusions

Being in a HPSA was associated with higher dental utilization possibly due to dentists or safety net dental clinics in these areas accepting Medicaid-eligible children.

Abstract Image

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俄亥俄州东北部初级保健机构中参加医疗补助计划的幼儿使用牙科服务的障碍。

方法：本观察性横断面研究使用了从俄亥俄州东北部的初级保健实践中招募的 1021 个儿童-家长二人组的基线数据（社会人口统计学、临床牙科需求）。然后，将基线数据与牙科医疗补助（Medicaid）报销数据（按过去 12 个月内的任何牙科就诊次数、数量和类型分类）和儿童电子病历数据中的 ICD-10 编码（个人层面）以及牙科保健提供者短缺地区（HPSA）状况和地区贫困指数（ADI）联系起来，这些数据是根据每个二人组的家庭住址在邻里层面获得的（社区层面）。结果医疗补助申请数据显示，在 1021 名儿童（平均年龄：4.3 ± 1.1 岁；54.4% 为男性；43.8% 为非西班牙裔黑人）中，大多数儿童在 4 岁之前每年至少看一次牙医（56.1%）。他们所在社区的平均 ADI 为 109.22（20.2），27.5% 的儿童生活在 HPSA 地区。GEE 分析表明，孩子年龄较大、父母已婚和连续参加医疗补助计划等个人因素与牙科使用率明显较高有关。在社区因素中，居住在 HPSA 地区与较高的牙科使用率相关的 OR = 1.53 (CI: 1.03, 2.27)。

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来源期刊

Community dentistry and oral epidemiology 医学-公共卫生、环境卫生与职业卫生

CiteScore

4.40

自引率

8.70%

发文量

审稿时长

6 months

期刊介绍： The aim of Community Dentistry and Oral Epidemiology is to serve as a forum for scientifically based information in community dentistry, with the intention of continually expanding the knowledge base in the field. The scope is therefore broad, ranging from original studies in epidemiology, behavioral sciences related to dentistry, and health services research through to methodological reports in program planning, implementation and evaluation. Reports dealing with people of all age groups are welcome. The journal encourages manuscripts which present methodologically detailed scientific research findings from original data collection or analysis of existing databases. Preference is given to new findings. Confirmations of previous findings can be of value, but the journal seeks to avoid needless repetition. It also encourages thoughtful, provocative commentaries on subjects ranging from research methods to public policies. Purely descriptive reports are not encouraged, nor are behavioral science reports with only marginal application to dentistry. The journal is published bimonthly.