Into the Mouths of Babes

Transcription

1 NC Department of Health and Human Services Into the Mouths of Babes Delivering Preventive Oral Health Services Kelly L. Close, MHA, RDH NC Oral Health Section December 6,

2 Into the Mouths of Babes (IMB) Objectives for today Describe IMB Recount IMB s 20 year evolution Explain evaluation and outcomes Define examples of oral health literacy in IMB Finish in 20 minutes 2

3 Original IMB Goals Increase access to POHS for low-income ages 0 to 3 Reduce prevalence of ECC Reduce burden of treatment needs on an inadequate and stretched dental workforce 3

4 IMB original partnership NC Academy of Family Physicians NC Medicaid NC Oral Health Section NC Pediatric Society UNC Gillings School of Global Public Health UNC School of Dentistry 4

5 IMB visit: POHS Oral evaluation Risk assessment Fluoride varnish Parent counseling Dental referral Age 1 Risk based (PORRT) 5

6 IMB: NC Medicaid Bundled POHS D0145 D1206 Tooth eruption to 42 months Maximum of 6 visits Minimum 60 day time interval Medical and dental providers are reimbursed for preventive services NC Division of Medical Assistance, Physician Fluoride Varnish Services Clinical Coverage Policy No.: 1A-23 Amended Date: October 1,

7 Example of Preventive Package Visits Well-Child Visit (months) Procedure Performed 6 Yes (if teeth are erupted) 9 Yes (if teeth are erupted) 12 Yes 18 Yes 24 Yes 36 Yes POHS may be provided at wellchild visits, sick visits, or a separately scheduled visit. 7

8 NC Medicaid requires training High proportion of trained practices provide POHS Live one-hour training session in medical office by OHS or CCNC staff (2013) AAFP CME prescribed credit/ AMA PRA Category 1 equivalent Training participants may train new staff using IMB online toolkit (no credit awarded) artners/imb-toolkit.htm E-learning training module in development for release mid-2019 Slade et al., Training Pediatric Health Care Providers in Prevention of Dental Decay: Results from a Randomized Controlled Trial. BMC Health Services Research. 2007;7:176(2Nov2007). 8

9 Number of visits with preventive oral health services in NC medical offices, No. Visits 180, , , , ,000 80,000 60,000 40,000 20, Source: NC Division of Medical Assistance.

10 IMB Outcomes In 2016, 57.8% of the average 47,025 quarterly wellchild visits for 1 and 2 year olds included POHS. In NC communities with Early Head Start programs, parents report 80% of young children received a POHS by a dentist or medical provider by age 3. IMB outcomes include all POHS components. Oral evaluation and risk assessment Parent counseling Fluoride varnish Dental referral NC Division of Medical Assistance; Burgette et al. JADA 2018:149(12):

11 Into the Mouths of Babes Outcomes Setting and provider type did not influence effectiveness of POHS on children s overall oral health. Kranz et al. American Journal of Public Health. 2014, 104(7) e JPH Children receiving four or more IMB visits before age three show a 17.7% reduction in tooth decay. Kranz et al. Pediatrics. 2015, 136(1) IMB has contributed to a statewide decline in decay rates since 2004 and helps reduce the gap in tooth decay between children from low-and otherincome families at the community level. Achembong et al. Pediatrics. 2014, 133(4) e827 11

12 2014 US Preventive Services Task Force Recommendation Statement Two ways primary care clinicians can help prevent tooth decay in children age 5 years and younger: Prescribe oral fluoride supplementation starting at age 6 months for children whose water supply is deficient. Apply fluoride varnish to the primary teeth of all children starting at tooth eruption. Evidence is insufficient for recommending routine screening examinations for dental caries. Moyer, Virginia on behalf of the US Preventive Services Task Force, Pediatrics Volume 133, No.6 June

13 IMB Parents Express satisfaction with POHS at primary care visits Experience low health literacy demands by medical providers during oral health counseling Are more likely to take their child for a dental visit when referred by a medical provider Rozier et al., Pediatric Dentistry, 2005;27: Kranz et al., Pediatric Dentistry.2013;35(2);E68-E74. Beil HA, Rozier,RG. Pediatrics. 2010;126(2). 13

14 Motivational Interviewing Communication technique Patient-centered Builds intrinsic motivation Resolves ambivalence Associated with improvements in pediatric health behaviors and health outcomes NC medical providers offered training through CCNC IMB e-learning module to include examples of MIbased parent counseling Borreli et al., Pediatric Dent 2015;37(3):

15 Community integration Public health WIC Home visitors Medical Dental Child care 15

16 It Takes a Community Evidence-based messages Plain language Consistency Collaboration Photo Credit: National Maternal and Child Oral Health Resource Center 16

17 QUESTIONS? 17