RESUMEN
Purpose: Little is known about the prevalence of multiple jobholding practices among dental hygienists or the factors contributing to these employment patterns. The purpose of this exploratory study was to examine predictors of multiple jobholding practices among dental hygienists in the state of Iowa.Methods: A mailed paper survey was sent to all licensed dental hygienists (n=2080) in Iowa in May 2018. The dependent variable was whether hygienists worked more than one job in dental hygiene. Key independent variables included individual, family, and practice-related factors. Descriptive, bivariate, and binary logistic regression analyses were completed.Results: A total of 1215 dental hygienists participated in the survey, for a response rate of 58%. Among respondents, 12.2% worked more than one job overall, with 10.7% working 2 jobs and 1.5% working three or more. Respondents who had at least a bachelor's degree, did not have children in the household, were not married, had worked more years at their primary job, and worked more hours per week, were more likely to hold multiple jobs after adjusting for other factors.Conclusions: Consistent with national estimates, there was a high multiple jobholding rate among dental hygienists in Iowa. Multiple individual, family, and practice characteristics were found to be related to multiple jobholding, with the strongest predictors being the hygienist's highest level of education and the number of hours worked at the primary job.
Asunto(s)
Higienistas Dentales , Empleo , Niño , Escolaridad , Humanos , IowaRESUMEN
BACKGROUND: In Iowa from 2014 to 2017, there were 2 separate public dental benefit programs for Medicaid-enrolled adults: one for the Medicaid expansion population called the Dental Wellness Plan (DWP), and one for the traditional, non-expansion adult Medicaid population. The programs differed with respect to reimbursement, administration, and benefit structure. This study explored differences in patterns and predictors of dentist participation in the two programs. METHODS: Authors sent a survey to all private practice dentists in Iowa (n = 1301) 2 years after DWP implementation. Descriptive, bivariate, and logistic regression analyses were used to examine patterns and predictors of dentist participation in Medicaid and DWP. RESULTS: Overall rates of dentists' acceptance of new Medicaid and DWP patients were 45 and 43%, respectively. However, Medicaid participants were much more likely than DWP participants to place limits on patient acceptance. Adjusting for other factors, practice busyness was the only significant predictor of DWP participation, and practice location was the only significant predictor of Medicaid participation. Dentists who were not busy enough were more than twice as likely to participate in DWP compared to others, and dentists in rural areas were almost twice as likely to participate in Medicaid compared to dentists in urban areas. CONCLUSIONS: Dentist participation in Medicaid is an ongoing concern for states aiming to ensure access to dental care for low-income populations. We found distinct participation patterns and predictors between a traditional Medicaid dental program and the DWP, suggesting different motivations for participation between the two programs.
Asunto(s)
Atención Odontológica , Accesibilidad a los Servicios de Salud , Medicaid , Adulto , Odontólogos , Humanos , Iowa , Estados UnidosRESUMEN
BACKGROUND: In this study, the authors used observational data from 2014 to evaluate the association between the number of general dentists and several community characteristics. METHODS: The authors collected community-level characteristics from secondary sources for all 947 Iowa incorporated communities to study their relationships with the mean number of general dentists per 1,000 population per square mile (population density), the dependent variable. The authors used zero-inflated negative binomial models to examine the association between the dependent and predictor variables. RESULTS: Only 22.8% of communities had a dentist. Urban, young, well-educated, fluoridated communities with at least 1 elementary school had the highest estimated mean concentration of dentists. Isolated communities with older, less educated adults and lacking fluoridation and an elementary school had the fewest dentists. CONCLUSIONS: Although population is an important determinant for where a dentist practices, other variables such as urbanization, demographic characteristics, fluoridation status, and presence of at least 1 elementary school are also predictors of the number of dentists in a community. PRACTICAL IMPLICATIONS: These findings provide dental students and young practitioners useful information by highlighting community characteristics that are associated with office locations.
Asunto(s)
Odontólogos , Fuerza Laboral en Salud , Estudiantes de Odontología , Adulto , Fluoruración , Humanos , IowaRESUMEN
OBJECTIVE: To examine the effects of distance to dentists and dentist supply on dental services use among children with Medicaid coverage in Iowa. DATA SOURCE: Iowa Medicaid claims for enrolled children between 2000 and 2009. STUDY DESIGN: The study sample included 41,554 children (providing 158,942 child-year observations) who were born in Iowa between 2000 and 2006 and enrolled from birth in the Iowa Medicaid program. Children were followed through 2009. We used logistic regression to simultaneously examine the effects of distance (miles to nearest dentist) and county-level dentist supply on a broad range of dental services controlling for key confounders. Additional models only used within-child variation over time to remove unobservable time-invariant confounders. PRINCIPAL FINDINGS: Distance was related to lower utilization of comprehensive dental exams (2 percent lower odds per 1 mile increase in distance), an effect that also held in models using within-child variation only. Dentist supply was positively related to comprehensive exams and other preventive services and negatively related to major dental treatments; however, these associations became smaller and insignificant when examining within-child changes except for other preventive services. CONCLUSIONS: Longer distance to dentists is a barrier for use of comprehensive dental exams, conditional on dentist supply.
Asunto(s)
Atención Dental para Niños/estadística & datos numéricos , Odontólogos/provisión & distribución , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Medicaid/estadística & datos numéricos , Preescolar , Femenino , Humanos , Lactante , Iowa , Masculino , Estados UnidosRESUMEN
Some U.S. states have more difficulty than others in recruiting or retaining dentists. Part of the problem is that often dental students are not aware of opportunities across geographic regions of either their home state or the state where they were educated. With student input, the University of Iowa College of Dentistry and Dental Clinics designed and launched an interactive website that provides basic demographic, economic, and other meaningful information to help dental students locate potential practice locations and identify current employment opportunities in Iowa. Although this website is not a recruitment or retention panacea, it provides an easy method for dental students to explore all or parts of the state as they go about making one of the most important decisions of their careers. The website also provides a showcase for current practitioners and communities to demonstrate what they have to offer as practice opportunities.
Asunto(s)
Odontólogos/provisión & distribución , Internet , Área sin Atención Médica , Ubicación de la Práctica Profesional , Humanos , Iowa , Estados UnidosRESUMEN
OBJECTIVE: Examine the current capacity of Iowa's public dental safety net and organizational readiness for implementation of the Affordable Care Act (ACA). METHODS: We surveyed Iowa Community Health Center (CHC) dental clinics for factors related to clinic capacity and organizational readiness for ACA-related change. RESULTS: With 14 clinics (93%) responding, clinics had means of 13,064 patient visits and 23% broken appointments in 2012. Seventy percent of clinics reported high confidence in their ability to respond to changes associated with health care reform. However, over 60% agreed that current circumstances limited their ability to respond to these challenges. CONCLUSIONS: CHC dental clinics in Iowa understand ACA-related changes regarding their patient population, but are limited in their ability make needed changes in response to increased demand. This may affect the clinics' transition into an environment with increased demand for dental services as a result of Medicaid expansion in Iowa.
Asunto(s)
Centros Comunitarios de Salud , Reforma de la Atención de Salud , Patient Protection and Affordable Care Act , Humanos , Iowa , Medicaid , Estados UnidosRESUMEN
PURPOSE: To evaluate the availability of general dentists who treat very young children with private insurance in the context of recommendations for age one dental visit. METHODS: Administrative data from Delta Dental of Iowa were analyzed to identify general dentists providing care to children younger than 18 years old in 2005 and 2012. Characteristics of dentists providing care to children younger than two years old were compared, examining changes over time. Geographical distribution of dentists who treated children younger than two years old was examined. RESULTS: The proportion of dentists treating children younger than two years old increased from six percent in 2005 to 18 percent in 2012. Younger dentists, females, graduates of The University of Iowa College of Dentistry, and those in metropolitan locations were significantly more likely to treat children younger than two years old. Fifty-one of 99 counties lacked any dentists who had provided care to privately insured children younger than two years old. CONCLUSIONS: The proportion of dentists in Iowa treating privately insured children younger than two years old has increased since 2005. However, relatively few general dentists provided care to very young children when compared to previous survey-based figures. Geographic distribution of providers supports the hypothesis that provider availability may pose a barrier to early dental visits.
Asunto(s)
Odontólogos/provisión & distribución , Adolescente , Niño , Odontología , Femenino , Humanos , Iowa , Población Rural , Encuestas y CuestionariosRESUMEN
OBJECTIVES: Using administrative data from Iowa Medicaid and a large private dental insurer, we compared distance to the nearest primary care dentist for children ages 6-15 in 2012. Additionally, we examined rates of provider bypass in both populations as an indicator of spatial accessibility to dental care. METHODS: We calculated measures of travel burden, including distance to the nearest primary care dentist and distance to current primary care dentist. Distance outcomes and rates of bypass, traveling beyond the nearest dentist for care, were compared by insurance type. RESULTS: We found that Medicaid-enrolled children lived farther from the nearest dentist and farther from their current dentist than privately insured children. However, rates of bypass were higher among the privately insured population. These results were consistent among urban and rural residents; additionally, both rural populations demonstrated greater travel distances than urban dwellers. CONCLUSIONS: Travel burden was greater among Medicaid-enrolled children. Lower rates of bypass, in conjunction with lower rates of dental utilization in this population, may indicate a distance threshold beyond which dental care becomes unattainable.
Asunto(s)
Atención Dental para Niños , Seguro Odontológico , Medicaid , Viaje , Adolescente , Niño , Femenino , Accesibilidad a los Servicios de Salud , Humanos , Iowa , Masculino , Estados UnidosRESUMEN
OBJECTIVES: To identify the factors associated with paediatric emergency department (ED) visits and parental perceptions of the avoidability of their child's ED visit. DESIGN: Cross-sectional study by performing secondary analysis of 2010-2011 Iowa Child and Family Household Health Survey data. SETTING: State-wide representative population-based sample of families with at least one child in the state of Iowa in the USA. PATIENTS/PARTICIPANTS: Among the eligible households, 2386 families completed the survey, yielding a cooperation rate of 80%. EXPOSURE/INTERVENTION: Presence of a medical home. MAIN OUTCOME MEASURES: Child visiting an ED in the past year; parents believing that ED care could have been provided in a primary-care setting. RESULTS: Among children who needed medical care in the past year, 26% visited an ED. Younger children, non-Hispanic black children, non-Hispanic others, children whose parents were not married, children who were from food-insecure households and had poorer health status were more likely to visit an ED. Having a medical home was not associated with ED visits (OR=0.80, 95% CI 0.61 to 1.04), even after stratifying by the child's health status. About 69% of parents who took their child to an ED agreed that ED care could have been provided in a primary-care setting. Parents of children with public insurance, those who were not referred to the ED and those who could not get routine care appointments were more likely to report a primary-care preventable ED visit. CONCLUSIONS: The majority of parents believed that paediatric ED visits could be avoided if adequate primary-care alternatives were available. Expanding access to primary care could lead to a reduction in avoidable ED visits by children.
Asunto(s)
Servicios de Salud del Niño/estadística & datos numéricos , Servicio de Urgencia en Hospital/estadística & datos numéricos , Padres/psicología , Aceptación de la Atención de Salud/estadística & datos numéricos , Adolescente , Adulto , Niño , Preescolar , Estudios Transversales , Femenino , Accesibilidad a los Servicios de Salud , Estado de Salud , Humanos , Lactante , Seguro de Salud , Iowa , Modelos Logísticos , Masculino , Factores de Riesgo , Factores SocioeconómicosRESUMEN
BACKGROUND: Dental emergency department (ED) visits are increasing nationally, but EDs provide only palliative care. The authors examine time to subsequent dentist visit within 6 months after the ED visit, as well as the effect of having a dentist visit in the prior year. METHODS: Using 2010-2012 Iowa Medicaid claims data, the authors identified adults with an index dental ED visit. The authors examined the claims data for a subsequent dentist visit within the next 6 months. The authors used Kaplan-Meier curves and log-rank tests for bivariate analyses. The authors included a dentist visit in the year before the index ED visit, subsequent ED visits, and sociodemographic characteristics in a Cox multivariable regression model. RESULTS: A total of 2,430 adults enrolled in Medicaid satisfied the study inclusion criteria. Within 6 months, 52.4% had a subsequent dentist visit, 12.0% lost Medicaid eligibility, and 35.6% did not have subsequent dentist visit. Bivariate and multivariable analyses revealed that nonwhites, those without a dentist visit in the prior year, and those with subsequent ED visits had a significantly lower rate of subsequent dentist visits. CONCLUSIONS: Almost one-half of adults with a dental ED visit did not visit a dentist in the next 6 months. Adults who did not visit a dentist in the past year and those with repeated ED visits may be living with unresolved dental problems that can affect their quality of life. PRACTICAL IMPLICATIONS: Adults without a dentist visit in the past year and those who visit ED repeatedly can be targeted by ED diversion programs because they are at higher risk of not receiving follow-up dental care.
Asunto(s)
Atención Odontológica/estadística & datos numéricos , Servicio de Urgencia en Hospital/estadística & datos numéricos , Medicaid/estadística & datos numéricos , Enfermedades Estomatognáticas/terapia , Adulto , Femenino , Humanos , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Modelos de Riesgos Proporcionales , Enfermedades Estomatognáticas/epidemiología , Estados Unidos/epidemiología , Adulto JovenRESUMEN
OBJECTIVES: Private practice dentists are the major source of care for the dental safety net; however, the proportion of dentists who participate in state Medicaid programs is low, often due to poor perceptions of the program's administration and patient population. Using a discrete choice experiment and a series of hypothetical scenarios, this study evaluated trade-offs dentists make when deciding to accept Medicaid patients. METHODS: An online choice-based conjoint survey was sent to 272 general dentists in Iowa. Hypothetical scenarios presented factors at systematically varied levels. The primary determination was whether dentists would accept a new Medicaid patient in each scenario. Using an ecological model of behavior, determining factors were selected from the categories of policy, administration, community, and patient population to estimate dentists' relative preferences. RESULTS: 62 percent of general dentists responded to the survey. The probability of accepting a new Medicaid patient was highest (81 percent) when reimbursement rates were 85 percent of the dentist's fees, patients never missed appointments, claims were approved on first submission, and no other practices in the area accepted Medicaid. Although dentists preferred higher reimbursement rates, 56 percent would still accept a new Medicaid patient when reimbursement decreased to 55 percent if they were told that the patient would never miss appointments and claims would be approved on initial submission. CONCLUSIONS: This study revealed trade-offs that dentists make when deciding to participate in Medicaid. Findings indicate that states can potentially improve Medicaid participation without changing reimbursement rates by making improvements in claims processing and care coordination to reduce missed appointments.
Asunto(s)
Actitud del Personal de Salud , Toma de Decisiones , Odontólogos/psicología , Medicaid/economía , Administración de la Práctica Odontológica/economía , Odontología General , Humanos , Iowa , Probabilidad , Encuestas y Cuestionarios , Estados UnidosRESUMEN
Spatial accessibility of dental care is mediated by dentist workforce availability and travel costs. In this study, we generated dental service areas through small area analysis of Medicaid administrative data and claims. Service areas were then used to assess dimensions of spatial accessibility, including dentist-to-population ratios, and examine relationships in geographic variation of routine dental care among Medicaid-enrolled children. Our findings indicate significant geographic differences in accessibility for Hispanic children compared to other children, even after controlling for individual and service area characteristics.
Asunto(s)
Atención Dental para Niños/estadística & datos numéricos , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Adolescente , Niño , Preescolar , Odontólogos/estadística & datos numéricos , Odontólogos/provisión & distribución , Femenino , Sistemas de Información Geográfica , Geografía Médica , Humanos , Masculino , Medicaid , Pobreza , Estados UnidosRESUMEN
Dental coverage for adults is an elective benefit under Medicaid. As a result of budget constraints, California Medicaid eliminated its comprehensive adult dental coverage in July 2009. We examined the impact of this policy change on emergency department (ED) visits by Medicaid-enrolled adults for dental problems in the period 2006-11. We found that the policy change led to a significant and immediate increase in dental ED use, amounting to more than 1,800 additional dental ED visits per year. Young adults, members of racial/ethnic minority groups, and urban residents were disproportionately affected by the policy change. Average yearly costs associated with dental ED visits increased by 68 percent. The California experience provides evidence that eliminating Medicaid adult dental benefits shifts dental care to costly EDs that do not provide definitive dental care. The population affected by the Medicaid adult dental coverage policy is increasing as many states expand their Medicaid programs under the ACA. Hence, such evidence is critical to inform decisions regarding adult dental coverage for existing Medicaid enrollees and expansion populations.
Asunto(s)
Servicio de Urgencia en Hospital/economía , Servicio de Urgencia en Hospital/estadística & datos numéricos , Cobertura del Seguro/economía , Cobertura del Seguro/estadística & datos numéricos , Seguro Odontológico/economía , Seguro Odontológico/estadística & datos numéricos , Medicaid/economía , Medicaid/estadística & datos numéricos , Uso Excesivo de los Servicios de Salud/economía , Uso Excesivo de los Servicios de Salud/estadística & datos numéricos , Adulto , Costos de la Atención en Salud/estadística & datos numéricos , Humanos , Patient Protection and Affordable Care Act/economía , Patient Protection and Affordable Care Act/estadística & datos numéricos , Estados UnidosRESUMEN
Early preventive dental visits are vital to the oral health of children. Yet many children, especially preschool-age children enrolled in Medicaid, do not receive early visits. This study attempts to uncover factors that can be used to encourage parents to seek preventive dental care for preschool-age children enrolled in Medicaid. The extended parallel process model was used as a theoretical framework for this research. This model suggests that people will act if the perceived threat (severity and susceptibility) is high enough and if efficacy levels (self-efficacy and response efficacy) are likewise high. Following Witte's method of categorizing people's perceptions and emotions into one of four categories based on levels of threat and efficacy, this article describes four groups (high threat/high efficacy, high threat/low efficacy, low threat/high efficacy, and low threat/low efficacy) of parents and how they compare to each other. Using logistic regression to model if a child had a preventive visit, results indicate that parents with low threat/high efficacy and parents with high threat/high efficacy had approximately 2.5 times the odds of having a child with a preventive oral health visit compared to parents with low threat/low efficacy, when controlling for perceived oral health status, health literacy, and child's age. The importance of efficacy needs to be incorporated in interventions aimed at increasing preventive dental visits for young children.
Asunto(s)
Atención Dental para Niños/estadística & datos numéricos , Medicaid , Preescolar , Femenino , Encuestas de Atención de la Salud , Humanos , Lactante , Masculino , Modelos Teóricos , Salud Bucal , Padres , Estados UnidosRESUMEN
BACKGROUND: The authors investigated the role of private practitioners in the dental safety net, including the provision of care for Medicaid enrollees and attitudinal factors that affect participation. METHODS: In 2013, the authors sent a mixed-mode survey to all general dentists in Iowa assessing their current Medicaid participation and factors affecting participation, including attitudinal statements about altruism, the Medicaid program, and the government's role in providing access to dental care. RESULTS: Fifty-six percent of responding dentists accepted new Medicaid-enrolled patients; dentists living in nonmetropolitan areas were significantly more likely to accept Medicaid than were those in metropolitan areas. Results from a logistic regression model demonstrated that participating dentists scored significantly higher in altruistic attitudes and perceived problems with Medicaid as less important. CONCLUSIONS: Dentists who accepted Medicaid-enrolled patients had significantly more positive attitudes about Medicaid administration and altruistic attitudes in general. Investigators in future studies should examine how these attitudes are shaped by educational and professional experiences. PRACTICAL IMPLICATIONS: Dentists' perceptions about Medicaid potentially are modifiable by changing program policies in ways to improve access for vulnerable populations, including new Medicaid enrollees.
Asunto(s)
Altruismo , Actitud del Personal de Salud , Medicaid/estadística & datos numéricos , Adulto , Femenino , Accesibilidad a los Servicios de Salud , Humanos , Iowa , Masculino , Persona de Mediana Edad , Administración de la Práctica Odontológica/estadística & datos numéricos , Encuestas y Cuestionarios , Estados UnidosRESUMEN
BACKGROUND: Existing research about the influence of educational debt on students' decision to enter general practice immediately after graduation is conflicting. Other potential factors that could affect this decision include the influence of a spouse or other family member, the importance of a mentoring dentist, and how students perceive the burden of their debt. The goal of this study was to examine the importance of debt on career decision-making while also considering the role of other influences. METHODS: Responses to a self-completed questionnaire of all final (fourth) year students at the University of Iowa College of Dentistry from 2007 through 2010 were analyzed to identify the importance of educational debt and the influence of spouses, other family members, and mentoring dentists in the decision to enter private general practice immediately after graduation. Statistical analysis included bivariate tests (t-tests and Chi-square tests) and multivariable logistic regression. RESULTS: 58.9% of respondents (N = 156) planned to immediately enter private practice after dental school. Bivariate analyses revealed women to be more likely to enter private practice than their male counterparts (69.0% vs. 51.8%, p = .006). Students planning to enter practice immediately did not differ significantly from those with other career plans on the basis of marital status or having a family member in dentistry. Anticipated educational debt of at least $100,000 was positively associated with plans to enter private practice immediately after graduation. Self-reported importance of educational debt was not associated with career plans. However, the influence of a spouse, other family members, and family dentists were also positively associated with the decision to enter private practice. These factors all maintained significance in the final multivariable model (p < 0.05); however, educational debt of at least $100,000 was the strongest predictor of plans to enter private practice (OR = 2.34; p = 0.023). CONCLUSIONS: Since the 1970s, increasing numbers of dentists in the U.S. have pursued specialty training after dental school. However, rising educational debts may counter this trend as increasing numbers of dentists choose to immediately pursue general dentistry at graduation. This project has demonstrated the significant influence of educational debt, beyond other external influences.
Asunto(s)
Selección de Profesión , Práctica Privada , Estudiantes de Odontología , Toma de Decisiones , Educación en Odontología/economía , Docentes de Odontología , Familia , Femenino , Odontología General , Humanos , Estudios Longitudinales , Masculino , Estado Civil , Mentores , Personal Militar , Padres , Autoinforme , Factores Sexuales , Especialidades Odontológicas/educación , EspososRESUMEN
OBJECTIVES: The study assessed the time until first dental caries for young children seen at five Federally Qualified Health Centers (FQHC) in Iowa and the relationship with the frequency and gaps (in months) of dental episodes, the number of topical fluoride treatments, and the number of dentists caring for the subject. METHODS: Forty children were randomly selected at each FQHC (n = 200). All children were continuously enrolled in the Medicaid program and had their first dental visit prior to age 6. Dental chart findings, claims data for the child and family, and birth certificate information were merged into one dataset. Dental visits were followed for a minimum of 36 months, including dental visits external to the FQHCs. Using time until first caries as the dependent variable, the data were subject to left, interval, and right censoring and were analyzed via Weibull regression. RESULTS: Slightly more than half of the 200 children experienced caries. Regression analysis indicated that the hazard of first dental caries increased by approximately 2% with each additional month that transpired between preventive recall examinations. In addition, children with older siblings who had a dental visit at the same center during the previous year prior to the subject's first visit were more likely to have a longer time until first dental caries. CONCLUSIONS: Timing of dental care episodes was associated with caries experience in young children from low income families. Dental professionals should focus on regularity of dental care to prevent or delay caries experience in young children.
Asunto(s)
Centros Comunitarios de Salud/estadística & datos numéricos , Atención Dental para Niños/estadística & datos numéricos , Caries Dental/epidemiología , Preescolar , Femenino , Humanos , Lactante , Masculino , Medicaid , Estudios Retrospectivos , Factores de Tiempo , Estados Unidos/epidemiologíaRESUMEN
The Institute of Medicine and the Commission on Dental Accreditation (CODA) have recommended that dental schools incorporate community-based dental education (CBDE) programs into their curricula. The expectation is that CBDE participation will help dental students gain the skills and motivation to treat vulnerable populations after graduation. The purpose of this study was to determine whether dentists' involvement with charitable dental care is associated with participation in CBDE as dental students. A questionnaire was mailed to private practice Iowa dentists (N=1,312); the response rate was 41.2 percent (n=541). Logistic regression analyses, controlling for age, gender, number of hours worked per week, graduation year, and alma mater, were conducted. A majority of the respondents provided charitable care: 85 percent in their offices, and 70 percent in the community. Seventy-nine percent had participated in CBDE as dental students. Respondents who reported being very satisfied/satisfied with their charitable care experiences were more likely to provide charitable care in their offices and the community than respondents who were not satisfied with their experiences. Respondents who participated in CBDE as dental students were more likely to provide charitable care in the community than respondents who did not participate in CBDE. The type of sites where dentists completed their CBDE experiences was associated with where they provide charitable care. This study suggests that participation in CBDE may be associated with dental students' providing charitable dental care after graduation.
Asunto(s)
Organizaciones de Beneficencia , Odontología Comunitaria/educación , Atención Odontológica , Odontólogos , Educación en Odontología , Curriculum , Atención Odontológica/estadística & datos numéricos , Odontólogos/estadística & datos numéricos , Femenino , Humanos , Iowa , Masculino , Estudiantes de Odontología/estadística & datos numéricos , Encuestas y Cuestionarios , Atención no Remunerada , Voluntarios , Poblaciones VulnerablesRESUMEN
BACKGROUND: Well baby visits (WBVs) are a cornerstone of early childhood health, but few studies have examined the correlates of WBVs for socioeconomically vulnerable infants. The study objective was to identify factors related to the number of WBVs received by Medicaid-enrolled infants in the first three years of life and to present a preliminary explanatory model. METHODS: We analyzed Iowa Medicaid claims files and birth certificate data for infants born in calendar year 2000 (N = 6,085). The outcome measure was the number of well baby visits (WBVs) received by Medicaid-enrolled infants between age 1 and 41 months (range: 0 to 10). An ecological health model and existing literature were used to evaluate 12 observed factors as potential WBV correlates. We ran multiple variable linear regression models with robust standard errors (α = 0.05). RESULTS: There were a number of infant, maternal, and health system factors associated with the number of WBVs received by Medicaid-enrolled infants. Infants whose mothers had a greater number of prenatal healthcare visits (ß = 0.24 to 0.28; P = .001) or were married (ß = 0.20; P = .002) received more WBVs. Having a chronic health condition (ß = 0.51; P < .0001) and enrollment in a case management program (ß = 0.48; P < .0001) were also positively associated with WBVs. Eligibility for Medicaid through the Supplemental Security Income Program (ß = -0.70; P = .001), increased maternal age (ß = -0.27 to -0.35; P = .004), higher levels of maternal education (ß = -0.18; P = .005), maternal smoking (ß = -0.13; P = .018), and enrollment in a health maintenance organization plan (ß = -1.15; P < .0001) were negatively associated with WBVs. There was a significant interaction between enrollment in a health maintenance organization plan and enrollment in a Medicaid case management program (P = .015). Maternal race, maternal alcohol use during pregnancy, and rurality were not significantly related to the number of WBVs. CONCLUSIONS: Multiple infant, maternal, and health system variables were related to the number of WBVs received by Medicaid-enrolled infants. Additional research is needed to develop strategies to optimize access to WBVs for Medicaid-enrolled infants at risk for poor use of preventive medical care services.