Research Proposal on "Identifying Opportunities to Improve Oral Health Care Services Access"

Research Proposal 16 pages (7727 words) Sources: 16 Style: APA

[EXCERPT] . . . .

For example, a study by Kelly, Binkley, Neace and Gale (2005) conducted eight focus groups with a random sample of 76 participants to evaluate psychosocial, cultural and structural barriers to access to oral health care services for children from low-income families.

This study drew on Medicaid utilization records to identify Medicaid-enrolled children of white and African-American caregivers in Jefferson County, Kentucky to recruit participants for the focus groups. The analytical method was a stratified random sampling of participants with a qualitative analysis of the focus group transcripts. The results identified expectations of poor oral health, discriminatory behaviors on the part of providers as well as problems locating providers who accepted Medicaid as being major barriers to access for low-income consumers (Kelly et al., 2005).

The results of a study by Taylor and Marino (2014) emphasize that the combination of a scarcity of dental professionals together with the pressing need for timely and effective oral health care services has resulted in growing calls for improved access in general and for low-income consumers and their children in particular. For instance, Taylor and Marino report that, "dental caries is the silent epidemic" and "in children, dental caries are the most prevalent chronic disease" (2014, p. 5). Similarly, Sams, Rozier, Wilder and Quinonez (2013) cite dental caries among preschool-aged children as a national public health threat. The objectives of this study were to identify the number of state Medicaid programs that had implemented the provision of support preventive dental services by allied health practitioners, the perceived attributes of this alternative providers and barriers to implementation (Sams et al. 2013). These researchers employed a 2008 cross-section survey of Medicaid dental program managers to identify the respective organizational stage of implementation based on the Transtheoretical Model of Behavior Change together with a 3-year follow-up. An assessment of the perceptions of the influence of 18 initiative attributes concerning the adopted decision based on Roger's diffusion of innovations theory was incorporated with descriptive analyses of stage and date of adoption. In addition, barriers and attributes were evaluated according to their adoption stage using variance analyses. The results of this study showed by 42 states had adopted a policy by 2011, but just nine states had incorporated a comprehensive set of preventive services with the most frequently adopted method being fluoride varnish. The level of adoption was found to be influenced by the perceived simplicity of the initiative as well its congruence with other Medicaid programs. Although the types of barriers to constrain access to oral health care services vary from jurisdiction to jurisdiction, the most commonly encountered barrier is administrative in nature in the 15 studies analyzed (Sams et al., 2013), suggesting that many low-income residents of Westside experience bureaucratic delays in obtaining oral health care services. A cross-sectional analysis by Sams et al. of Medicaid dental programs found that just nine states had adopted a comprehensive set of oral health preventive policies with administrative barriers being cited as the most common constraint. itiatives to support preventive dental services provision by nondental health care professionals, their perceived attributes, and implementation barriers. Based on these findings, Sams et al. concluded that there has been an increase in state Medicaid policies to reimburse nondental providers for preventive dental services, but that interventions are still required in order to assure oral health services delivery at the practice level.

Not surprisingly, in households where money is already tight, there may be little or nothing left for oral health care services for any member of the family, despite the need for these services for younger people in particular (Gross-Panico & Freeman, 2012). A study by Gross-Panico and Freeman (2012) identified dental caries among young people from low-income homes as being the result of a lack of sufficient resources to pay for oral health care service. This study used the results of 34 self-report surveys (English=21; Spanish=13) of parents/guardians of young people aged 0-18 years receiving preventive dental services from an affiliated practice dental clinic in Chandler, Arizona.

The data was analyzed using the Friedman's, Kendall's W and Wilcoxon Signed Ranks Tests to provide descriptive statistics and non-parametric findings. The results of the Gross-Panico and Freedman (2012) study indicate that although transportation and geographic proximity to services represented major constraints to access, the main barrier was the cost of oral health care services for low-income populations. Based on these findings, Gross-Panico and Freeman (2012) concluded that, "Funding efforts, reimbursement mechanisms and legislative policies should support this dental care delivery model to provide care to underserved children, adults and seniors throughout the U.S." (p. 306).

Likewise, Taylor and Marino emphasize that, "More than half of 5-year-olds from low income families have early childhood caries [ECC] with a high rate of preschool children being untreated" (2014, p. 6). This finding suggests that even when oral health care services are available, low-income residents may not be able to access them due to the other constraints described further below.

Left untreated, ECC can result in a wide range of other health problems, including problems with chewing, insufficient nutritional intake, oral pain, and in some cases, a failure to thrive (Taylor & Marino, 2014). In addition, there are other impairments that can be caused by poor oral health that have specific implications for younger people. For example, Taylor and Marino caution that, "Dental decay and tooth loss can also lead to speech-language development issues, poor self-esteem, declining school performance and costly emergency medical services and dental restorations" (2014, p. 6). These are important issues because the findings that emerged from a study by Brickhouse, Rozier and Slade (2008) indicate that, "Untreated tooth decay continues to be a significant problem for children with public insurance coverage" (p. 877). Using a retrospective cohort design, Brickhouse et al. (2008) evaluated untreated dental caries levels for 79,731 children and found that among those enrolled in public insurance programs, nearly one-third (30%) had dental caries. These findings were based on a calibrated oral screening of kindergarten children dental health outcomes obtained during the 2000-2001 school year together with data concerning eligibility and claims for children enrolled in Medicaid and State Children's Health Insurance Program (SCHIPs) who were eligible for dental services during the period from 1999 to 2000.

A series of logistic regression models were developed in order to analyze children's extent and likelihood of experiencing untreated dental caries based on enrollment in Medicaid and SCHIP programs. Irrespective of the program used, enrolled children experienced better oral health care outcomes compared to those who were not. Based on their statistical analysis, Brickhouse et al. found that children enrolled in Medicaid or SCHIP were 1.7 times more likely to experience untreated dental caries compared to children who were not enrolled in one of these programs. Based on the results of a two-part regression model, these researchers concluded that untreated tooth decay remains a serious issue for children from low-income families that rely on public insurance coverage. For low-income residents of Westside, then, access to oral health care services may be constrained by their existing public health insurance coverage.

Even though a majority of oral diseases are controllable or outright preventable, oral health care for low-income residents of communities such as Westside remains largely unmet (Taylor & Marino, 2014). These issues assume even greater importance and urgency when the long-term costs of untreated dental diseases are taken into account. As Taylor and Marino point out, "Early oral health intervention and preventative services can set the stage for healthy dentition and oral health habits. Yet, profound disparities exist in the level of dental services obtained by children, especially for children of low socioeconomic status" (2014, p. 6). In some cases, even when young children finally receive oral health care services, the damage has already been done. As Taylor and Marino conclude, "Of particular concern is the low rate of early detection and preventative care for children three years and younger. Unfortunately, preventative and curative dental care for children often occurs after damage to teeth has taken place" (2014, p. 7). These findings underscore the need for improving access to oral health care services for low-income residents in Westside as a cost-preventative measure.

The lack of timely and efficacious oral health care services for low-income families was also the subject of a study by Larsen and Larsen (2009) who report that far too many children from these families lack access to oral health care services today. According to Larsen and Larsen (2009), "Tooth decay is the most common chronic childhood disease in the United States. Every year, children lose an estimated 52 million school hours due to dental-related problems" (p. 117). Based on their analysis of visit and billing data from CAS, a privately operated social welfare agency based in New York City, during the period July 2004 to June 2005, Larsen and Larsen determined that young people from low-income families are at far more risk of developing untreated cavities compared to their… READ MORE

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