The impact of dentists' availability in delivering dental care in Florida Elementary Schools

IF 1.8 4区医学 Q2 DENTISTRY, ORAL SURGERY & MEDICINE Journal of public health dentistry Pub Date : 2022-10-11 DOI:10.1111/jphd.12551

Simin Ma MS, Nicoleta Serban PhD, Amin Dehghanian PhD, Scott L. Tomar DMD, MPH

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Abstract

Objective

This study evaluates the dentists' availability to deliver preventive dental care to children in schools and the impact of school-based programs on access.

Methods

The study population included Florida elementary-school children, differentiated by dental insurance (Medicaid, CHIP, private, or none). We considered the implementation of school-based programs using optimization modeling to (re)allocate the dentists' caseload to schools to meet demand for preventive care under resource constraints. We considered multiple settings for school-based program implementation: (i) school prioritization; and (ii) dentists' participation in public insurance. Statistical inference was used to identify communities to improve access and reduce disparities.

Results

School-based programs reduced unmet demand (3%–12%), being more efficient if prioritizing schools in communities targeted to improve access. The access improvement varied by insurance status and geography. Uninsured urban children benefited most from school-based programs, with 15%–75% unmet need reduction. The percentage of urban communities targeted to improve access decreased by 12% against no-school program. Such percentage remained large for suburban (15%–100%) and rural (50%–100%) communities. Disparity in access for public-insured vs. private-insured children persisted under school-based programs (32%–84% identified communities).

Conclusion

School-based programs improve dental care access; the improvement was however different by insurance status, with uninsured children benefiting the most. Accounting to the dentists' availability in prioritizing schools resulted in effective resource allocation to school-based programs. Access disparities between public and private-insured children did not improve; school-based programs shifted resources from public-insured to uninsured. School-based programs are effective in addressing access barriers to those children experiencing them most.

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牙医在佛罗里达州小学提供牙科护理的可用性的影响

目的本研究评估牙科医生在学校为儿童提供预防性牙科护理的可获得性，以及学校为基础的项目对可获得性的影响。方法研究人群包括佛罗里达州小学儿童，根据牙科保险(医疗补助、CHIP、私立或无)进行区分。我们考虑实施以学校为基础的项目，使用优化模型(重新)分配牙医的病例量到学校，以满足资源限制下对预防保健的需求。我们考虑了以学校为基础的项目实施的多种设置:(1)学校优先级;以及(ii)牙医参加公共保险的情况。统计推断用于确定社区，以改善获取和减少差距。结果:以学校为基础的项目减少了未满足的需求(3%-12%)，如果优先考虑以改善入学为目标的社区的学校，则效率会更高。获得改善的情况因保险状况和地理位置而异。未参保的城市儿童从学校项目中受益最多，未满足的需求减少了15%-75%。与无学校计划相比，改善教育机会的城市社区比例下降了12%。这一比例在郊区(15%-100%)和农村(50%-100%)社区仍然很高。在以学校为基础的项目中，公共保险与私人保险儿童获得机会的差距仍然存在(32%-84%确定的社区)。结论:校本项目提高了牙科保健的可及性;然而，不同的保险状况也有不同的改善，没有保险的孩子受益最多。考虑到牙医在优先考虑学校方面的可用性，有效地将资源分配给以学校为基础的项目。公立和私立医疗保险儿童在获取医疗服务方面的差距没有改善;以学校为基础的项目将资源从公共保险转移到无保险人群。以学校为基础的项目有效地解决了那些经历最多障碍的儿童的入学障碍。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of public health dentistry 医学-公共卫生、环境卫生与职业卫生

CiteScore

3.80

自引率

4.30%

发文量

审稿时长

6-12 weeks

期刊介绍： The Journal of Public Health Dentistry is devoted to the advancement of public health dentistry through the exploration of related research, practice, and policy developments. Three main types of articles are published: original research articles that provide a significant contribution to knowledge in the breadth of dental public health, including oral epidemiology, dental health services, the behavioral sciences, and the public health practice areas of assessment, policy development, and assurance; methods articles that report the development and testing of new approaches to research design, data collection and analysis, or the delivery of public health services; and review articles that synthesize previous research in the discipline and provide guidance to others conducting research as well as to policy makers, managers, and other dental public health practitioners.