Training pediatric health care providers in prevention of dental decay: results from a randomized controlled trialReport as inadecuate

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BMC Health Services Research

, 7:176

First Online: 02 November 2007Received: 28 March 2007Accepted: 02 November 2007DOI: 10.1186-1472-6963-7-176

Cite this article as: Slade, G.D., Rozier, R.G., Zeldin, L.P. et al. BMC Health Serv Res 2007 7: 176. doi:10.1186-1472-6963-7-176


BackgroundPhysicians report willingness to provide preventive dental care, but optimal methods for their training and support in such procedures are not known. This study aimed to evaluate the effect of three forms of continuing medical education CME on provision of preventive dental services to Medicaid-enrolled children by medical personnel in primary care physician offices.

MethodsPractice-based, randomized controlled trial. Setting: 1,400 pediatric and family physician practices in North Carolina providing care to an estimated 240,000 Medicaid-eligible children aged 0–3 years. Interventions: Group A practices n = 39 received didactic training and course materials in oral health screening, referral, counseling and application of fluoride varnish. Group B practices n = 41 received the same as Group A and were offered weekly conference calls providing advice and support. Group C practices n = 41 received the same as Group B and were offered in-office visit providing hands-on advice and support. In all groups, physicians were reimbursed $38–$43 per preventive dental visit. Outcome measures were computed from reimbursement claims submitted to NC Division of Medical Assistance. Primary outcome measure: rate of preventive dental services provision per 100 well-child visits. Secondary outcome measure: % of practices providing 20 or more preventive dental visits.

Results121 practices were randomized, and 107 provided data for analysis. Only one half of Group B and C practices took part in conference calls or in-office visits. Using intention-to-treat analysis, rates of preventive dental visits did not differ significantly among CME groups: GroupA = 9.4, GroupB = 12.9 and GroupC = 8.5 P = 0.32. Twenty or more preventive dental visits were provided by 38–49% of practices in the three study groups P = 0.64.

ConclusionA relatively high proportion of medical practices appear capable of adopting these preventive dental services within a one year period regardless of the methods used to train primary health care providers.

Trial NCT00464009

Electronic supplementary materialThe online version of this article doi:10.1186-1472-6963-7-176 contains supplementary material, which is available to authorized users.

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Author: Gary D Slade - R Gary Rozier - Leslie P Zeldin - Peter A Margolis


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