Training pediatric health care providers in prevention of dental decay: results from a randomized controlled trial.
BACKGROUND
Physicians 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.


METHODS
Practice-based, randomized controlled trial.


METHODS
1,400 pediatric and family physician practices in North Carolina providing care to an estimated 240,000 Medicaid-eligible children aged 0-3 years.


METHODS
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.


METHODS
rate of preventive dental services provision per 100 well-child visits.


METHODS
% of practices providing 20 or more preventive dental visits.


RESULTS
121 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).


CONCLUSIONS
A 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.


BACKGROUND
ClinicalTrials.gov NCT00464009
Slade
Gary D
GD
Australian Research Centre for Population Oral Health, Dental School, University of Adelaide, Adelaide, SA, Australia. gary.slade@adelaide.edu.au
Rozier
R Gary
RG
Zeldin
Leslie P
LP
Margolis
Peter A
PA
D001291:Attitude of Health Personnel; D002675:Child, Preschool; D019140:Dental Care for Children / Q000191:economics / Q000379:methods / Q000706:statistics & numerical data*; D003731:Dental Caries / Q000175:diagnosis / Q000517:prevention & control*; D004502:Education, Medical, Continuing / Q000379:methods*; D005194:Family Practice / Q000193:education*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008484:Medicaid; D009657:North Carolina; D010377:Pediatric Dentistry / Q000193:education*; D010372:Pediatrics / Q000193:education*; D011313:Preventive Dentistry / Q000193:education; D015397:Program Evaluation; D011795:Surveys and Questionnaires