title: Provision of fluoride varnish treatment by medical and dental care providers: variation by race/ethnicity and levels of urban influence.
abstract: OBJECTIVE
  In 2004, Wisconsin Medicaid policy changed to allow medical care providers to be reimbursed for fluoride varnish treatment (FVT) to children's teeth to improve access and utilization. To date, no study has been published on whether geographic and racial/ethnic variation in the provision of FVT in response to this policy change exists. This study's objective is to examine the association of rates of FVT for children enrolled in Wisconsin Medicaid with race/ethnicity, urban influence codes (UIC), and dental health professional shortage area (DHPSA) designation based on county of residence.
  
  
  METHODS
  A retrospective, pre-post design was used based on FVT claims for children in the Wisconsin Medicaid program from 2002 to 2006. Poisson regression models were used to evaluate the association of rates of FVT claims with race/ ethnicity, UIC, and DHPSA designation.
  
  
  RESULTS
  The rate of FVT claims varied by resident county-type according to UIC and DHPSA designation, age, and race/ethnicity. Post-policy, the largest increases were observed for Native Americans residing in non-DHPSA counties, enrollees living in rural counties, and for Hispanics living in partial and entire DHPSA counties. African-Americans residing in partial DHPSA and metropolitan counties displayed the lowest rates of FVT claims.
  
  
  CONCLUSIONS
  Overall access and utilization of FVT increased, but substantial racial/ ethnic and geographic variation in the provision of FVT for children enrolled in Wisconsin Medicaid was observed. Future policies should incorporate measures that will specifically address the racial and geographic variations identified in this study.
authors.affiliation: Department of Clinical Services, School of Dentistry, Marquette University, Milwaukee, WI 53201-1881, USA. christopher.okunseri@marquette.edu
authors.forename: Christopher
authors.initials: C
authors.lastname: Okunseri
authors.forename: Aniko
authors.initials: A
authors.lastname: Szabo
authors.forename: Raul I
authors.initials: RI
authors.lastname: Garcia
authors.forename: Scott
authors.initials: S
authors.lastname: Jackson
authors.forename: Nicholas M
authors.initials: NM
authors.lastname: Pajewski
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D003815:Dentists / Q000600:supply & distribution; D005006:Ethnicity / Q000706:statistics & numerical data*; D018588:Fee-for-Service Plans / Q000706:statistics & numerical data; D005460:Fluorides, Topical / Q000008:administration & dosage / Q000627:therapeutic use*; D006291:Health Policy; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D007198:Indians, North American / Q000706:statistics & numerical data; D007223:Infant; D008329:Managed Care Programs / Q000706:statistics & numerical data; D008484:Medicaid / Q000706:statistics & numerical data; D008507:Medically Underserved Area; D012111:Residence Characteristics / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012424:Rural Population / Q000706:statistics & numerical data; D014481:United States; D014505:Urban Population / Q000706:statistics & numerical data; D014922:Wisconsin
chemical_list: D005460:Fluorides, Topical
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