title: Adoption and implementation of policies to support preventive dentistry initiatives for physicians: a national survey of Medicaid programs.
abstract: OBJECTIVE
  We determined the number of state Medicaid programs adopting initiatives to support preventive dental services provision by nondental health care professionals, their perceived attributes, and implementation barriers.
  
  
  METHODS
  We used Qualtrics to conduct a cross-sectional survey in 2008 of Medicaid dental program managers to determine organizational stage of adoption classified according to the Transtheoretical Model of Behavior Change with 3-year follow-up. We assessed perceptions of the influence of 18 initiative attributes on the decision to adopt, drawn from Roger's diffusion of innovations theory. Stage and date of adoption are presented descriptively. Attributes and barriers were analyzed by stage of adoption by using analyses of variance or χ(2) statistics.
  
  
  RESULTS
  By 2011, 42 states had adopted a policy. Only 9 states included a comprehensive set of preventive services, the most common being fluoride varnish. Adoption was affected by perceived initiative simplicity and its compatibility with other Medicaid programs. Administrative barriers were the most common among the 15 studied.
  
  
  CONCLUSIONS
  State Medicaid policies to reimburse nondental providers for preventive dental services are becoming widespread. Interventions are needed to ensure oral health services delivery at the practice level.
authors.affiliation: Department of Dental Ecology, University of North Carolina at Chapel Hill School of Dentistry, 3240 Old Dental Building, Chapel Hill, NC 27599-7450, USA. samsl@dentistry.unc.edu
authors.forename: Lattice D
authors.initials: LD
authors.lastname: Sams
authors.forename: R Gary
authors.initials: RG
authors.lastname: Rozier
authors.forename: Rebecca S
authors.initials: RS
authors.lastname: Wilder
authors.forename: Rocio B
authors.initials: RB
authors.lastname: Quinonez
mesh_terms: D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D019140:Dental Care for Children / Q000191:economics*; D003731:Dental Caries / Q000517:prevention & control*; D004059:Diffusion of Innovation; D005260:Female; D005460:Fluorides, Topical / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D008484:Medicaid; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011313:Preventive Dentistry / Q000191:economics*; D011795:Surveys and Questionnaires; D014481:United States
chemical_list: D005460:Fluorides, Topical