Geographic and health system correlates of interprofessional oral health practice

Abstract

Objective: This study explores geographic, system, and organizational constructs that predict medical care teams’ willingness to administer fluoride varnish and conduct oral health risk assessments. Methods: A cross-sectional survey of voluntary health professionals attending trainings on interprofessional oral health practice was completed at ten meetings across the United States from April through September, 2016. Bivariate and multivariate analyses were used to examine unknown correlates of oral health prevention and intervention at geographic, organizational, and system levels relating to the impact of referral mechanisms and systems as well as health information technology on fluoride varnish administration and risk-based oral evaluations. Results: A convenience cohort (n = 560) from 44 states was examined. Most (68.7%, n = 385) agreed with the dependent variable “medical providers at our site, or part of our network, are administering fluoride varnish and identifying oral health risk factors in the majority of patients seen.” In bivariate analysis, organization type (P = 0.0067), having successful referral systems (P < 0.0001), and electronic health record (EHR) utility (P < 0.0001) were associated with the dependent variable. No geographic indicators were significant. All referral system indicators were significant in multivariate analysis. Dependable referrals (P < 0.0001), EHR utility (P = 0.0054), and type of referral (P = 0.0009) were predictors of the dependent variable. The odds of those reporting a dependable referral system and dependent variable agreement were 4.5 times greater than for those who lacked dependable referral systems (odds ratio 4.54, confidence interval 2.79–7.39). The odds of those who had dependable EHRs and dependent variable agreement were 2.4 times greater than for those who lacked useful EHRs (odds ratio 2.4, confidence interval 1.29–4.37). Conclusion: The dependability of medical-to-dental referral systems and processes impacts the administration of fluoride varnish and identification of oral health risk factors by motivated primary care teams. Additionally, the ease of EHR use and the availability of electronic information exchange were found to impact primary care oral health practice.

Keywords

• Oral health
• referral management
• risk-based care
• population health
• coordinated care