BackgroundTo achieve optimal health and oral health, the system of care must place a person and their social well-being at the center of decision making and understand factors spent outside the clinical settings, including individual behavior, context and lifestyle.Main textPerson-centered care offers a unique and compelling opportunity for dentistry, and its practitioners, to improve quality of care and overall health outcomes. For decades, the dominant treatment modalities within dentistry primarily focused on a surgical, treatment-oriented approach as opposed to health promotion and improvement. However, new business and care models are disrupting the dental care system, and transforming it into one that is focused on disease management and prevention-oriented primary care that considers overall health and well-being. We proposed a person-centered care model to improve oral health as an integral part of overall health. The model identified three key players who act as change agents with their respective roles and responsibilities: Person, provider, and health care system designer.ConclusionsWhile previous person-centered models in dentistry focused on the role of providers within the clinical setting, this work emphasizes the role of the care designer in creating an environment where both person and provider are able to communicate effectively and achieve improved health outcomes.
Objectives: This study aimed to update dental service utilization during pregnancy and to evaluate whether there are persistent disparities in dental care during pregnancy by race/ethnicity and Medicaid status. Methods: This retrospective secondary data analysis examined dental service utilization during and prior to pregnancy and met dental or oral health needs using the Pregnancy Risk Assessment Monitoring System (PRAMS) data sets on 75,876 women between 2012 and 2015. Results: Only about half of the women (51.7%) reported that they had at least 1 dental visit for cleaning during their most recent pregnancy. One of 5 women (19.7%) experienced dental problems during pregnancy, and 34.4% of these women did not visit dentists to address the problems. Non-Hispanic Black women had 14% lower odds of visiting dentists for cleaning during pregnancy compared to non-Hispanic White women (odds ratio [OR], 0.86; 95% CI confidence interval [CI], 0.80–0.92). There was no difference in dental visits prior to pregnancy between non-Hispanic Black and White women. Women enrolled in Medicaid showed significantly lower odds of visiting dentists for cleaning during pregnancy compared to women covered by private health insurance (OR, 0.55; 95% CI, 0.52–0.58). Conclusion for Practice: Oral health, as an integral part of primary care, needs to be included in the standard prenatal care through oral health education and timely dental care during pregnancy. With mounting evidence of persisting disparities in dental service utilization during pregnancy, both public and private prenatal programs and policies should address specific barriers in accessing and using dental care during pregnancy, especially for women from socially disadvantaged backgrounds. Knowledge Transfer Statement: The current study updated the previous findings with more recent multiyear PRAMS data (2012–2015) and found the Black-White disparity and disparity among Medicaid-enrolled women in visiting dentists during pregnancy persist. The results of this study can be used by policymakers and practitioners to integrate oral health into prenatal care for pregnant women from marginalized backgrounds to achieve oral health parity.
Background: The causes of preterm birth are multi-dimensional, including delayed and inadequate prenatal services as well as other medical and socioeconomic factors. This study aimed to examine the different levels of association between preterm birth and major medical co-morbidities among various racial/ethnic women enrolled in Medicaid. Methods: This is a retrospective analysis of 457,200 women aged between 15 and 44 with a single live birth from the IBM® MarketScan® Multi-State Medicaid Database from 2014 to 2015. Preterm birth, defined by delivery before 37 completed weeks of gestation, was the primary dependent variable. All births were dichotomously categorized as either preterm or full-term birth using the International Classification of Diseases, Ninth Revision, Clinical Modification codes. Independent variables included race/ethnicity, categorized as non-Hispanic white, non-Hispanic black, Hispanic, or other. Medical co-morbidities included smoking, drug dependence, alcohol dependence, diabetes, and hypertension. Total healthy prenatal visit count and high-risk prenatal visit encounters identified during 30 weeks prior to the delivery date were included in the analysis. Results: A significantly higher preterm birth rate was found in black women after controlled for medical comorbidities, age, prenatal visit count, and high-risk pregnancy. Different levels of association between preterm birth outcome and major medical co-morbidities were examined among various racial/ethnic women enrolled in Medicaid. Drug dependence was associated with higher odds of preterm birth in black (OR = 2.56, 95% CI [1.92-3.41]) and white women (OR = 2.12, 95% CI [1.91-2.34]), when controlled for other variables. In Hispanic women, diabetes (OR=1.44, 95% CI [1.27, 1.64]) and hypertension (OR=1.98, 95% CI [1.74, 2.26]) were associated with higher odds of preterm birth. White women diagnosed with drug dependence had a 14.0% predicted probability of preterm birth, whereas black women diagnosed with drug dependence had a predicted probability of preterm birth of 21.5%. Conclusions: The associations of medical co-morbidities and preterm births varied across racial and ethnic groups of women enrolled in Medicaid. This report calls for future research on racial/ethnic disparity in preterm birth to apply integrative and qualitative approaches to understand the disparity from a contextual perspective, especially for vulnerable pregnant women like Medicaid enrollees.
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