Delivering Equitable Care to Underserved Communities

Demby, Neal A.; Northridge, Mary E.

doi:10.2105/ajph.2018.304701

Cited by 7 publications

(7 citation statements)

References 6 publications

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“…Study participants were caregivers of children 14 years and younger who presented for dental care due to caries at community health centers, the vast majority of whom were covered by public insurance (Medicaid / CHIP). Hence, findings may not be generalizable to caregivers and their children with caries who are covered by private insurance or did not seek care for childhood dental caries, including undocumented immigrants who are either ineligible for care or forced to forgo care because they fear interactions with public agencies [42].…”

Section: Discussionmentioning

confidence: 99%

A survey of caregiver acculturation and acceptance of silver diamine fluoride treatment for childhood caries

Kumar¹,

Cernigliaro²,

Northridge³

et al. 2019

BMC Oral Health

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BackgroundInterest in aqueous silver diamine fluoride (SDF) has been growing as a treatment for caries arrest. A cross-sectional study was conducted to identify factors associated with caregiver acceptance of SDF treatment for children presenting with caries at 8 Federally Qualified Health Centers. The study purpose was to examine associations between caregiver acceptance of SDF treatment for children with caries and (1) sociodemographic and acculturation characteristics of caregivers and (2) clinical assessments of the children by dentists.MethodsA caregiver survey collected information on: sociodemographic characteristics; acculturation characteristics, measured using the validated Short Acculturation Scale for Hispanics (SASH); perceived benefits and barriers of SDF treatment, including caregiver comfort; and perceived health-related knowledge. Chart reviews were conducted to assess: the medical / dental insurance of pediatric patients; cumulative caries experience, measured using decayed, missing, filled teeth total scores (dmft / DMFT); whether operating room treatment was needed; and a record of caregiver acceptance of SDF treatment (the outcome measure). Standard logistic regression models were developed for caregiver acceptance of SDF treatment for their children as the binary outcome of interest (yes / no) to calculate unadjusted odds ratios (OR) and adjusted ORs for covariates of interest.ResultsOverall, 434 of 546 caregivers (79.5%) accepted SDF treatment for their children. A U-shaped relationship between caregiver odds of accepting SDF treatment and age group of pediatric patients was present, where caregivers were most likely to accept SDF treatment for their children who were either < 6 years or 9–14 years, and least likely to accept SDF treatment for children 6 to < 9 years. The relationship between acculturation and caregiver acceptance of SDF treatment depended upon whether or not caregivers were born in the United States: greater acculturation was associated with caregiver acceptance of SDF treatment among caregivers born in this country, and lower acculturation was associated with caregiver acceptance of SDF treatment among caregivers born elsewhere.ConclusionsCaregiver acceptance of SDF treatment is high; child’s age and caregiver comfort are associated with acceptance. Providers need to communicate the risks and benefits of evidence-based dental treatments to increasingly diverse caregiver and patient populations.

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Section: Discussionmentioning

confidence: 99%

A survey of caregiver acculturation and acceptance of silver diamine fluoride treatment for childhood caries

Kumar¹,

Cernigliaro²,

Northridge³

et al. 2019

BMC Oral Health

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“…Family-based and intergenerational interventions have proven effective in populations with severe oral health care needs, including older racial/ethnic minorities, immigrants, and homeless people (39,70,102). At the individual level, more interventions are needed that include less well-studied populations such as Chinese Americans and other Asian subgroups, Indigenous people, rural residents, refugees, and immigrants (23,37,100,115,127).…”

Section: Targeted Interventions To Reduce Disparities In Access To Oral Health Care During Adulthood and Older Agementioning

confidence: 99%

“…While the imperative to eliminate disparities in oral health has long been recognized (65,66,132), the vital role of access to quality oral health care for people who are low-income, uninsured, and/or members of racial/ethnic minority, immigrant, or rural populations has heretofore received insufficient attention in the public health literature (23,37,77,129). Disparities need to be more fully investigated in all aspects of oral health care, including the allocation of resources for oral health care (11,66), the actual receipt (utilization) of oral health care services (95,139), the quality of oral health care services (31,32,34), the oral health care workforce (90,125), and the financing of oral health care, particularly with respect to the burden of payment on individuals and households (9,65,66,132,138,142).…”

Section: Introductionmentioning

confidence: 99%

Disparities in Access to Oral Health Care

Northridge

Kumar²,

Kaur³

2020

Annu. Rev. Public Health

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246

198

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In the United States, people are more likely to have poor oral health if they are low-income, uninsured, and/or members of racial/ethnic minority, immigrant, or rural populations who have suboptimal access to quality oral health care. As a result, poor oral health serves as the national symbol of social inequality. There is increasing recognition among those in public health that oral diseases such as dental caries and periodontal disease and general health conditions such as obesity and diabetes are closely linked by sharing common risk factors, including excess sugar consumption and tobacco use, as well as underlying infection and inflammatory pathways. Hence, efforts to integrate oral health and primary health care, incorporate interventions at multiple levels to improve access to and quality of services, and create health care teams that provide patient-centered care in both safety net clinics and community settings may narrow the gaps in access to oral health care across the life course.

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“…A range of topics relating to equity and interprofessional care delivery was covered. These included the relationship between models (Martin-Misener et al , 2012; Oelke et al , 2013), the impact of models on access and equity (Demby and Northrige, 2017; O'Malley et al , 2015; Wilkinson et al , 2017; Waldron, 2010; Glazier, 2007), care teams and impact (McPherson and McGibbon, 2010; Schuttner and Parchman, 2019), organisational interventions (Khanassov et al , 2016) and personal interventions (Kinser, 2016). Countries represented within the data where the UK, USA, Canada, the Netherlands, Brazil, Australia and Slovenia; some papers examined multiple countries (see Table 3).…”

Section: Resultsmentioning

confidence: 99%

“…However, it was also determined that these individuals may have less power within the interprofessional care team, which, in turn, may reduce their impact on care outcomes for vulnerable communities. Demby and Northridge (2018) highlight that healthy equity goals cannot be achieved without addressing social justice concerns, as they are intricately interconnected. The social justice focus of Aboriginal health services in Australia may be contributing to the success of the interprofessional practice model.…”

Section: Discussionmentioning

confidence: 99%

The impact of interprofessional practice models on health service inequity: an integrative systematic review

Carey

Taylor

2021

JHOM

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PurposeThe purpose of this review was to explore the literature for evidence of the impact of interprofessional practice models on health service inequity, particularly within community care settings for diverse ageing populations.Design/methodology/approachAn integrative systematic literature review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework combined with the EndNote reference management system. Following the collection and comprehensive screening process completion, a thematic analysis of the included articles occurred utilising within NVivo 12 software.FindingsThe review found that there was a paucity of evidence related to the relationship between interprofessional practice models (IPM) and health service equity for ageing populations. There is a need to improve collaborative practices between social care, public health care and health service providers to more clearly define team member roles. Key aspirations included the need for future innovations in health service delivery to place health service equity as a goal for interprofessional practice. There is a need to find ways to measure and articulate the impact for vulnerable populations and communities.Research limitations/implicationsThe review offers insight into the need for health care delivery models to place health service equity at the centre of the model design. In practice settings, this includes setting interprofessional team goals around achieving equitable care outcomes for, and with, vulnerable populations. Implications for practice relate to improving how interprofessional teams work with communities to achieve health care equity.Originality/valueThere is a consensus across the literature that there continues to be health service inequity, yet IPE and interprofessional collaborative practice (IPC) have been growing in momentum for some time. Despite many statements that there is a link between interprofessional practice and improved health service equity and health outcomes, evidence for this is yet to be fully realised. This review highlights the urgent need to review the link between education and practice, and innovative health models of care that enable heath care professionals and social care providers to work together towards achieving health equity for ageing populations. It is clear that more evidence is required to establish evidence for best practice in interprofessional care that has the mitigation of health care inequity as a central objective.

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Delivering Equitable Care to Underserved Communities

Cited by 7 publications

References 6 publications

A survey of caregiver acculturation and acceptance of silver diamine fluoride treatment for childhood caries

A survey of caregiver acculturation and acceptance of silver diamine fluoride treatment for childhood caries

Disparities in Access to Oral Health Care

The impact of interprofessional practice models on health service inequity: an integrative systematic review

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