Fluoride Varnish Use in Primary Care: What Do Providers Think?

Abstract

ABSTRACT. Objective. A number of state Medicaid programs, including Washington, reimburse pediatricians and other pediatric health care providers to apply fluoride varnish, a caries preventive agent, to eligible patients' teeth. Little is known about the factors that encourage or impede diffusion of fluoride varnish into primary care physicians' (PCPs') offices. The objective of this study was to perform an in-depth case study of fluoride varnish diffusion in 12 pediatric, family medicine, and nurse practitioner offices that underwent fluoride varnish training.Methods. We conducted focus groups with providers and staff in 12 community-based medical practices that had undergone fluoride varnish training within the previous 18 months. Topics of discussion included how the office staff learned about and sought fluoride varnish training, the perceived role of PCPs in oral health, oral health problems within the practice, specific details about the training, and organizational and logistic factors that promoted or impeded adoption. Focus groups were audiotaped and professionally transcribed; content analyses of the transcripts were conducted by the 3 authors.Results. Three major themes emerged about the fluoride varnish diffusion process; these were preexisting factors, communication, and logistics. Within preexisting factors, PCPs learned about fluoride varnish through their involvement in public health-related activities and were influenced to participate in the training by their concerns for their patients' oral health and difficulty gaining access to professional dental care. Among communication factors identified as important were qualities of the training session and the communication that occurred within the practice about fluoride varnish. When staff were included in the fluoride varnish decision-making and planning process, the practice was more likely to be successful in implementing fluoride varnish. Logistic factors included systems used to identify and capture eligible patients for fluoride varnish application. Other important logistic factors that were considered included division of labor and timing of the fluoride varnish application during the visit. Access to dental care was a persistent theme throughout the focus group discussions that had an impact on the other 3 major themes.Conclusions. Fluoride varnish can be adopted successfully into medical practice given PCP and staff commitment and openness, training that leaves participants motivated, appropriate systems, and resources for professional dental care referral. In addition, PCP involvement

Oral Health and Pediatricians: Results of a National Survey

“…11 Practicing pediatricians who responded to this survey seemed to face particular challenges when it came to adopting fluoride varnish. 16 There are numerous logistical steps that must take place within a pediatrician's office before fluoride varnish can be applied to a patient. However, pediatricians must first have opportunities to learn about (ie, observability) and practice (ie, trialability) fluoride varnish.…”

“…Pediatric offices must identify Medicaid-insured patients and flag them as candidates to receive fluoride varnish. 16 This has proven complicated for many offices and is also incompatible with the way that most pediatricians practice; ie, pediatricians often do not know the insurance status of individual patients. 16,17 In Washington State, pediatricians and other pediatric primary care providers have recently been allowed to bill Medicaid for additional oral health services for their patients under 6 years.…”

Prevention of Dental Caries in Children From Birth Through Age 5 Years: US Preventive Services Task Force Recommendation Statement

“…However, providers and other qualified staff may require some training before offering this procedure. 24,25 Dentists and physicians can apply varnish in all states. In some states, physician assistants, nurse practitioners, nurses, and medical assistants can do so also.…”

Fluoride Varnish for Caries Prevention: Efficacy and Implementation

“…Nevertheless, the sparse literature does identify some factors that may facilitate FV application by US medical care providers, should that be required by stakeholders: Medicaid eligibility, working relationships with dentists or community centers for referrals, and strong cooperation and communication between physicians and support staff. Barriers to address may be insufficient time to integrate oral health services into well-child visits, difficulty in applying FV (lack of skills/ training), resistance among colleagues and staff, difficulty referring children to a dentist and low volume of eligible patients [Lewis et al, 2005;Slade et al, 2007;O'Callaghan and Douglass, 2013].…”