Dental safety net capacity: An innovative use of existing data to measure dentists' clinical engagement in state Medicaid programs.

BACKGROUND: The demand for dentists available for state Medicaid populations has long outpaced the supply of such providers. To help understand the workforce dynamics, this study sought to develop a novel approach to measuring dentists' relative contribution to the dental safety net and, using this new measurement, identify demographic and practice characteristics predictive of dentists' willingness to participate in Indiana's Medicaid program. METHODS: We examined Medicaid claims data for 1,023 Indiana dentists. We fit generalized ordered logistic regression models to measure dentists' level of clinical engagement with Medicaid. Using a partial proportional odds specification model, we estimated proportional adjusted odds ratios for covariates and separate estimates for each contrast of nonproportional covariates. RESULTS: Though 75% of Medicaid-enrolled dentists were active providers, only 27% of them had 800 or more claims during fiscal year 2015. As has been shown in previous studies, our findings from the proportional odds model reinforced certain demographic and practice characteristics to be predictive of dentists' participation in state Medicaid programs. CONCLUSIONS: In addition to confirming predictive factors for Medicaid enrollment, this study validated the clinical engagement measure as a reliable method to assess the level of Medicaid participation. Prior studies have been limited by self-reported data and variations in Medicaid claims reporting. PRACTICAL IMPLICATIONS: Our findings have implications for state Medicaid policymakers by enabling access to data regarding dental providers' level of participation in Medicaid in addition to identifying factors predictive of such participation. This information will inform Medicaid program plans and provider recruitment efforts.

Impact of State Workforce Policies on Underserved Patients' Access to Dental Care: A longitudinal study.

Purpose: Dental diseases are almost entirely preventable, but discrepancies in access to oral healthcare limit the effectiveness of preventive interventions. Dental hygienists are strategically positioned to improve access to preventive dental procedures; however, state workforce policies determine their permitted clinical tasks.Methods: This study cross-referenced oral healthcare service use at Federally Qualified Health Centers (FQHCs) between 2004 and 2012 with the Dental Hygiene Professional Practice Index (DHPPI), which quantifies the various aspects of state policy environments for the dental hygiene workforce. More specifically, the study used generalized linear mixed-effects models to examine the influence of state policy environment on access to dental care at 958 FQHC grantees.Results: States with "favorable" policy environments consistently reported the highest proportion of FQHC patients accessing dental care services (18%), whereas states with "restrictive" environments reported the lowest proportion (12%).Conclusion: A smaller proportion of FQHC patients' receive dental examinations in states with restrictive state workforce policies; state lawmakers should frame workforce policies to protect public safety without limiting the oral health workforce's ability to provide important oral health services to underserved people.

Primary Care Physician Roles in Health Centers with Oral Health Care Units.

INTRODUCTION: Integrating oral health care and primary care is a priority for improving population health. Primary care physicians (PCP) are filling expanded roles within oral health care to secure strong overall health for their patients. METHODS: This comparative case study examines the roles of PCPs at 5 federally qualified health centers that have integrated oral health care and primary care. Administrative data were obtained directly from the Health Resources and Services Administration. Key informant interviews were performed with administrators and clinical care team members at each of the health centers. Data were reviewed by 2 experts in oral health to identify emerging roles for physicians. RESULTS: PPCPs' roles in health centers' integration models vary, but 3 distinct roles emerged: (1) the physician as a champion, (2) the physician as a collaborator, and (3) the physician as a member of an interprofessional team. In addition, providing physicians with the necessary training to identify oral health issues was critical to preparing physicians to take on expanded roles in integrated health care delivery models. CONCLUSIONS: Regardless of the roles that they play, family physicians can contribute a great deal to the success of integration models.

A qualitative analysis of prescribers' and dispensers' views on improving prescription drug monitoring programs.

BACKGROUND: Prescription drug abuse is epidemic in the United States (US). To help address the problem, most states operate prescription drug monitoring programs (PDMPs). PDMPs are designed to monitor and help control the distribution of controlled therapeutic medications and to assist prescribers and dispensers in making informed clinical decisions. To this end, PDMPs rely on timely and accurate data submission, as well as review of the data. Consequently, provider acceptance of these systems is essential to maximize their effectiveness. OBJECTIVES: This article explores licensed prescribers' and dispensers' opinions regarding prescription drug monitoring. METHODS: The study surveyed licensed prescribers and dispensers about their experiences and views on drug monitoring, prescribing and dispensing practices, and on prescription drug abuse in general. Two open-ended questions were posed as part of a larger, end-user survey. The analysis culled thematically-coded excerpts to these two questions. RESULTS: Respondents offered a range of comments that unearthed important disagreements among prescribers and dispensers over the administration and ethics pertaining to PDMPs. At the same time, some respondents suggested means to enhance PDMPs functionality. CONCLUSION: Attending to and rectifying providers' views, while considering their improvement suggestions may boost PDMPs effectiveness by maximizing buy-in and utilization. The potential speaks to advancing a tool that intends to help address alarming rates of prescription drug abuse.

Administrative Challenges to the Integration of Oral Health With Primary Care: A SWOT Analysis of Health Care Executives at Federally Qualified Health Centers.

Inadequate access to preventive oral health services contributes to oral health disparities and is a major public health concern in the United States. Federally Qualified Health Centers play a critical role in improving access to care for populations affected by oral health disparities but face a number of administrative challenges associated with implementation of oral health integration models. We conducted a SWOT (strengths, weaknesses, opportunities, and threats) analysis with health care executives to identify strengths, weaknesses, opportunities, and threats of successful oral health integration in Federally Qualified Health Centers. Four themes were identified: (1) culture of health care organizations; (2) operations and administration; (3) finance; and (4) workforce.

State policy environment and the dental safety net: a case study of professional practice environments' effect on dental service availability in Federally Qualified Health Centers.

OBJECTIVES: To determine whether and to what extent the state policy environment for the dental hygiene workforce affects the availability of dental services at Federally Qualified Health Centers (FQHCs). METHODS: We examined data drawn from the Uniform Data System on 1,135 unique FQHC grantees receiving community health center funding from the U.S. Health Center program between 2004 and 2012. The Dental Hygiene Professional Practice Index was used to quantify variations in state policy environment. We then examined the influence of state policy environment on the availability of dental care through generalized linear mixed-effects models. RESULTS: Approximately 80% of FQHCs reported delivering dental services. We consistently observed that FQHCs with favorable levels of state support had the highest proportion of FQHCs that delivered dental services, even more so than FQHCs with extremely high support. FQHCs located in the most restrictive states had 0.28 the odds of delivering dental services as did those located in the most supportive states. CONCLUSIONS: The state policy environment for the dental hygiene workforce is likely associated with the availability of dental services at FQHCs. The greatest proportion of FQHCs delivering dental services was found in states with policy provisions supporting professional independence in public health settings. Nevertheless, additional research is needed to understand the specific mechanism by which these policies affect FQHCs.

Promoting consistent use of prescription drug monitoring programs (PDMP) in outpatient pharmacies: Removing administrative barriers and increasing awareness of Rx drug abuse.

BACKGROUND: Prescription drug monitoring programs (PDMPs) are proving to be valuable resources in fighting the prescription drug abuse epidemic through improved access to patient drug histories. Ninety-four percent of Indiana pharmacists have heard of Indiana's PDMP (INSPECT), only 71% of them reported using the program in 2012. OBJECTIVE: To identify barriers to PDMP use in outpatient pharmacies and determine the impact these barriers have on utilization. METHODS: A cross-sectional study examined pharmacists' knowledge and use of INSPECT. Bivariate analyses on utilization and perceived barriers were conducted using cross-tabulations and chi-squared tests. Multiple logistic regression examined the relationship between pharmacists' level of concern with prescription drug abuse and reported utilization. RESULTS: Pharmacists were significantly less likely to use INSPECT if they reported at least one barrier and 3 times more likely to use INSPECT if they reported no barrier. Pharmacists were 10 times more likely to use INSPECT and 18 times more likely to use it more consistently if they were extremely concerned about prescription drug abuse in their community as compared to those not at all concerned. CONCLUSION: Strategies to improve utilization of PDMPs should look for innovative ways to limit barriers and build outpatient pharmacists' awareness of prescription drug abuse and misuse within their community.

Integration of prescription drug monitoring programs (PDMP) in pharmacy practice: Improving clinical decision-making and supporting a pharmacist's professional judgment.

BACKGROUND: Pharmacists have shared responsibility to investigate the validity of controlled substance prescriptions (CSPs) that raise concerns, or red flags, and subsequently exercise their right to refuse to dispense a CSP if its validity cannot be verified. Improving access to clinical practice tools, such as prescription drug monitoring programs (PDMPs), may increase availability of a patient's drug history, which is critical to making informed clinical decisions about dispensing CSPs. OBJECTIVES: The purpose of this study was to examine how integration and consistent use of a PDMP in pharmacy practice impacts pharmacists' dispensing practices related to CSPs. METHODS: A cross-sectional study examined pharmacists' knowledge and use of Indiana's (US State) PDMP (INSPECT) and dispensing practices of CSPs. Three outcome measures were analyzed using multiple logistic regression so as to examine the relationship between PDMP use and pharmacists' controlled substance dispensing behaviors. RESULTS: Pharmacists were 6.4 times more likely to change their dispensing practice to dispense fewer CSPs if they reported that INSPECT provides increased access to patient information. Pharmacists who always use INSPECT refused an average of 25 CSPs annually compared to an average of 7 refusals for pharmacists not using INSPECT. Pharmacists using INSEPCT consistently (at every visit) were 3.3 times more likely to refuse to dispense more CSPs than pharmacists who report never using INSPECT. CONCLUSIONS: Integration of PDMPs in pharmacy practice may improve a pharmacist's ability to make informed clinical decisions and exercise sound professional judgment. Providing clinical practice tools to both prescribers and pharmacists is important to preventing drug diversion and prescription drug abuse. Future research should focus on understanding the barriers and challenges to successful integration of PDMPs in pharmacy practice.

Fighting Prescription Drug Abuse Through State Policy: The Role of Nursing in Successful Implementation.

Prescription drug abuse has become a top public health concern in the United States in recent years. Changes in prescribing practices and the way in which health providers manage pain resulted from national quality improvement efforts in the 1990s. Most efforts to reduce morbidity and mortality associated with the prescription drug abuse epidemic occur through policy initiatives at the state level. In 2011, Indiana ranked 17th in the United States and had only implemented a few intervention and prevention strategies. However, through a coordinated effort within the state, Indiana has expanded Good Samaritan laws and adopted rescue drug policies. Furthermore, the nursing workforce in Indiana has played a critical role in the successful implementation of these new policies. Nurses across the state have provided education and training to first responders and lay persons. They have also consulted with law enforcement agencies and other organizations looking to fully leverage the potential of these new state policies. Because of their versatility and clinical expertise, the nursing workforce has and will continue to play a critical role in the successful implementation of state policy initiatives aimed at fighting the prescription drug abuse epidemic.