Delivery of Preventive Oral Health Services by Rurality: A Cross‐Sectional Analysis

Abstract

Purpose: Integrating oral health care into primary care has been promoted as a strategy to increase delivery of preventive oral health services (POHS) to young children, particularly in rural areas where few dentists practice. Using a multistate sample of Medicaid claims, we examined a child’s odds of receiving POHS in a medical office by county rurality. Methods: We used 2012–2014 Medicaid Analytic eXtract claims data for 6,275,456 children younger than 6 years in 39 states that allowed Medicaid payment for POHS in medical offices. We used county-level characteristics from the Area Health Resources File, including a 3-level measure of county rurality. We used logistic regression to estimate a child’s odds of receiving POHS in a medical office by county rurality, while controlling for other patient and county characteristics. Findings: POHS in medical offices were received by 7.8% of children. Rates of POHS in medical offices were higher in metropolitan (metro) counties (8.4%) than non-metro adjacent to metro (5.8%) and non-metro not adjacent to metro (4.3%). In adjusted analysis, children living in non-metro not adjacent to metro (OR=0.79, 95% CI: 0.64–0.99) and adjacent to metro counties (OR=0.70, 95% C: 0.59–0.82) were significantly less likely to receive POHS in medical offices than children living in metro counties. Conclusions: In this study of POHS in medical offices among young Medicaid-enrolled children, we found POHS rates were lowest in non-metro counties. Given barriers to dental care in rural areas, states should take additional steps beyond allowing Medicaid reimbursement to increase delivery of POHS in medical offices.

Dental care utilization: examining the associations between health services deficits and not having a dental visit in past 12 months

“…Addressing rural needs is especially important since rural adults are more likely to have untreated dental disease and poorer oral health. In rural American there are more physicians per capita then dentists [68] and Khan, et al [69] recommended enhancing the integration of rural oral healthcare into primary care as a strategy to mitigate the challenges of providing dental care in rural settings.…”

Variation in dental services by rurality among privately insured adults in the United States

“…Notably, while reimbursement for primary care-based preventive oral health services (POHS) is standard for both publicly and privately insured children, it is only rarely reimbursed for adult patients, even those at high risk of dental disease, and rates of POHS delivery are lower in rural areas. 7 Policy mechanisms to facilitate primary care-based preventive services for rural adults, especially older rural adults, could be considered to improve oral health equity in rural areas. 34 In our results, although rural residents were twice as likely to have a procedure code related to a removable prosthesis, after correcting for patient age and gender and ZIP code income and number of dentists, rurality was associated with lower rates of denture visits.…”

“…Early detection of untreated disease and subsequent referral to a dental provider may reduce the need for procedures such as tooth extraction. Notably, while reimbursement for primary care‐based preventive oral health services (POHS) is standard for both publicly and privately insured children, it is only rarely reimbursed for adult patients, even those at high risk of dental disease, and rates of POHS delivery are lower in rural areas 7 . Policy mechanisms to facilitate primary care‐based preventive services for rural adults, especially older rural adults, could be considered to improve oral health equity in rural areas 34 …”

“…Member age and gender were included as individual‐level covariates, with median household income, number of dentists, and rurality as ZIP code‐level covariates. Covariates were selected à priori on the basis of previous studies on rural access 7,8,22 …”

“…These challenges have led to findings of worse oral health outcomes and lower rates of dental utilization among rural Americans. 1,6 While these disparities have been especially well-studied in children, [7][8][9][10] they persist for rural adults as well. Rural adults report worse oral healthrelated quality of life.…”