Five-year follow-up of an interdisciplinary oral health education program: Clinical practice behaviors in working pediatric nurse practitioners

Abstract

Many interdisciplinary oral health education programs have been implemented for pediatric primary care providers (e.g., pediatric nurse practitioner [PNP]) to raise awareness and gain skills related to the prevention of early childhood caries (ECC). However, no studies have evaluated if these educational programs provided to PNPs during their training resulted in clinical practice behavior changes. A 33-item survey was designed on a web-based platform (Survey Monkey) and distributed to 71 PNP graduates. The survey included demographics, current clinical practice, clinical practice behaviors, and perceived barriers to practice. Descriptive statistics were used to assess the survey items and thematic analyses on the open-ended questions. The survey response rate was 70% (50/71 PNPs). Most practicing PNPs were in acute care or specialty clinics (n = 33; 66%) where oral health was not part of the focused visit. Majority used knowledge learned in assessment and anticipatory guidance skills. However, only 14% of primary care providers were applying fluoride varnish with 10% billing for this procedure. Barriers to application were time, available supplies, COVID protocols, lack of support staff, or not billing due to minimal reimbursement. Many primary care-trained PNPs were practicing in acute or subspecialty areas where prevention of ECC is not viewed as part of their focused visit. Pediatric nurse practitioners working in primary care demonstrated some clinical practice changes. However, areas for improvement are time to perform a risk assessment and application of fluoride varnish, access to these supplies, and standard billing and insurance reimbursement for these preventable services.

Mixed methods evaluation of an oral health education program for pediatric dental, medical and nursing providers

“…Conversely, among PNPs, there was a high mean score for performing an oral health risk assessment at both pre‐program and post‐program. This finding together with the PNPs high mean score of conducting anticipatory guidance during patient visits is very promising and supports prior research findings about PNPs applying what they learn in oral health education programs to their clinical practice 18,24–26,39 …”

“…This finding together with the PNPs high mean score of conducting anticipatory guidance during patient visits is very promising and supports prior research findings about PNPs applying what they learn in oral health education programs to their clinical practice. 18,[24][25][26]39 There was no change in mean score from pre-program to post-program for any of the three primary care provider cohorts in terms of applying fluoride varnish to a child's teeth. These findings indicate that while participants reported feeling more confident applying fluoride varnish, applying it has still not been incorporated into their professional practices even though national standards require it.…”