Adoption and implementation of policies to support preventive dentistry initiatives for physicians: a national survey of Medicaid programs

Abstract

Objectives: We determined the number of state Medicaid programs adopting initiatives to support preventive dental services provision by nondental health care professionals, their perceived attributes, and implementation barriers.

Methods: We used Qualtrics to conduct a cross-sectional survey in 2008 of Medicaid dental program managers to determine organizational stage of adoption classified according to the Transtheoretical Model of Behavior Change with 3-year follow-up. We assessed perceptions of the influence of 18 initiative attributes on the decision to adopt, drawn from Roger's diffusion of innovations theory. Stage and date of adoption are presented descriptively. Attributes and barriers were analyzed by stage of adoption by using analyses of variance or χ(2) statistics.

Results: By 2011, 42 states had adopted a policy. Only 9 states included a comprehensive set of preventive services, the most common being fluoride varnish. Adoption was affected by perceived initiative simplicity and its compatibility with other Medicaid programs. Administrative barriers were the most common among the 15 studied.

Conclusions: State Medicaid policies to reimburse nondental providers for preventive dental services are becoming widespread. Interventions are needed to ensure oral health services delivery at the practice level.

FIGURE 1—

Cumulative percentage adoption curve for fluoride varnish: state Medicaid programs, United States, 1998–2011. Note. Nonadopting states were AZ, AR, DC, DE, HI, IN, NH, NJ, and WV.