摘要：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 χ2 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. Dental caries among preschool-aged children has emerged as a major public health issue, 1–3 with numerous strategies created by state Medicaid programs to alleviate the oral health needs of low-income populations. 4–6 One innovative approach has been to expand the role of primary health care providers in the delivery of preventive dental services, particularly screening for pediatric dental disease, providing fluoride therapy, and counseling parents. 7–9 These programs were developed to increase access to preventive care, reduce the burden of dental disease in very young children, and improve dental referrals based on detection of risk factors or disease. The American Academy of Pediatrics (AAP) reports implementation of Medicaid preventive oral health programs in medical settings in a number of states. 10 They have intuitive appeal, because most children receive primary medical care very early in life but not dental care. 11 Although these programs are based on a strong rationale, little is known about them beyond some limited information regarding the benefits included in insurance coverage. The purpose of this study was to determine (1) the number of state Medicaid programs with policies supporting the delivery of preventive dental services by nondental primary health care providers, their stage of adoption at the time of a baseline assessment, and subsequent adoption in a 3-year follow-up period; (2) the characteristics and perceived attributes of these initiatives and their relationship to baseline stage of adoption; and (3) the barriers Medicaid programs have experienced in developing and implementing these initiatives. Information on perceptions of initiative attributes held by program managers and barriers to implementation will benefit our understanding about the diffusion of these programs in the United States and ways to improve them.
