The relationship between diabetes and oral health status, and dental visits among American Indian, Alaska Native, and Native Hawaiian elders.

BACKGROUND: American Indian (AI), Alaska Native (AN), and Native Hawaiian (NH) populations report higher rates of diabetes, poorer oral health, and fewer dental visits than their peers. The authors aimed to identify relationships between oral health and dental visits and diabetes diagnosis among AI, AN, and NH elders. METHODS: Data were obtained from a national survey of AI, AN, and NH elders 55 years and older (April 2014-2017) and included 16,136 respondents. Frequencies and χ2 tests were used to assess the relationship between oral health and dental visits, and diabetes. RESULTS: Nearly one-half of the elders reported receiving a diagnosis of diabetes (49.2%). A significantly (P < .01) greater proportion of elders with diabetes reported a dental visit in the past year (57.8%) than those without. Differences (P < .01) were found between reported diabetes and need for extraction, denture work, and relief of dental pain. The authors found lower dental visit rates among elders with diabetes who were low income, older, unemployed, not enrolled in the tribe, lived on the reservation, and had only public insurance. CONCLUSIONS: There is a need to increase oral health literacy and dental visits among elders with diabetes and, more urgently, a need to focus on providing care for subpopulations reporting lower visit rates. PRACTICAL IMPLICATIONS: Dental providers must serve as a referral resource for at-risk elders and must work with and educate about the importance of oral health those who assist tribal elders with diabetes management, including primary care physicians, certified diabetes educators, nutritionists and dietitians, and public health care professionals.

Identifying Variability in Patient Characteristics and Prevalence of Emergency Department Utilization for Mental Health Diagnoses in Rural and Urban Communities.

PURPOSE: In order to redirect at-risk patients to more appropriate, cost-effective behavioral health care, research must identify the prevalence, and common characteristics, of patients presenting to the emergency department (ED) for mental disorders. QUESTION: Are large, small, and/or isolated rural patients presenting to the ED for mental disorders in greater proportion than urban ED patients? METHODS: Analyses included data from the Health Care Cost and Utilization Project State Emergency Department Databases (2013) provided by 7 states, covering all Census regions. Variables included patient demographics, ZIP code, and primary and secondary ED diagnoses. ZIP codes were linked to the Rural-Urban Commuting Areas, aggregating into 4 categories. Prevalence rates were compared within and between groups (P < .05). FINDINGS: Nearly 1 in 20 ED visits carried a primary/secondary diagnosis of mental disorder. Large, small, and isolated rural patients were not more likely than urban patients to present to the ED for mental disorders. Large, small, and isolated rural residents diagnosed with a primary/secondary mental disorder in the ED were more likely than urban to be female, 65 years of age or older, covered by Medicaid or Medicare, and dual eligible. The top 3 diagnoses for mental disorders in the ED were anxiety-state, unspecified; depressive disorder; and suicidal ideation. CONCLUSIONS: EDs treating large, small, or isolated rural patients with mental disorders are more likely to treat populations identified in the literature at greater risk of preventable visits, readmitting, and more costly care. Recommendations are made for policy, community interventions, workforce, and training.

Changing Population Health Policy: A Model for Identifying Health Needs and Recommendations to Improve Health Status.

In the spring of 2014, the North Dakota Center for Rural Health (CRH) was tasked with completing an objective assessment of the state oral health environment. This included an assessment of oral health status, review of workforce needs, evaluation of current oral health programs, and policy recommendations to ameliorate identified oral health needs. The report was prepared for the North Dakota Legislative Health Services Interim Committee. This article highlights a research method developed and employed to identify current population health status and policy recommendations through statewide collaboration, transparent process, and objective analyses, regardless of the health specialty of focus. Evidenced-based decision making in health policy requires more than presentation of data. It requires input from the population or community utilizing or struggling to gain access to the given health service. It is now understood that health services researchers must employ a variety of research methods, include end users in the research process, tailor presentation of the findings for the appropriate audience, and include the population of study in the research, allowing them to provide recommended solutions when possible. Although the effort to be described focused specifically on oral health in North Dakota, the methodologies used to answer the research questions could, and are encouraged to, be employed in other states with regard to other specialty health disciplines and population health studies. The study sought to answer 3 questions: (1) What is the population health need?; (2) What is already being done?; and (3) What are the recommendations to improve population health? (Population Health Management 2016;19:216-223).