Oral Health Care Strategies in Rural Communities: A Case Study.

ABSTRACT: Dental caries affect 97% of the world's population during their lifetime. Early childhood caries are the number one chronic disease affecting young children, and it disproportionately affects children of low-income families. American Academy of Pediatrics recommends fluoridated toothpaste to all children starting at tooth eruption, regardless of caries risk. In addition, fluoride varnish is recommended in all children every 3 to 6 months from tooth emergence until they have an established dental home. The health disparities that are most apparent in the rural communities are inadequate prenatal care, low birth weight, cancer, chronic respiratory disease, heart disease, unintentional injury, and stroke. When it comes to oral health, water fluoridation is one of the most cost-effective strategies in preventing dental caries. The need for oral health education in physician assistant/associate (PA) programs is well documented. Implementation has largely been performed using interprofessional education. This article describes an interprofessional education program that teaches PA students to apply fluoride varnish so that they are practice-ready when they graduate and practice medicine.

Longitudinal survey of clinician behavior change in CKD management.

OBJECTIVE: To assess longitudinal improvement for a simple intervention to teach physician assistants (PAs) and NPs management of patients with diabetes and chronic kidney disease (CKD). METHODS: The original cohort from the Kidneys in a Box quality improvement project was revisited at the 3-year mark and asked about patient statin use, A1C measurement, urine albumin-creatinine ratio (UACR), CKD staging, distribution of over-the-counter (OTC) medication caution lists, and documentation of smoking history. RESULTS: A statistically significant increase in quality metrics was seen at 3 months postintervention for the original cohort. At the 3-year mark, these improvements were sustained. For UACR and smoking quality metrics, performance increased beyond the gains initially seen at 3 months. CONCLUSIONS: This study demonstrates that a single-intervention quality improvement program can affect sustained improvements in clinical care of patients with diabetes and CKD. The results provide evidence that one-time quality improvement interventions have the power to promote longitudinal practice changes associated with reduced rates of CKD progression and potentially reduced healthcare costs.