The Effect of a Rural Workforce Intervention to Improve Oral Health of Children: Evidence From an Interrupted Time Series Study of Southeast Alaska

Abstract

Objectives: Geographic isolation, limited resources, and inadequate access to dental care have led to poor oral health for Alaska Native children. In the early 2000s, the Alaska Native Tribal Health Consortium (ANTHC) began training alternative oral health practitioners including primary dental health aides (PDHAs) who provide dental education and preventive procedures and dental health aid therapists (DHATs) who provide additional specific treatments. Most members employ DHATs but only the Southeast Alaska Regional Health Consortium (SEARHC) systematically employed PDHAs starting in 2008. We evaluated whether the employment of PDHAs by SEARHC was associated with changes in the delivery of oral preventive and treatment procedures at the beginning of the program. Methods: We analyzed Alaska Medicaid claims data for children ages 0–18 from 2003 to 2004 and 2008 to 2012. We compared procedure use of enrollees treated by SEARHC with remaining ANTHC members and other Medicaid dental providers. We used regression models to compare changes in the predicted rate of fluoride varnish (FV) and treatment procedures for each group before and after the employment of PDHAs at SEARHC. Results: Significantly higher predicted rate of FVs (1.74 vs. 1.05 and 1.14) and lower rate of restorative treatment procedures (1.62 vs. 2.21 and 2.87) among SEARHC patients compared to other ANTHC patients or patients of other Medicaid providers in 2012. Conclusions: Findings highlighted likely benefits of employing PDHAs in the delivery of needed preventive procedures in remote areas like Alaska. Implementation of the SEARHC model requires multiple legislative and regulatory steps to establish the scope of practice, Medicaid reimbursement, and infrastructure to recruit, train, and place practitioners.