Removing Barriers to Fluoride Varnish Application in Primary Care Settings (Supplement) Project Summary/Abstract: Dental decay is an important, ongoing public health concern that impacts children from low-income households and from racial and ethnic minorities at higher rates than the general population. Because young children are much more likely to visit a primary care provider (PCP) than a dentist, including appropriate and effective preventive oral health services (POHS) at pediatric well-child visits has the potential to dramatically improve children’s oral health. Fluoride varnish (FV) application is one such POHS that is reimbursed by insurance programs in the primary care setting for younger children, yet only a small proportion of physicians apply FV. Federally Qualified Health Centers (FQHCs) play a vital role in reaching populations that experience health disparities. In this supplement, we propose to expand the scope of our original R15 AREA grant ‘Removing Barriers to Fluoride Varnish (FV) Application in Primary Care Settings’ by studying FQHCs in greater depth. The Specific Aims for this administrative supplement to address preventive interventions with populations that experience health disparities include: Aim 1: Understand the program level challenges and status of FV integration during well visits in FQHC clinics. Surveys of PCPs at FQHC clinics across Georgia will yield quantitative data that will elucidate the status of FV delivery at the individual FQHCs and provide insights on program level challenges to FV implementation. Aim 2: Assess barriers and facilitators to FQHC FV integration and implementation at the organizational level. Guided by the Consolidated Framework for Implementation Research (CFIR), FQHC directors will be interviewed to understand their perceptions of the factors that either impede or facilitate the integration of FV application in the FQHC setting. Aim 3: Complete workflow modeling and analysis for FQHCs. Workflow maps that can be the starting point for FQHCs to understand how FV application can fit into the well- visit, will be built and assessed. These will enhance the R15 Aim 3 simulation model. The objective of this study is to assess and reduce barriers currently dissuading FQHC PCPs from providing FV during well-child visits. The overall research contribution will be specific workflow suggestions and resulting resource and cost data, as well as a better understanding of barriers and facilitators to implementation, that will allow physicians’ offices to make decisions on how to integrate FV in their pediatric well-child visits based on their own unique practice characteristics. These improved frameworks, widely disseminated, will facilitate more widespread delivery of POHS and reduce health disparities in preventive care.

Project Narrative: Despite demonstrated effectiveness of fluoride varnish (FV) application in reducing dental decay, and insurance reimbursements available for primary care providers (PCPs) in all states, few PCPs currently offer FV to their eligible patients. The proposed research is highly relevant to public health because the study findings will help interested PCPs, including those from Federally Qualified Health Centers specifically, to integrate FV into their well-child visit workflow efficiently, effectively increasing the number of young children who receive preventive oral health services and reducing health disparities in preventive care receipt.