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RIMA DESAI_MS Dental Public Health_Thesis2.36 MB
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Thesis
Dentists’ treatment of underserved populations: accuracy of students’ predictions and variables associated with current treatment
University of Iowa
Master of Science (MS), University of Iowa
Summer 2024
DOI: 10.25820/etd.007630
Abstract
Oral health disparities exist in the United States. Certain underserved populations, such as those who have Medicaid or special health care needs, face barriers accessing dental care. Relatively few studies have evaluated which characteristics of dental students and dentists are associated with their likelihood of treating underserved populations post-graduation. Most importantly, longitudinal studies have not been conducted to determine whether students who anticipate treating underserved patients treat the same populations post-graduation.
The primary aim of this study was to investigate the concordance between dental students’ anticipated willingness to treat underserved populations five or more years post-graduation and the populations they actually treat as dentists. The secondary aim was to investigate which variables are associated with dentists’ treatment of underserved populations, specifically examining patients: 1) with Medicaid, and 2) who are mentally compromised.
A survey was developed and mailed to 741 alumni of the University of Iowa College of Dentistry who graduated between 2009 and 2018. The “alumni” survey inquired whether they provide care to 13 different underserved populations. It also collected information about the respondents pertaining to: demographics, indebtedness, post-doctoral dental training, their comfort level in treating underserved populations, and their dental practice environment. Alumni responses were linked to surveys that the respondents completed as D1 and D4 students, which assessed their anticipated willingness to treat these same 13 populations 5 years post-graduation.
Descriptive statistics were calculated to depict the characteristics of the survey respondents. Cohen’s Kappa Coefficient was calculated to evaluate the degree of agreement between the respondents’ anticipated willingness to treat each of the underserved populations as students and their current treatment of the same populations. McNemar’s test was conducted to determine whether there was a significant difference between students’ and alumni’s treatment responses. Further analyses (i.e. bivariate and multivariable logistic regression) were conducted to determine which variables were associated with treating two populations: Medicaid and mentally compromised patients.
In total, 227 alumni surveys were received, giving an overall response rate of 30.6%.There were 135 D1 surveys and 155 D4 surveys that could be matched with their alumni surveys.Among the alumni respondents, 107 had completed both a D1 and D4 survey. In general, the majority of dental students predicted which populations they would treat (i.e. other ethnic groups, Limited English proficiency, medically complex, HIV+/known AIDS, mentally compromised, frail elderly, children under age 3) and not treat (i.e. homebound/nursing home, Medicaid, and incarcerated patients). However, McNemar’s tests and the Kappa Coefficients suggest that discrepancies exist. Specifically, many of the respondents reported treating more populations as alumni than they anticipated treating as dental students.
With respect to the secondary aim of the study, there were few significant associations with treating Medicaid and mentally compromised patients. Respondents who indicated as D4 students that they would be willing to treat Medicaid patients were more likely to treat Medicaid patients as alumni than respondents who did not anticipate treating the population as D4 students (OR 4.10; 95% CI 1.44 - 11.65; p=0.008). Respondents who currently feel comfortable treating mentally compromised patients were more likely to treat the population compared to respondents who do not currently feel comfortable treating mentally compromised patients (OR 10.40; 95% CI 4.25- 25.47; p<0.001). The findings from the study suggest that it is not easy to predict who will treat underserved populations. However, the results suggest that strategies to increase students’ anticipated willingness to treat underserved populations, as well as enhancing dentists’ comfort in treating the patients, may be beneficial in increasing dentists’ likelihood of treating underserved populations.
Details
- Title: Subtitle
- Dentists’ treatment of underserved populations: accuracy of students’ predictions and variables associated with current treatment
- Creators
- Rima Desai
- Contributors
- Michelle McQuistan (Advisor)Fang Qian (Committee Member)Mark Moss (Committee Member)Daniel Caplan (Committee Member)
- Resource Type
- Thesis
- Degree Awarded
- Master of Science (MS), University of Iowa
- Degree in
- Dental Public Health
- Date degree season
- Summer 2024
- Publisher
- University of Iowa
- DOI
- 10.25820/etd.007630
- Number of pages
- xvii, 174 pages
- Copyright
- Copyright 2024 Rima Desai
- Grant note
- An application for grant funding (Graduate Thesis Award) was made in July 2023 to the Delta Dental of Iowa Foundation. The Foundation provided funding to cover the costs of printing and mailing the alumni surveys, the financial incentives for participation (a $2 bill was included with each distributed survey), and the cost of hiring a student to carry out data entry. (59)
- Language
- English
- Date submitted
- 07/02/2024
- Description illustrations
- illustrations, tables
- Description bibliographic
- Includes bibliographical references (pages 140-150).
- Public Abstract (ETD)
- Underserved populations face difficulties accessing dental care and experience poor oral health. It is important that dentists are willing to treat underserved patients to reduce oral health disparities. The main aim of this study was to investigate whether there is agreement between dental students’ anticipated willingness to treat 13 underserved populations 5 years post - graduation and their treatment of these populations as dentists. The secondary aim was to determine which variables are associated with d entists’ likelihood of treating patients: 1) with Medicaid, and 2) who are mentally compromised. A survey was developed and mailed to 741 alumni who graduated from the University of Iowa College of Dentistry between 2009 - 2018. The survey asked participants which populations they treat and collected information about the participants. Alumni responses were linked to surveys that the respondents completed as dental students. Statistical analyses were conducted. There were 227 alumni who completed the survey (Matched surveys: D1=135; D4=155). In general, dental students did not accurately predict the patients they would treat post -graduation because they underestimated treating several populations. Anticipated willingness to treat Medicaid patients 5 years post-graduation when in the D4 year was associated with treating the population as alumni (OR 4.10; 95% CI 1.44-11.65; p=0.008). Currently feeling comfortable treating mentally compromised patients was associated with treating the population as alumni (OR 10.40; 95% CI 4.25-25.47; p<0.001). Strategies focused on increasing students’ anticipated willingness to treat underserved populations and strengthening dentists’ comfort in treating the patients could increase dentists’ likelihood of treating underserved populations.
- Academic Unit
- Preventive and Community Dentistry
- Record Identifier
- 9984698054102771
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