Tuesday, November 14, 2017

Transitioning from Pediatric to Adult Dental Care for Adolescents with Special Health Care Needs: Adolescent and Parent Perspectives - Part One



Resident: Suhyun Rue, DMD                                                                            Date: 11/15/2017
Article Title: Transitioning from Pediatric to Adult Dental Care for Adolescents with Special Health Care Needs: Adolescent and Parent Perspectives—Part One
Author(s): Stephanie Cruz, BA; John Neff, MD; Donald L. Chi, DDS, PhD
Journal: Pediatric Dentistry
Date: September/October 2015
Major Topic: Dental Care Transitions
Type of Article: Cross-Sectional Study
Main Purpose: To better understand dental care transitions from pediatric dental care to adult dental care for adolescents with special health care needs (ASHCNs) from parental and adolescent perspectives
METHODS
·  Interviews were conducted with 59 (of 462) parents and 13 (of 59) adolescent-parent dyads
·  Initial goal was to conduct focus groups with the 59 parents  --> After conducting seven focus groups with 21 parents, it became difficult to recruit for focus groups--> Therefore,  the study design was modified and one-on-one parent interviews were conducted with the remaining 38 parents
·  The one-hour parent focus groups or interviews were digitally recorded
·  The focus of the adolescent-parent dyad interviews was the adolescent
·  Parents were present to provide support and prompts when necessary
·  Each of the 13 adolescent-parent dyad interviews lasted approximately one hour and was digitally recorded
·  7 theoretical constructs were examined
    o Susceptibility (level of risk for cavities)
    o Severity (how bad it would be if no transition took place)
    o Self-efficacy (extent of empowerment to transition)
    o Benefits and drawbacks (outcomes associated with transitions)
    o Saliency (importance of transitions)
    o Barriers (factors that make transitions difficult)
    o Cues to action (transition catalysts)
RESULTS
· Most ASHCNs were not concerned about tooth decay, but parents believed their ASHCNs were at  increased risk for  dental caries
· Parents of adolescents with complex SHCN believed it would be acceptable to continue seeing a pediatric dentist
· Parents of Medicaid-enrolled ASHCNs reported lower self-efficacy in their ability to transition their adolescent.
· ASHCNs desired personalized, adolescent-centered dental care
· ASHCNs were motivated to transition when they felt out of place at the pediatric dentist office
· Parents believed pediatric dentists play an important role in initiating and facilitating transitions
DISCUSSION
· Pediatric dentists are well positioned to implement family and adolescent-centered policies to ensure dental transitions for adolescents with special health care needs and their families
· To improve transitions, pediatric dentists could collaborate with medical providers to ensure that dental transition planning is part of broader health care transitions for ASHCNs
· General dentists need to be prepared to care for ASHCNs, which points to the importance of meaningful clinical experiences during dental school.
Assessment of Article
·   Level of Evidence/Comments: Cross-sectional study III


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