In-Office Management of Medicaid Patients: Diabetes and Smoking Cessation

Objectives: The opportunity exists for general practice dentists (GPDs) to improve the management of patients who present with diabetes and who smoke by reducing the impact of these risk factors on periodontal conditions. Given the link between both risk factors and lower socioeconomic status, GPDs who treat higher proportions of Medicaid patients may treat more patients who have diabetes and who smoke. Our research aims to investigate whether the proportion of patients paying for dental treatment through Medicaid influences the extent to which GPDs are involved in diabetic patient management and delivery of smoking cessation services. Methods: Data were obtained from a mail survey of a representative random sample of active GPDs in the northeastern United States [n=105, response rate 80%]. The study's two dependent variables were the mean values of items measuring level of active diabetic patient management and level of smoking cessation activity. Setwise hierarchical regression was used to assess the predictive power of two sets of variables for each dependent variable: set 1) knowledge, self-assessed competence, positive/negative attitudes toward performing the respective practice activities, and perceived support from patients/colleagues; set 2) percentage of patients paying for dental treatment through Medicaid. Results: When regressing active diabetic patient management on the predictor variables, set 1 r² is 0.28, set 2 r² is 0.38. The most influential predictors are percentage Medicaid patients and knowledge level. When regressing smoking cessation activity on the predictor variables, set 1 r² is 0.44, set 2 r² is 0.44. The most influential predictors are knowledge level and perceived support from patients/colleagues. Conclusions: Study results indicate differences in the two predictive models: percentage of Medicaid patients plays an important role in influencing level of active diabetes patient management but not in influencing level of smoking cessation activity, where knowledge level and perceived support are most important. Supported by NIDCR DE014898.