Experiences of the Kansas Extended Care Permit Providers: A descriptive study

Purpose: A total of 40 states to date have expanded the role of dental hygienists with the goal of improving access to basic oral health services for underserved populations. In Kansas, legislative changes have resulted in the Extended Care Permit (ECP) designation. The purpose of this study is to describe the experiences of registered dental hygienists in Kansas holding ECP certificates (ECP RDH) as of July of 2014.Methods: Secondary data analysis was performed utilizing data collected from a survey conducted in 2014 by Oral Health Kansas. All registered ECP RDH's were sent the 32-item survey via Survey Monkey®. Descriptive statistical analyses consisted of frequency distributions, and measures of central tendency. Inferential analyses using t-tests and ANOVA were conducted to compare groups.Results: A total of 73 responses were received from the (n= 176) surveys that were e-mailed for a 41% response rate. Of the clinicians who responded, 80%, worked at least part-time and in school settings. The most consistent barriers to providing care were the inability to directly bill insurance (52%), financial sustainability (42%) and physical requirements (42%). Follow-up tests found significant differencs between clinician groups when examining barriers.Conclusion: Although the ECP legislation appears to be expanding access to care for citizens in Kansas, significant barriers still exist in making this a viable model for oral healthcare delivery.

Using Registered Dental Hygienists to Promote a School-Based Approach to Dental Public Health

We examine a strategy for improving oral health in the United States by focusing on low-income children in school-based settings. Vulnerable children often experience cultural, social, economic, structural, and geographic barriers when trying to access dental services in traditional dental office settings. These disparities have been discussed for more than a decade in multiple US Department of Health and Human Services publications. One solution is to revise dental practice acts to allow registered dental hygienists increased scope of services, expanded public health delivery opportunities, and decreased dentist supervision. We provide examples of how federally qualified health centers have implemented successful school-based dental models within the parameters of two state policies that allow registered dental hygienists varying levels of dentist supervision. Changes to dental practice acts at the state level allowing registered dental hygienists to practice with limited supervision in community settings, such as schools, may provide vulnerable populations greater access to screening and preventive services. We derive our recommendations from expert opinion.

Analysis of Nigerian dentists' opinion and consequences on expanded function dental auxiliaries

OBJECTIVE

To examine Nigerian dentists' opinion on expanded function dental auxiliaries.

METHODS

This cross-sectional study of Nigerian dentists attending a dental conference was conducting in 2012 using self-administered questionnaire. The data were analyzed using Statistical Package for the Social Sciences version 16.0. P < 0.05 was considered statistically significant.

RESULTS

The majority of the 82 dentists that participated in this study were male, aged 31-40 years, either specialist or specializing (residents), practiced for < 10 years, teaching hospital and urban practitioners. Of the participants, 22 (26.8%) reported favorable opinion towards expanded duty dental auxiliaries. The mean scores on consequences, of expanded function dental auxiliaries ranked redundancy of dentist as highest. Males and non-specialist significantly reported expanded function dental auxiliaries would lead to redundancy of dentists. Practitioners working in other hospitals other than teaching hospital significantly reported that appropriate legislation are necessary before expansion of duties of the dental auxiliaries can be done. The dentists with favorable opinion significantly reported that expanded duty dental auxiliaries would not cause redundancy of dentist and the task are not too difficult for dental auxiliaries with necessary training but will increase service delivery and efficiency, increase job satisfaction, lead to dental auxiliary specialization with legislation.

CONCLUSION

Data from this study revealed overall unfavorable opinion of Nigerian dentists on the expanded duty dental auxiliaries. However, those with favorable opinion were significantly supportive of expanded function dental auxiliaries. This information would serve as a useful tool for Nigerian oral healthcare policy formulators.

[Involvement of healthcare assistants in nursing procedures]

Healthcare assistants are authorised to perform nursing procedures in accordance with regulated conditions. They do not perform their functions autonomously but carry out their actions within the framework of the nurse's responsibilities.

Perceptions of Kansas Extended Care Permit dental hygienists' impact on dental care

PURPOSE

In 2003, Kansas addressed their access to oral health care needs with amended state dental practice act for registered dental hygienists. The Extended Care Permits (ECP) I, II and III have expanded the dental hygiene scope of practice, allowing dental hygienists to provide oral care to Kansans in different settings beyond the dental office. The purpoase of this study was to examine the perceptions of Kansas ECP dental hygienists on change to oral care in Kansas.

METHODS

A questionnaire was mailed to all ECP dental hygienists (n=158) registered with the Kansas Dental Board. Questions were open-ended, close-ended and Likert scale. Information was sought regarding demographics, areas of employment, work related activities and impact to oral health care. Study exclusions included ECP providers no longer practicing in Kansas, practice more than 50% in another state or no longer practice dental hygiene at all.

RESULTS

A total of 69 surveys were returned, with 9 surveys excluded for exclusion criteria. Most respondents (92%) agreed the ECP is a solution to oral health care access issues in Kansas. Barriers to utilizing their permits fully included: difficulty locating a sponsoring dentist (12%), locating start up finances (22%), limited work space (14%) and difficulty with facility administrators (39%). Many respondents (62%) agreed the proposed registered dental practitioner would improve access to oral health care to Kansans.

CONCLUSION

The Extended Care Permit providers in Kansas appear to be satisfied with their current employment situations and feel oral health care has improved for their patients served but they are unable to utilize their permits fully for various reasons.

The origins of Minnesota's mid-level dental practitioner: alignment of problem, political and policy streams

PURPOSE

Using John Kingdon's agenda-setting model, this paper explores how Minnesota came to legislate a mid-level dental practitioner to its oral health workforce. Using a pluralist framework embracing the existence of various interests and convictions, this analysis highlights the roles of issue formation, agenda setting and politics in policymaking.

METHODS

Using Kingdon's agenda-setting model as a theoretical lens, and applying case study methodology, this paper analyzes how Minnesota came to legislate a mid-level dental practitione to its oral health workforce. Data have come from scholarly research, governmental and foundation agency reports, interviews with leaders involved in the mid-level dental practitioner initiative, news articles, and Minnesota statute.

RESULTS

After 2 years of contentious and challenging legislative initiatives, the problem, policy and political streams converged and aligned with the compromise passage of a bill legalizing mid-level dental practitioner practice. The Minnesota Dental Therapist Law was the first-in-the-nation licensing law to develop a new dental professional workforce model to address access to oral health care.

CONCLUSION

The Minnesota mid-level dental practitioner initiative demonstrates the important convergence and alignment of the access to oral health care problem and the subsequent collaboration between political interest groups and policymakers. Through partnerships and pluralist compromise, mid-level dental practitioner champions were able to open the policy window to move this legislation to law, enhancing the oral health workforce in Minnesota.

A qualitative study of extended care permit dental hygienists in Kansas

Currently, 37 states allow some type of alternative practice settings for dental hygienists. This qualitative study was designed to explore the experiences of the Extended Care Permit (ECP) dental hygienist in the state of Kansas. As a first ever study of this workforce model, a qualitative research design was chosen to illuminate the education and experiences of extended dental hygiene practitioners in order to understand the impact ECP legislation has had on increasing the public's access to oral health care services and define the advantages and limitation of this model as one potential solution to access to oral care. Snowball sampling was used to identify study participants who were actively engaged in extended care practice. Nine subjects, which included one ECP consultant and eight ECP providers, participated in this study. Data obtained via personal interviews and through document analysis data were subsequently coded and thematically analyzed by three examiners. An independent audit was conducted by a fourth examiner to confirm dependability of results. Seven major categories emerged from the data analysis: entrepreneur dental hygienist, partnerships, funding, barriers, sustainability, models of care and the impact of the ECP. The findings of this study revealed that ECP hygienists are making an impact with underserved populations, primarily children, the elderly and special needs patients.

Liability of physicians supervising nonphysician clinicians

Physicians confront a variety of liability issues when supervising nonphysician clinicians (NPC) including: (1) direct liability resulting from a failure to meet the state-defined standards of supervision/collaboration with NPCs; (2) vicarious liability, arising from agency law, where physicians are held accountable for NPC clinical care that does not meet the national standard of care; and (3) responsibility for medical errors when the NPC and physician are co-employees of the corporate enterprise. Physician-NPC co-employee relationships are highlighted because they are new and becoming predominant in existing healthcare models. Because of their novelty, there is a paucity of judicial decisions determining liability for NPC errors in this setting. Knowledge of the existence of these risks will allow physicians to make informed decisions on what relationships they will enter with NPCs and how these relationships will be structured and monitored.

Delegation and beyond: what happens when things go wrong?

Both midwives and maternity support workers can be confused about who is liable if a task is delegated and something goes wrong. With proper understanding of roles and a knowledge of which tasks can and can't be delegated, however, the midwife should be protected, particularly as in practice the NHS body will have vicarious liability in the event of any claim. Clinical negligence training identifies the risks and responsibilities involved--and, leaving aside issues of delegation, training should also instil common sense safeguards against incurring criminal liability, which is independent from any professional or civil sanction.

A retrospective comparison of dental hygiene supervision changes from 2001 to 2011

PURPOSE

The purpose of this study is to evaluate the extent of change in the professional practice environment for dental hygienists in the 50 states and District of Columbia by comparing the state supervision requirements for dental hygienists during 2001 to 2011 to the previous 7 year period, 1993 to 2000.

METHODS

A retrospective comparison evaluation was conducted using the 2 tables entitled "Tasks Permitted and Mandated Supervision of Dental Hygienists by State, 1993, 1998 and 2000" and "Dental Hygiene Practice Act Overview: Permitted Functions and Supervision Levels by State." To score the net change in supervision, a numerical score was assigned to each level of alteration in supervision with a +1 or -1 for each level of change.

RESULTS

With a 95% confidence level, the mean change in dental hygiene supervision from 2001 to 2011 was 6.57 with a standard deviation of 5.70 (p-value=0.002). The mean change of supervision from 1993 to 2000 was 2.61 with a standard deviation of 4.36 (p-value=0.0002). The difference in the mean scores for the periods 1993 to 2000 and 2001 to 2011 was 3.96 (p-value=0.06).

CONCLUSION

This study shows that the majority of the states are moving toward a decrease in dental hygiene supervision. Study results suggest that the movement appears to be accelerating with more states adopting fewer supervision regulations at a faster rate. Therefore, direction is moving toward more access to dental health care for underserved populations.

Dubious delegation: Article III limits on mental health treatment decisions

A common condition of supervised release requires a defendant, post-incarceration, to participate in a mental health treatment program. Federal district courts often order probation officers to make certain decisions ancillary to these programs. However, Article III delegation doctrine places limits on such actions. This Note addresses the constitutionality of delegating the "treatment program" decision, in which a probation officer decides which type of treatment the defendant must undergo; the choice is often between inpatient treatment and other less restrictive alternatives. The resolution of this issue ultimately depends on whether this decision constitutes a "judicial act." Finding support in lower court case law, this Note argues that a "judicial act" encompasses decisions affecting the defendant's significant liberty interests. The Supreme Court case law and the mental health literature make clear that significant liberty interests are at stake in these "treatment program" decisions. Thus, delegating the "treatment program" decision to probation officers is unconstitutional under Article III. The Note concludes by suggesting a constitutionally permissible scheme whereby the judge orders a maximally intrusive treatment while giving the probation officer the discretion to choose a less restrictive program.

CDHC, a possible change agent promoting access to care

Access to oral health care has been a topic of concern among dental and community health professionals in the United States for some time. The American Dental Association is piloting a new program aimed at expanding the current dental health workforce and alleviating some of the problems associated with access to care. This paper explores the potential benefits of the community dental health coordinator program while examining some of the lessons learned in its initial implementation in Oklahoma.

Getting help for children: the need to expand the dental workforce

Millions of children in America suffer from poor oral health due to lack of access to dental care. The landmark U.S. Surgeon General's Report in 2000 highlighted significant disparities, yet poor oral health remains an epidemic. America's system of delivering dental care is poorly equipped to address access disparities. However, opportunities abound to improve access and expand the dental workforce. Creative thinking and innovative solutions are needed to expand care to children in need.

Dental students' part-time jobs in dental practices in the Netherlands

OBJECTIVE

In the Netherlands, the Individual Health Care Professions Act (IHCP Act) allows dental students, amongst other non-qualified individuals, to work under certain conditions in a dental practice. The aim of the study was to determine how many dental students have part-time employment in dental practice and which professional tasks they carry out. We also asked the dental students their opinion about the IHCP Act.

MATERIAL AND METHODS

All the enrolled dental students at the Academic Centre for Dentistry Amsterdam (ACTA) in the Netherlands received a questionnaire by e-mail. Within 1 month, two reminders were sent.

RESULTS

The response was 44% (427 students). Of the responding students, 71% had paid employment in addition to their study. Twenty-five per cent of all students worked in a dental practice, usually 8 h a week. Study year and age were positively related to working part-time in dental practice. Activities frequently performed were providing chair side assistance, giving oral hygiene instruction, fluoride applications, scaling and root planning. The self-reported knowledge about the IHCP Act was positively related to study year and working in a dental practice. Hardly any information about the requirements of the IHCP Act with regard to delegation of tasks was provided by the employer.

CONCLUSION

Many Dutch dental students work in a dental practice, taking over a variety of tasks. Although the self-reported knowledge about the IHCP Act was relatively high, many dental students expressed the need for more detailed information about the legal aspects of their tasks.