Transcript Alternative Workforce Models

Alternative Workforce
Models
Ben Youel, Illinois ‘13, Vice President
Tim Calnon, Buffalo ‘13, Leadership Development
Work Group, Chair
“there are profound
and consequential
disparities in the oral
health of our
citizens”
“silent epidemic”
http://www.nidcr.nih.gov/datastatistics/surgeongeneral/report/executivesummary.htm
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“Programming has taken a
multi-pronged approach
including:
Increasing
the
number
of
Funding
Improving
mobile
public
dental
healthvans
Supporting
community-led
underrepresented
to
dental
reach
education,
rural
populations,
projects
for
new
workforce
minorities
models.” enrolled in dental
school, and
http://www.wkkf.org/what-we-support/healthy-kids/dental-therapy.aspx
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“The Pew children's dental
campaign works on four
efficient, cost-effective
solutions:
1.
Ensure
that
Medicaid
and
2.
Expand
sealant
programs
4.
the
number
of
3.
Help
expandHealth
access to
the
Children’s
for
kids who
need
most
professionals
who them
can
optimally
fluoridated
water
Insurance
Program
provide dental
care –
tothe
lowprograms
that serve lowincome children”
income children – work
better for kids and for
providers so that insurance
coverage translates into real
access to needed care
http://www.pewtrusts.org/our_work_detail.aspx?id=574
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Dental Health Aide
Therapist (DHAT)
http://depts.washington.edu/dentexak/
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Advanced Dental
Hygiene Practitioner
(ADHP)
“In
response
the accessiscrisis,
Among
thesetoinnovations
the
state
policymakers,
consumer
creation
of a mid-level
oral
advocates
and oral
health much
health provider
to provide
coalitions
are pioneering
needed restorative
dental care
innovations
to extend
the reach
to underserved
populations.”
of the oral health care delivery
system and improve oral health
infrastructure.
http://www.adha.org/workforce-models-apdh
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“Unsupervised
private dental
hygiene practice has
not had a notable
effect on access to
care in Colorado.”
http://www.ada.org/sections/professionalResources/pdfs/report_hygiene.pdf
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“New Zealand’s
program in the schools
has been in place a long
time, and thus it may be
surprising to learn that
Baltimore adolescents
had … the lowest
number of DMF teeth
and the second- or thirdlowest number of
decayed teeth.”
http://www.ncbi.nlm.nih.gov/pubmed/16674756
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Community Dental
Health Coordinator
(CDHC)
http://www.ada.org/
cdhc.aspx
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Dental Therapists /
Advanced Dental
Therapists (DT/ADT)
First State to License a
Dental Midlevel Provider
http://www.dentalboard.state.mn.us/Default.aspx?tabid=1165
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“Nearly 9,500 new dental
providers are needed to
meet the country’s
current oral health
needs.
However, there are more
dentists retiring each
year than there are
dental school graduates
to replace them.”
http://www.sanders.senate.gov/imo/media/doc/DENTALCRISIS.REPORT.pdf
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Four MLP Programs
DHAT
ADHP
CDHC
DT/ADT
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Locations
• DHAT = Alaska (trained in University of
Washington)
• CDHC = University of Oklahoma, Temple
University, & A.T. Still University Arizona
School of Dentistry; New Mexico
• ADHP = Nowhere
• Dental Therapist / Advanced Dental Therapist
= Minnesota
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What can each program do?
All can do:
• Collect information (photographs,
radiographs)
• Screenings
• Fluoride treatments
• Sealants
• Temporary fillings (IRM)
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What can each program do?
CDHC
DT
DHAT
ADHP
Triage
Develop and implement
community education
programs
Direct Restorations
Pre-formed crowns
Primary teeth extraction
Perio-involved perm
teeth extraction (ADT)
Pulp capping
Pulpotomies
Local/Nitrous
Provide & administer
analgesics, antiinflammatories and
antibiotics (ADT)
Dx & Tx Planning (ADT)
Repair removable pros
Re-cement fixed pros
Space maintainers
Splinting
Full hygiene scope
Direct Restorations
Pre-formed crowns
Primary tooth
extraction
Non-surgical perm teeth
extraction
Pulpotomies
Local
Full hygiene scope
Direct Restorations
Pre-formed crowns
“Uncomplicated
extractions”
Repair removable pros
Re-cement fixed pros
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REVERSIBLE
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IR REVERSIBLE
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What do WE think?
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C1 Expanded Functions of Dental Assistants and Dental Hygienists
•
endorses expanded functions for
dental auxiliaries only when each has received the appropriate
education and training to guarantee competence, and when such
The American Student Dental Association
functions fall within the laws established by their respective state of employment.
•
It is incumbent on the profession to assure that expanded functions for dental auxiliaries will not adversely affect the
health and well-being of the public.
•
The practice of dentistry entails more than the simple performance of routine technical procedures. A dentist must possess
a wide range of knowledge of the biological, anatomical, and physiological sciences in order to successfully and safely
perform such procedures. A dentist must also be able to process and apply both the knowledge and the skills acquired in
dental school in order to successfully and safely perform these tasks.
•
Thus,
not limited to:
a.
b.
c.
d.
Examination, diagnosis and treatment planning
Prescribing work authorizations
Performing irreversible dental procedures
Prescribing drugs and/or other medications
only the dentist should perform the following functions. These functions include but are
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C2 Independent Practice
• The American Student Dental
Association is strongly opposed to
independent dental hygiene practice,
and favors the team approach for
providing comprehensive dental care.
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Opposition to Pilot Programs Which Allow Nondentists to
Diagnose Dental Needs or Perform Irreversible Procedures
• Resolved, that the American Dental Association
opposes pilot programs that are in violation of
the ADA policy stated in Resolution 24H-2004
(stating that, “The ADA is opposed to nondentists making diagnoses, developing
treatment plans or performing irreversible
procedures.”)
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Diagnosis or Performance of Irreversible
Dental Procedures by Nondentists
• Resolved, that the American Dental Association
by all appropriate federal legislative and judicial
means resist any effort compromising the quality
of dental health care services by allowing any
nondentist to diagnose or perform irreversible
dental procedures except as otherwise
authorized by state law with reference to
physicians.
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What is the root of
the debate over
Alternative
Workforce models?
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“Breaking down Barriers to Oral Health
for All Americans”
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…“must guard against
focusing on any one barrier
to the exclusion of others
that are equally critical.”
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“Everyone
deserves a
Dentist.”
- Dr. Ray Gist, 2010-2011 ADA President
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- 82 million underserved
- 27.8% visit dentist
-System with 7-8
Million capacity
“Coordination is critical”
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Underserved populations
=
Unserved individuals
1 million/ 1%
$2.16 Billion Charity
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- Internal understanding
- 34 Graduates practicing
- 7 Core Competencies
- Sunset evaluation
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SYSTEMATIC REVIEW
“In populations where nondentists conduct
diagnostic, treatment planning, and/or
irreversible/surgical dental procedures, is
there a change in disease increment,
untreated dental disease, and/or costeffectiveness of dental care?”
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The Journal of the American Dental Association January 1, 2013 vol. 144 no. 1 75-91
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• 18 Observational studies from 7,701
citations
• Conclusion: Poor quality evidence
– Decease in caries with MLP, but same as with
dentist treated pop.
– Select pop. Treated by MLP show greater
decrease
– *Results should be applied with caution*
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What about our future...?
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JOIN TODAY!
In Washington, if you’re not at the
table, you’re on the menu.
$5 = Your Future
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A
D
V
O
C
A
C
Y
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Don’t let the tail
wag the dog!
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Thank you!
• Ben Youel
– [email protected]
• Tim Calnon
– [email protected]
PACE Verification Code: AS1304
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