close

Вход

Забыли?

вход по аккаунту

код для вставкиСкачать
Florida Oral Health
Conference
August 2012
Ron Nagel DDS MPH
CAPT USPHS (ret)
Barriers to Access



Geographic (distribution)
Economic (capacity)
Cultural (social)
Dental Therapists




At least 52 countries utilize Dental Therapists
– IDJ (2008) 58, 01-70
Function as part of the dental team under the
supervision of a dentist
New Zealand has 90 yrs experience and
Canada has over 40
Exceptional safety record under general
supervision for children and adults – Nash 2012
Dental Therapists - Scope






Clinic, Village, or School based
Provide the spectrum of health education and
preventive services
Restore teeth to function utilizing amalgam
and composite materials
Provide SSCs and pulp treatment for primary
teeth
Extract teeth and manage dental emergencies
Screen for oral and peri-oral disease
Clinical Guidance
AFHCAN
Cart
Alaska Federal Health Care Access Network



Wireless Networking
Touchscreen
Mobile – Customized
 Consultation
 Patient
education
 Provider education

WWW. AFHCAN.ORG
Oversight






Educate and calibrate supervising dentists
Dental therapists are assigned to a primary
supervising dentist
Supervising dentists provide patient
consultations and program planning
Monitor the referral process and the scope of
practice
QA: chart reviews, patient satisfaction, direct
observation
Standardization of treatment to improve
outcomes

“Finally, we have pointed out the lack of
published data available to serve as valid
sources for comparison to assess the
technical competence and practice
procedures of those in the DHAT program.
We have very little information about these
qualities and characteristics from the practice
settings in which the majority of private
dentists in this country currently operate.”

Evaluation of the Dental Health Aide Therapist Workforce
Model in Alaska, Final Report, October 2010, Pg. 5-9,
prepared by Scott Wetterhall, MD, MPH, James D. Bader,
DDS, MPH, Barri B. Burrus, PhD, Jessica Y. Lee, DDS, PhD,
Daniel A. Shugars, DDS, PhD, MPH
Quality Assurance in the Alaska program





Begins with a 400+ hour directly supervised
preceptorship
DHAs must demonstrate the practical
professional competencies for their level of
certification throughout their career
Every two years each DHA must provide
evidence that they completed the CE
requirements (24 hrs)
Dentists proactively monitor sentinel events
and treatment outcomes
These administrative controls help to assure
quality and that a single standard of care is met
in tribal programs
Competency Based Credentialing




Frequent sampling of knowledge and skills over
time – not a single event test
We look directly at the services that they
provide day to day to achieve high predictive
validity with this process
Each DHAs’ scope of practice is individually
assigned based on competency through
standing orders
A Federal board oversees the process
DENTEX Training Program





University of Washington
MEDEX Northwest
Two year program based on NZ,
Canadian, and other models
Integration into community
based prevention programs
throughout training
A new mix of skills that includes
the behavioral and public health
skills needed to affect change
The use of simulation and
extensive patient contact to
develop a high level of skill
Alaska DHAT training program information:
First year: 40 weeks
Second year: 39 weeks
Total: 79 weeks (3160 hours)
Curriculum Break-down first year
Biological Science: 30%
Social Science: 10%
Pre-clinic: 40%
Clinic: 20%
Curriculum Break-down second year
Biological Science: 15%
Social Science: 7%
Pre-clinic: 0%
Clinic: 78% (1215 hours)
Curriculum Break-down two years
combined:
Biological Science: 22.5%
Social Science: 8.5%
Pre-clinic: 20% (632 hours)
Clinic: 49% (1548 hours)

2 year vs. 3 year combined RDH programs
 Cost
 Infrastructure
 Career
opportunities
 Provider Demographics
The truth about motivation and
changing behavior…
Not going to
be motivated
right now
Motivated
by
information
Motivated by how I interact with provider over time
10 %
10 %
80 %
Miller & Rollnick, Motivational Interviewing, 2002
Foundations for Great Primary Care
Effective Relationships =
Empanelment + Access + Continuity
What should new providers
look like?








Nash DA, Friedman JW, et al. Dental therapists: a global perspective. Int Dent J. 2008
Apr;58(2):61-70
McDermott, PT, Mayhall, JT, Leake, JL, Dental therapists and the delivery of dental
care in Canada’s Northwest Territorties. Circumpolar Health 1990: 668-671,
Ambrose ER, Hord AB, Simpson, WJA. Quality evaluation of specific dental services
provided by the Saskatchewan dental plan: final report. Regina, Saskatchewan, Canada,
1976:19 pages
Friedman JW, Ingle JI. New Zealand dental nurses. J Am Dent Assoc 1973;8:1331
Barkley RF, Successful preventive dental practices 1972 English Book 256 p. : ill. ;
Macomb, Ill. : Preventive Dentistry Press
Saultz JW, Lochner J. Interpersonal continuity of care and care outcomes: a critical
review. Ann Fam Med. 2005;3(2):159-66.
Haggerty JL, Reid RJ, Freeman GK, Starfield BH, Adair CE, McKendry R. Continuity of
Care: a Multidisciplinary Review. BMJ. 2003;327(7425):1219-21
Nash DA, A Review of the Global Literature on Dental Therapists: In the Context of the
Movement to Add Dental Therapists to the Oral Health Workforce in the United States,
Apr 2012.
"WHEN THE DENTAL HISTORY OF OUR TIME
IS EVENTUALLY WRITTEN, I BELIEVE THE
NEW ZEALAND DENTAL NURSE PROGRAM
WILL BE CONSIDERED ONE OF THE
LANDMARK DEVELOPMENTS IN THE
PRACTICE OF DENTISTRY AND DENTAL
PUBLIC HEALTH.“
HAROLD HILLENBRAND
EXECUTIVE DIRECTOR
AMERICAN DENTAL ASSOCIATION, 1947-1969
1/--страниц
Пожаловаться на содержимое документа