1
|
Llaneza AJ, Seward J, Holt A, Stephens LD. Oral Health Workforce and American Indian and Alaska Native Communities: a Systematic Review. J Racial Ethn Health Disparities 2024; 11:248-254. [PMID: 36692659 PMCID: PMC10781823 DOI: 10.1007/s40615-023-01515-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 12/02/2022] [Accepted: 01/04/2023] [Indexed: 01/25/2023]
Abstract
OBJECTIVE Understanding the oral health workforce representing and serving American Indian and Alaska Native (AI/AN) communities is vital to improving community dental health outcomes. No systematic review of recent published literature on the oral health workforce among this population has been completed. METHODS We conducted a systematic review of published literature examining the oral health workforce representing and serving AI/AN communities in the USA. We analyzed 12 articles according to the PRISMA Statement. RESULTS The studies suggested that AI/AN identity is an important aspect of routine and accessible oral healthcare. There are unique barriers and motivations that personnel in the oral health workforce face, let alone the distinctiveness of serving AI/AN communities. CONCLUSIONS This review provides evidence that expanded oral health positions aid in community members receiving more routine and preventative care and is an upstream public health approach that has diversified the dental workforce.
Collapse
Affiliation(s)
| | - Julie Seward
- Southern Plains Tribal Health Board, Oklahoma City, OK, USA
| | - Alex Holt
- Southern Plains Tribal Health Board, Oklahoma City, OK, USA
| | - Lancer D Stephens
- Health Promotion Sciences, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Oklahoma Shared Clinical and Translational Resources, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| |
Collapse
|
2
|
Cunha-Cruz J, Hilgert JB, Harter C, Rothen ML, Hort K, Mallott E. Feedback on audit and action planning for dental caries control: a qualitative study to investigate the acceptability among interdisciplinary pediatric dental care teams. FRONTIERS IN ORAL HEALTH 2023; 4:1195736. [PMID: 37456360 PMCID: PMC10348878 DOI: 10.3389/froh.2023.1195736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 06/20/2023] [Indexed: 07/18/2023] Open
Abstract
Introduction American Indian and Alaska Native children suffer from the poorest oral health of all populational groups in the United States. Evidence-based practices (EBP) for caries control are well established, but systematically implementing such practices have proven difficult. Audit and feedback with goal setting, and action planning to implement these EBPs have not been tested or adapted for Alaska Native healthcare settings. The aim of this study was to investigate acceptability and perceived feasibility of an audit and feedback intervention for pediatric dental caries control among dental providers and patient stakeholders. Methods The pilot program was implemented in two dental clinics from a tribal healthcare consortium in Alaska. Key-informant interviews were conducted to investigate the contextual, organizational, and behavioral facilitators and barriers to the implementation and expansion of the program. Interview transcripts were analyzed by two researchers using thematic analysis. Results Eight key informants were interviewed twice (during and after the intervention period), and one once, for a total of 17 interviews. Patient stakeholders were not interviewed due to COVID-19 pandemic clinic closures and social isolation mandates. Three principal themes emerged: a positive organizational climate and culture fostered the acceptability of the program, the positive impacts of the program observed in the pediatric dental teams and the organization, and the challenges to implement the program including understanding the data reports, trusting the accuracy of the data, and competing priorities. Conclusions The intervention of audit and feedback with goal setting and action planning was well accepted and perceived as feasible by the study participants given the financial and human resources provided by the research project. This qualitative study can inform the design and evaluation of process-oriented implementation strategies geared towards decreasing health inequities and improving health outcomes, such as dental caries in American Indian and Alaska Native children and adolescents.
Collapse
Affiliation(s)
- Joana Cunha-Cruz
- Department of Oral Health Sciences, School of Dentistry, University of Washington, Seattle, WA, United States
- Department of Clinical and Community Sciences, School of Dentistry, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Juliana Balbinot Hilgert
- Post Graduate Program in Epidemiology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Post Graduate Program in Dentistry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Catherine Harter
- Department of Oral Health Sciences, School of Dentistry, University of Washington, Seattle, WA, United States
| | - Marilynn L. Rothen
- Department of Oral Health Sciences, School of Dentistry, University of Washington, Seattle, WA, United States
| | - Kim Hort
- SouthEast Alaska Regional Health Consortium (SEARHC), Juneau, AK, United States
| | - Elizabeth Mallott
- SouthEast Alaska Regional Health Consortium (SEARHC), Juneau, AK, United States
| |
Collapse
|
3
|
Secular trends in dental services provided by dental therapists and dentists in Southwest Alaska. J Am Dent Assoc 2022; 153:1145-1153. [DOI: 10.1016/j.adaj.2022.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 08/26/2022] [Accepted: 08/26/2022] [Indexed: 11/05/2022]
|
4
|
Lavoie JG, Stoor JP, Rink E, Cueva K, Gladun E, Larsen CVL, Healey Akearok G, Kanayurak N. Cultural competence and safety in Circumpolar countries: an analysis of discourses in healthcare. Int J Circumpolar Health 2022; 81:2055728. [PMID: 35451927 PMCID: PMC9037165 DOI: 10.1080/22423982.2022.2055728] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Circumpolar Indigenous populations continue to experience dramatic health inequities when compared to their national counterparts. The objectives of this study are first, to explore the space given in the existing literature to the concepts of cultural safety and cultural competence, as it relates to Indigenous peoples in Circumpolar contexts; and second, to document where innovations have emerged. We conducted a review of the English, Danish, Norwegian, Russian and Swedish Circumpolar health literature focusing on Indigenous populations. We include research related to Alaska (USA); the Yukon, the Northwest Territories, Nunavik and Labrador (Canada); Greenland; Sápmi (northmost part of Sweden, Norway, and Finland); and arctic Russia. Our results show that the concepts of cultural safety and cultural competence (cultural humility in Nunavut) are widely discussed in the Canadian literature. In Alaska, the term relationship-centred care has emerged, and is defined broadly to encompass clinician-patient relationships and structural barriers to care. We found no evidence that similar concepts are used to inform service delivery in Greenland, Nordic countries and Russia. While we recognise that healthcare innovations are often localised, and that there is often a lapse before localised innovations find their way into the literature, we conclude that the general lack of attention to culturally safe care for Sámi and Greenlandic Inuit is somewhat surprising given Nordic countries' concern for the welfare of their citizens. We see this as an important gap, and out of step with commitments made under United Nations Declarations on the Rights of Indigenous Peoples. We call for the integration of cultural safety (and its variants) as a lens to inform the development of health programs aiming to improve Indigenous in Circumpolar countries.
Collapse
Affiliation(s)
- Josée G Lavoie
- Ongomiizwin Research, University of Manitoba, Winnipeg, MB Canada
| | - Jon Petter Stoor
- Department of Epidemiology and Global Health, Umeå University, Centre for Sami Health Research, UiT - the Arctic University of Norway, Sweden, Norway
| | - Elizabeth Rink
- Health & Human Development, Montana State University, USA
| | - Katie Cueva
- Institute of Social and Economic Research (ISER), University of Alaska, Anchorage, AK, USA
| | | | | | | | | |
Collapse
|
5
|
Simon L, Donoff RB, Friedland B. Dental therapy in the United States: Are developments at the state level a reason for optimism or a cause for concern? J Public Health Dent 2021; 81:12-20. [PMID: 32805762 DOI: 10.1111/jphd.12388] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Revised: 05/03/2020] [Accepted: 07/02/2020] [Indexed: 01/18/2023]
Abstract
Access to dental care continues to be a challenge for millions of vulnerable Americans. In more than 50 nations worldwide, dental therapists (DTs), mid-level providers who deliver a limited scope of dental care under the supervision of a dentist, have helped increase access to needed care. Since 2003, when the Alaska Native Tribal Health System introduced DTs as part of the Federally authorized Alaska Community Health Aide Program, a total of 13 states have adopted the role. However, as of April 2020, there are fewer than 150 DTs in practice throughout the country, and educational and licensing requirements as well as scope of practice vary between each state. Such heterogeneity makes the training and recruitment of future DTs a challenge. This article summarizes the current state of the DT workforce in the United States and discusses the possible future of the profession as other states contemplate adopting the model in the face of ongoing oral health disparities.
Collapse
Affiliation(s)
- Lisa Simon
- Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, MA, USA
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - R Bruce Donoff
- Department of Oral and Maxillofacial Surgery, Harvard School of Dental Medicine, Boston, MA, USA
| | - Bernard Friedland
- Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, Boston, MA, USA
| |
Collapse
|
6
|
Mertz E, Kottek A, Werts M, Langelier M, Surdu S, Moore J. Dental Therapists in the United States: Health Equity, Advancing. Med Care 2021; 59:S441-S448. [PMID: 34524241 PMCID: PMC8428854 DOI: 10.1097/mlr.0000000000001608] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Dental therapists (DTs) are primary care dental providers, used globally, and were introduced in the United States (US) in 2005. DTs have now been adopted in 13 states and several Tribal nations. OBJECTIVES The objective of this study is to qualitatively examine the drivers and outcomes of the US dental therapy movement through a health equity lens, including community engagement, implementation and dissemination, and access to oral health care. METHODS The study compiled a comprehensive document library on the dental therapy movement including literature, grant documents, media and press, and gray literature. Key stakeholder interviews were conducted across the spectrum of engagement in the movement. Dedoose software was used for qualitative coding. Themes were assessed within a holistic model of oral health equity. FINDINGS Health equity is a driving force for dental therapy adoption. Community engagement has been evident in diverse statewide coalitions. National accreditation standards for education programs that can be deployed in 3 years without an advanced degree reduces educational barriers for improving workforce diversity. Safe, high-quality care, improvements in access, and patient acceptability have been well documented for DTs in practice. CONCLUSION Having firmly taken root politically, the impact of the dental therapy movement in the US, and the long-term health impacts, will depend on the path of implementation and a sustained commitment to the health equity principle.
Collapse
Affiliation(s)
- Elizabeth Mertz
- Healthforce Center, University of California, San Francisco
- Preventive and Restorative Dental Sciences, School of Dentistry, University of California, San Francisco, San Francisco, CA
| | - Aubri Kottek
- Healthforce Center, University of California, San Francisco
- Preventive and Restorative Dental Sciences, School of Dentistry, University of California, San Francisco, San Francisco, CA
| | - Miranda Werts
- Healthforce Center, University of California, San Francisco
- Preventive and Restorative Dental Sciences, School of Dentistry, University of California, San Francisco, San Francisco, CA
| | - Margaret Langelier
- Center for Health Workforce Studies, School of Public Health, University at Albany, State University of New York, Rensselaer, NY
| | - Simona Surdu
- Center for Health Workforce Studies, School of Public Health, University at Albany, State University of New York, Rensselaer, NY
| | - Jean Moore
- Center for Health Workforce Studies, School of Public Health, University at Albany, State University of New York, Rensselaer, NY
| |
Collapse
|
7
|
Brocklehurst P, Hoare Z, Woods C, Williams L, Brand A, Shen J, Breckons M, Ashley J, Jenkins A, Gough L, Preshaw P, Burton C, Shepherd K, Bhattarai N. Dental therapists compared with general dental practitioners for undertaking check-ups in low-risk patients: pilot RCT with realist evaluation. HEALTH SERVICES AND DELIVERY RESEARCH 2021. [DOI: 10.3310/hsdr09030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Background
Many dental ‘check-ups’ in the NHS result in no further treatment. The patient is examined by a dentist and returned to the recall list for a further check-up, commonly in 6 or 12 months’ time. As the oral health of regular dental attenders continues to improve, it is likely that an increasing number of these patients will be low risk and will require only a simple check-up in the future, with no further treatment. This care could be delivered by dental therapists. In 2013, the body responsible for regulating the dental profession, the General Dental Council, ruled that dental therapists could see patients directly and undertake check-ups and routine dental treatments (e.g. fillings). Using dental therapists to undertake check-ups on low-risk patients could help free resources to meet the future challenges for NHS dentistry.
Objectives
The objectives were to determine the most appropriate design for a definitive study, the most appropriate primary outcome measure and recruitment and retention rates, and the non-inferiority margin. We also undertook a realist-informed process evaluation and rehearsed the health economic data collection tool and analysis.
Design
A pilot randomised controlled trial over a 15-month period, with a realist-informed process evaluation. In parallel, we rehearsed the health economic evaluation and explored patients’ preferences to inform a preference elicitation exercise for a definitive study.
Setting
The setting was NHS dental practices in North West England.
Participants
A total of 217 low-risk patients in eight high-street dental practices participated.
Interventions
The current practice of using dentists to provide NHS dental check-ups (treatment as usual; the control arm) was compared with using dental therapists to provide NHS dental check-ups (the intervention arm).
Main outcome measure
The main outcome measure was difference in the proportion of sites with bleeding on probing among low-risk patients. We also recorded the number of ‘cross-over’ referrals between dentists and dental therapists.
Results
No differences were found in the health status of patients over the 15 months of the pilot trial, suggesting that non-inferiority is the most appropriate design. However, bleeding on probing suffered from ‘floor effects’ among low-risk patients, and recruitment rates were moderately low (39.7%), which suggests that an experimental design might not be the most appropriate. The theory areas that emerged from the realist-informed process evaluation were contractual, regulatory, institutional logistics, patients’ experience and logistics. The economic evaluation was rehearsed and estimates of cost-effectiveness made; potential attributes and levels that can form the basis of preference elicitation work in a definitive study were determined.
Limitations
The pilot was conducted over a 15-month period only, and bleeding on probing appeared to have floor effects. The number of participating dental practices was a limitation and the recruitment rate was moderate.
Conclusions
Non-inferiority, floor effects and moderate recruitment rates suggest that a randomised controlled trial might not be the best evaluative design for a definitive study in this population. The process evaluation identified multiple barriers to the use of dental therapists in ‘high-street’ practices and added real value.
Future work
Quasi-experimental designs may offer more promise for a definitive study alongside further realist evaluation.
Trial registration
Current Controlled Trials ISRCTN70032696.
Funding
This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 9, No. 3. See the NIHR Journals Library website for further project information.
Collapse
Affiliation(s)
| | - Zoe Hoare
- School of Health Sciences, Bangor University, Bangor, UK
| | - Chris Woods
- School of Health Sciences, Bangor University, Bangor, UK
| | - Lynne Williams
- School of Health Sciences, Bangor University, Bangor, UK
| | - Andrew Brand
- School of Health Sciences, Bangor University, Bangor, UK
| | - Jing Shen
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Matthew Breckons
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | | | - Alison Jenkins
- School of Health Sciences, Bangor University, Bangor, UK
| | | | - Philip Preshaw
- Faculty of Dentistry, National University of Singapore, Singapore
- Faculty of Dentistry, Newcastle University, Newcastle upon Tyne, UK
| | - Christopher Burton
- School of Allied and Public Health Professions, Canterbury Christ Church University, Canterbury, UK
| | - Karen Shepherd
- Patient and public involvement representative, Bangor, UK
| | - Nawaraj Bhattarai
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| |
Collapse
|
8
|
Ingemann C, Hansen NF, Hansen NL, Jensen K, Larsen CVL, Chatwood S. Patient experience studies in the circumpolar region: a scoping review. BMJ Open 2020; 10:e042973. [PMID: 33020108 PMCID: PMC7537463 DOI: 10.1136/bmjopen-2020-042973] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 08/25/2020] [Accepted: 08/26/2020] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES Patient experiences with health systems constitute a crucial pillar of quality care. Across the Arctic, patients' interactions with the healthcare system are influenced by challenges of access, historical inequities and social determinants. This scoping review sought to describe the range and nature of peer-reviewed literature on patient experience studies conducted within the circumpolar region. DESIGN In a partnership between Danish/Greenlandic, Canadian and American research teams, a scoping review of published research exploring patient experiences in circumpolar regions was undertaken. DATA SOURCES Seven electronic databases were queried: MEDLINE, Embase, Scopus, 'Global Health 1910 to 2019 Week 11', CINAHL, PsycINFO and SveMed+. ELIGIBILITY CRITERIA Articles were eligible for inclusion if they (a) took place in the circumpolar region, (b) reported patients' perspective and (c) were focussed primarily on patient experiences with care, rather than satisfaction with treatment outcome. DATA EXTRACTION AND SYNTHESIS Title and abstract screening, full-text review and data extraction was conducted by four researchers. Bibliometric information such as publication date and country of origin was extracted, as was information regarding study design and whether or not the article contained results relevant to the themes of Indigenous values, rural and remote context, telehealth and climate change. Two researchers then synthesised and characterised results relevant to these themes. RESULTS Of the 2824 articles initially found through systematic searches in seven databases, 96 articles were included for data extraction. Findings from the review included unique features related to Indigenous values, rural and remote health, telehealth and climate change. CONCLUSIONS The review findings provide an overview of patient experiences measures used in circumpolar nations. These findings can be used to inform health system improvement based on patient needs in the circumpolar context, as well as in other regions that share common features. This work can be further contextualized through Indigenous methodologies such as sharing circles and community based participatory methods.
Collapse
Affiliation(s)
- Christine Ingemann
- National Institute of Public Health, University of Southern Denmark Faculty of Health Sciences, Copenhagen, Denmark
- Institute of Nursing and Health Sciences, University of Greenland, Nuuk, Greenland
| | | | - Nanna Lund Hansen
- National Institute of Public Health, University of Southern Denmark Faculty of Health Sciences, Copenhagen, Denmark
| | - Kennedy Jensen
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Christina Viskum Lytken Larsen
- National Institute of Public Health, University of Southern Denmark Faculty of Health Sciences, Copenhagen, Denmark
- Institute of Nursing and Health Sciences, University of Greenland, Nuuk, Greenland
| | - Susan Chatwood
- University of Alberta School of Public Health, Edmonton, Alberta, Canada
| |
Collapse
|
9
|
Chi DL, Hopkins S, Zahlis E, Randall CL, Senturia K, Orr E, Mancl L, Lenaker D. Provider and community perspectives of dental therapists in Alaska's Yukon-Kuskokwim Delta: A qualitative programme evaluation. Community Dent Oral Epidemiol 2019; 47:502-512. [PMID: 31464356 DOI: 10.1111/cdoe.12492] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 07/17/2019] [Accepted: 08/06/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Dental therapists deliver preventive and basic restorative care and have been practicing since 2006 in Alaska's Yukon-Kuskokwim (YK) Delta. In this qualitative programme evaluation, we documented health providers' and community members' experiences with dental therapy. The goal of the evaluation was to develop a conceptual model of dental care delivery in Alaska Native Communities centred on dental therapists. METHODS We developed semi-structured interview scripts and used snowball sampling to recruit 16 health providers with experience providing care in the YK Delta and 125 community members from six YK Delta Communities in 2017 and 2018. The six communities were a stratified convenience sample based on community-level exposure to dental therapists (high, medium and no exposure). Interview data were digitally recorded, transcribed, verified for accuracy and coded inductively into conceptual domains using content analytic methods. RESULTS Providers believed individuals living in the YK Delta have benefited from clinic-based restorative care and community-based education provided by dental therapists. The restricted scope of dental therapy practice limits the complexity of care that may be offered to patients. However, community members expressed high satisfaction with the quality of care provided by dental therapists. Community members noted more widespread knowledge and evolving norms about oral health and believed dental therapists are helping to prevent disease and improve quality of life. Participants believed access to dental care for children has improved over the years, but felt that many adults in the YK Delta continue to have unmet needs. A potential barrier to sustained programme effectiveness is low retention of dental therapists in the region, driven primarily by reports that dental therapists feel overworked, stressed and geographically isolated. CONCLUSIONS Dental therapists have contributed to the dental care delivery system in Alaska's YK Delta. Future opportunities remain within the system to address the needs of adults, develop strategies to retain dental therapists in the region and incorporate evidence-based, prevention-oriented strategies to improve oral health behaviours and reduce oral diseases.
Collapse
Affiliation(s)
- Donald L Chi
- University of Washington School of Dentistry, Seattle, Washington.,University of Washington School of Public Health, Seattle, Washington
| | | | - Ellen Zahlis
- University of Washington School of Dentistry, Seattle, Washington
| | | | - Kirsten Senturia
- University of Washington School of Dentistry, Seattle, Washington.,University of Washington School of Public Health, Seattle, Washington
| | - Eliza Orr
- University of Washington School of Dentistry, Seattle, Washington
| | - Lloyd Mancl
- University of Washington School of Dentistry, Seattle, Washington
| | - Dane Lenaker
- Southeast Alaska Regional Health Consortium, Sitka, Alaska
| |
Collapse
|
10
|
Senturia K, Fiset L, Hort K, Huebner C, Mallott E, Milgrom P, Nelson L, Parrish C, Cunha-Cruz J. Dental health aides in Alaska: A qualitative assessment to improve paediatric oral health in remote rural villages. Community Dent Oral Epidemiol 2018; 46:416-424. [PMID: 29863284 DOI: 10.1111/cdoe.12385] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 04/25/2018] [Indexed: 02/01/2023]
Abstract
OBJECTIVE Isolated villages in Alaska face disparities in oral health and access to care. Dental health aides such as the primary dental health aide (PDHA) and the dental health therapist (DHAT) fill a critical role for providing dental care in Alaska. Our objective was to describe strengths and barriers to paediatric dental care for children living in remote Alaska villages from the perspectives of the community and the health care system. METHODS This qualitative study collected data through semi-structured key informant interviews with community members (n = 19) and healthcare workers (n = 19) and focus groups with patients (n = 31 adolescents and 16 caregivers of children under 12 years) living in or providing health care to 3 remote villages in Alaska. Using an inductively developed codebook and a narrative approach, 3 researchers independently read and thematically analysed the transcripts. RESULTS Two themes emerged: (i) PDHAs and DHATs are perceived as sustainable and strongly positioned to meet the unique dental needs of the rural communities; (ii) PDHAs and DHATs face barriers that limit their effectiveness, and their distinct roles require clarification and administrative support. CONCLUSIONS Dental health aides, both PDHAs and DHATs, are well accepted in Alaska villages. An innate understanding of cultural norms and continuity of care are key elements driving village satisfaction. The potential exists administratively to strengthen the model with the implementation of clinical and office-system strategies to increase efficiency of the dental team. Culturally adapted implementation strategies will be critical to the successful expansion of new workforce models that are addressing health disparities.
Collapse
Affiliation(s)
- Kirsten Senturia
- Department of Health Services, University of Washington, Seattle, WA, USA
| | - Louis Fiset
- Department of Oral Health Sciences, University of Washington, Seattle, WA, USA
| | - Kim Hort
- SouthEast Alaska Regional Health Consortium, Juneau, AK, USA
| | - Colleen Huebner
- Department of Health Services, University of Washington, Seattle, WA, USA
| | | | - Peter Milgrom
- Department of Oral Health Sciences, University of Washington, Seattle, WA, USA
| | - Lonnie Nelson
- School of Nursing, Washington State University, Spokane, WA, USA
| | - Canada Parrish
- Department of Oral Health Sciences, University of Washington, Seattle, WA, USA
| | - Joana Cunha-Cruz
- Department of Oral Health Sciences, University of Washington, Seattle, WA, USA
| |
Collapse
|
11
|
Mertz EA, Wides CD, Kottek AM, Calvo JM, Gates PE. Underrepresented Minority Dentists: Quantifying Their Numbers And Characterizing The Communities They Serve. Health Aff (Millwood) 2018; 35:2190-2199. [PMID: 27920306 DOI: 10.1377/hlthaff.2016.1122] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The underrepresentation of Blacks, Hispanics or Latinos, and American Indians or Alaska Natives among dentists raises concerns about the diversity of the dental workforce, disparities in access to dental care and in oral health status, and social justice. We quantified the shortage of underrepresented minority dentists and examined these dentists' practice patterns in relation to the characteristics of the communities they serve. The underrepresented minority dentist workforce is disproportionately smaller than, and unevenly distributed in relation to, minority populations in the United States. Members of minority groups represent larger shares of these dentists' patient panels than of the populations in the communities where the dentists are located. Compared to counties with no underrepresented minority dentists, counties with one or more such dentists are more racially diverse and affluent but also have greater economic and social inequality. Current policy approaches to improve the diversity of the dental workforce are a critical first step, but more must be done to improve equity in dental health.
Collapse
Affiliation(s)
- Elizabeth A Mertz
- Elizabeth A. Mertz is an associate professor in the Department of Preventive and Restorative Dental Sciences, School of Dentistry, and the Healthforce Center, both at the University of California, San Francisco (UCSF)
| | - Cynthia D Wides
- Cynthia D. Wides is a research analyst in the Department of Preventive and Restorative Dental Sciences, School of Dentistry, and the Healthforce Center, UCSF
| | - Aubri M Kottek
- Aubri M. Kottek is a research analyst at the Philip R. Lee Institute for Health Policy Studies and the Healthforce Center, both at UCSF
| | - Jean Marie Calvo
- Jean Marie Calvo is a student in the School of Dentistry at UCSF
| | - Paul E Gates
- Paul E. Gates is chair of the Department of Dentistry at the Bronx-Lebanon Hospital Center and the Dr. Martin L. King Jr. Health Center, and a clinical associate professor in the Department of Dentistry at the Icahn School of Medicine at Mount Sinai, all in New York City
| |
Collapse
|
12
|
Chi DL, Lenaker D, Mancl L, Dunbar M, Babb M. Dental therapists linked to improved dental outcomes for Alaska Native communities in the Yukon-Kuskokwim Delta. J Public Health Dent 2018; 78:175-182. [PMID: 29377127 PMCID: PMC6019600 DOI: 10.1111/jphd.12263] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Revised: 11/14/2017] [Accepted: 12/15/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Dental Health Aide Therapists (DHATs) have been part of the dental workforce in Alaska's Yukon-Kuskokwim (YK) Delta since 2006. They are trained to provide preventive and restorative care such as filling and extractions. In this study, we evaluated community-level dental outcomes associated with DHATs. METHODS This was a secondary data analysis of Alaska Medicaid and electronic health record data for individuals in Alaska's YK Delta (2006-2015). The independent variable was the number of DHAT treatment days in each community. Child outcomes were preventive care, extractions, and general anesthesia. Adult outcomes were preventive care and extractions. We estimated Spearman partial correlation coefficients to test our hypotheses that increased DHAT treatment days would be associated with larger proportions utilizing preventive care and smaller proportions receiving extractions at the community-level. RESULTS DHAT treatment days were positively associated with preventive care utilization and negatively associated with extractions for children and adults (P < 0.0001). DHAT treatment days were not associated with increased dental treatment under general anesthesia for children. CONCLUSIONS Dental therapists are associated with more preventive care and fewer extractions. State-level policies should consider dental therapists as part of a comprehensive solution to meet the dental care needs of individuals in underserved communities and help achieve health equity and social justice.
Collapse
Affiliation(s)
- Donald L Chi
- School of Dentistry, University of Washington, Seattle, WA, USA
| | - Dane Lenaker
- Southeast Alaska Regional Health Consortium, Sitka, AK, USA
| | - Lloyd Mancl
- School of Dentistry, University of Washington, Seattle, WA, USA
| | - Matthew Dunbar
- Center for Studies in Demography and Ecology, University of Washington, Seattle, WA, USA
| | - Michael Babb
- Center for Studies in Demography and Ecology, University of Washington, Seattle, WA, USA
| |
Collapse
|
13
|
Nash DA, Mathu-Muju KR, Friedman JW. The dental therapist movement in the United States: A critique of current trends. J Public Health Dent 2017; 78:127-133. [DOI: 10.1111/jphd.12252] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 07/25/2017] [Accepted: 08/04/2017] [Indexed: 11/29/2022]
Affiliation(s)
- David A. Nash
- William R. Willard Professor of Dental Education, Professor of Pediatric Dentistry, College of Dentistry; University of Kentucky; Lexington KY USA
| | - Kavita R. Mathu-Muju
- Assistant Professor of Pediatric Dentistry, Faculty of Dentistry; University of British Columbia; Vancouver Canada
| | | |
Collapse
|
14
|
Cladoosby BS. Indian Country Leads National Movement to Knock Down Barriers to Oral Health Equity. Am J Public Health 2017; 107:S81-S84. [PMID: 28661807 PMCID: PMC5497874 DOI: 10.2105/ajph.2017.303663] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2017] [Indexed: 11/04/2022]
Abstract
Tribal and other underserved communities are struggling under the weight of devastating oral health disparities. Tribes as sovereign nations are searching for innovative solutions to address their unique barriers to oral health care. Dental therapists are primary oral health providers who work as part of the dental team to provide a limited scope of services to patients. They were first brought to tribal communities by the Alaska Native Tribal Health Consortium. Despite strong opposition from the American Dental Association aimed at protecting its monopoly on oral health care, dental therapists are sweeping the nation. Evidence shows that they are effective and provide high-quality care, particularly in underserved communities. A community's ability to develop public health policy solutions tailored to its needs and priorities is essential in eliminating health disparities and achieving health equity. The Swinomish Indian Tribal Community is leading the way to more effective and efficient dental teams and working hard to lay the groundwork for the elimination of oral health disparities.
Collapse
Affiliation(s)
- Brian Speepots Cladoosby
- Brian (Speepots) Cladoosby is the president of the National Congress of American Indians and chairman of the Swinomish Indian Tribal Community, La Conner, WA
| |
Collapse
|
15
|
Hill H, Macey R, Brocklehurst P. A Markov model assessing the impact on primary care practice revenues and patient's health when using mid-level providers, lesson learned from the United Kingdom. J Public Health Dent 2017; 77:334-343. [PMID: 28272806 DOI: 10.1111/jphd.12212] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 01/13/2017] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To evaluate the cost-effectiveness of using mid-level providers for dental "check-up" examinations and the treatment of caries in different NHS settings in the United Kingdom. Mid-level providers are a broad category that describes non-dentist members of dental teams. This study focused on the potential use of Dental Hygiene Therapists undertaking dental "check-up" examinations and simple restorative treatment, instead of dentists. METHODS A Markov model was used to construct the natural history of caries development in adults that visit a dental practice every six months over a five-year period. Three cost perspectives are taken: those borne to dental healthcare providers in England and Wales, Northern Ireland and Scotland. These represent three separate forms of retrospective payment system that are currently in use in the United Kingdom. The cost outcome was the average amount of retained practice earnings required to provide healthcare per patient visit. The health outcome was the average length of time in a cavity-free state and the cost-effectiveness outcome was incremental cost for six months in a cavity-free state. RESULTS No statistical difference was found between dentists and mid-level providers in the length of time in a cavity-free state but the use of the latter saved money in all three NHS health system jurisdictions. This ranged from £7.85 (England and Wales) to £9.16 (Northern Ireland) per patient visit ($10.20 to $11.90, respectively) meaning the incremental cost for six month in a cavity-free state ranged from £261.67 ($339.93) in England and Wales to £305.33 ($369.68) in Northern Ireland. Further, changes in baseline assumptions and parameter values did not change mid-level providers being the dominant service intervention. CONCLUSION In a time of limited funds for dental services, these results suggest that resources in public funded systems could be saved using mid-level providers in dental practices, without any health risk to patients or capital investment.
Collapse
Affiliation(s)
- Harry Hill
- School of Dentistry, The University of Manchester, Manchester, UK.,Manchester Centre for Health Economics, The University of Manchester, Manchester, UK
| | - Richard Macey
- Centre for Endrocinology and Diabetes, The University of Manchester, Manchester, UK
| | - Paul Brocklehurst
- North Wales Organisation for Randomised Trials in Health, Bangor University, Bangor, UK
| |
Collapse
|
16
|
Estai M, Kruger E, Tennant M. Role of telemedicine and mid-level dental providers in expanding dental-care access: potential application in rural Australia. Int Dent J 2016; 66:195-200. [PMID: 26846683 DOI: 10.1111/idj.12217] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Despite great progress in oral health over the past three decades, the rates of caries remain high in Australia, particularly among underserved populations. The reasons for poor oral health amongst underserved populations are multiple, but rests with socio-economic determinants of health. The present review considers international workforce models that have been created to enhance the recruitment and retention of dental providers in rural areas. Several strategies have been developed to address care access problems in rural areas, including the use of telemedicine and mid-level dental providers (MLDPs). Despite ongoing opposition from dentistry organisations, the Alaska and Minnesota workforce models have proven that developing and deploying dental therapists from rural communities has the potential to address the unmet needs of underserved populations. It is more efficient and cost-effective for MLDPs to perform triage and treat simple cases and for dentists to treat complicated cases. The use of MLDPs is intended to increase the capacity of the dental workforce in areas that are too isolated to entice dentists. Telemedicine has emerged as one solution to address limited access to health care, particularly in locations where there is a lack of providers. Telemedicine not only provides access to care, but also offers support, consultations and access to continuing education for practicing dental providers in rural areas. This strategy has the potential to free up resources to increase care access and reduce oral health disparities, thereby contributing to closing the rural-urban oral health gap.
Collapse
Affiliation(s)
- Mohamed Estai
- International Research Collaborative, Oral Health and Equity, Department of Anatomy, Physiology and Human Biology, University of Western Australia, Perth, WA, Australia
| | - Estie Kruger
- International Research Collaborative, Oral Health and Equity, Department of Anatomy, Physiology and Human Biology, University of Western Australia, Perth, WA, Australia
| | - Marc Tennant
- International Research Collaborative, Oral Health and Equity, Department of Anatomy, Physiology and Human Biology, University of Western Australia, Perth, WA, Australia
| |
Collapse
|
17
|
Dyer TA, Robinson PG. The acceptability of care provided by dental auxiliaries: A systematic review. J Am Dent Assoc 2015; 147:244-54. [PMID: 26581768 DOI: 10.1016/j.adaj.2015.09.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Revised: 09/21/2015] [Accepted: 09/28/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND Dental auxiliaries undertaking a limited range of intraoral clinical procedures normally performed by dentists could increase access to care and control costs, yet their acceptability to patients has been questioned. The aim of this study was to assess data on the social acceptability and patient satisfaction of dental auxiliaries performing intraoral clinical procedures. METHODS The authors searched 14 electronic databases and 2 trial registries for studies of any design (from inception to November 2013). They searched gray literature databases (from inception to July 2014), reference lists of included studies, and high-yield journals (from January 2000 to December 2014). Risk of bias was assessed, and data were extracted. RESULTS The authors identified 29 studies: 25 considered experiential and 4 on social acceptability. Twenty-three were cross-sectional, 2 were qualitative, 1 was mixed-methods, and 3 had unclear methods. The authors found that patients reported high acceptability of care, comparable or better than that from dentists. Social acceptability varied, with care for children being less acceptable. One-fifth of people were unwilling to receive any treatment from a dental auxiliary. All studies were at high risk of bias, and quality of the evidence was low. CONCLUSIONS Experiential acceptability of dental auxiliaries by patients appeared high in this study, but their social acceptability varied. PRACTICAL IMPLICATIONS Given the age of the studies, their settings, and their quality, generalizability to dental practices is limited. Additional high-quality, methodologically rigorous studies are needed.
Collapse
|
18
|
Clifford A, McCalman J, Bainbridge R, Tsey K. Interventions to improve cultural competency in health care for Indigenous peoples of Australia, New Zealand, Canada and the USA: a systematic review. Int J Qual Health Care 2015; 27:89-98. [PMID: 25758442 DOI: 10.1093/intqhc/mzv010] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2015] [Indexed: 11/14/2022] Open
Abstract
PURPOSE This article describes the characteristics and reviews the methodological quality of interventions designed to improve cultural competency in health care for Indigenous peoples of Australia, New Zealand, Canada and the USA. DATA SOURCES A total of 17 electronic databases and 13 websites for the period of 2002-13. STUDY SELECTION Studies were included if they evaluated an intervention strategy designed to improve cultural competency in health care for Indigenous peoples of Australia, New Zealand, the USA or Canada. DATA EXTRACTION Information on the characteristics and methodological quality of included studies was extracted using standardized assessment tools. RESULTS OF DATA SYNTHESIS Sixteen published evaluations of interventions to improve cultural competency in health care for Indigenous peoples were identified: 11 for Indigenous peoples of the USA and 5 for Indigenous Australians. The main types of intervention strategies were education and training of the health workforce, culturally specific health programs and recruitment of an Indigenous health workforce. Main positive outcomes reported were improvements in health professionals' confidence, and patients' satisfaction with and access to health care. The methodological quality of evaluations and the reporting of key methodological criteria were variable. Particular problems included weak study designs, low or no reporting of consent rates, confounding and non-validated measurement instruments. CONCLUSION There is a lack of evidence from rigorous evaluations on the effectiveness of interventions for improving cultural competency in health care for Indigenous peoples. Future evaluations should employ more rigorous study designs and extend their measurement of outcomes beyond those relating to health professionals, to those relating to the health of Indigenous peoples.
Collapse
Affiliation(s)
- Anton Clifford
- School of Public Health, University of Queensland, Brisbane, QLD, Australia
| | - Janya McCalman
- The Cairns Institute, James Cook University, Cairns, QLD, Australia
| | | | - Komla Tsey
- The Cairns Institute, James Cook University, Cairns, QLD, Australia
| |
Collapse
|
19
|
Brocklehurst P, Mertz B, Jerković-Ćosić K, Littlewood A, Tickle M. Direct access to midlevel dental providers: an evidence synthesis. J Public Health Dent 2014; 74:326-35. [DOI: 10.1111/jphd.12062] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Accepted: 05/02/2014] [Indexed: 11/29/2022]
Affiliation(s)
| | - Beth Mertz
- Preventive and Restorative Dental Sciences; School of Dentistry; University of California; San Francisco CA USA
| | - Katarina Jerković-Ćosić
- Research Centre for Innovation in Health Care; Hogeschool Utrecht University of Applied Science; Utrecht The Netherlands
| | - Anne Littlewood
- Cochrane Oral Health Group; School of Dentistry; The University of Manchester; Manchester UK
| | - Martin Tickle
- School of Dentistry; The University of Manchester; Manchester UK
| |
Collapse
|
20
|
Direct access to DCPs: what are the potential risks and benefits? Br Dent J 2013; 215:577-82. [DOI: 10.1038/sj.bdj.2013.1145] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2013] [Indexed: 11/09/2022]
|
21
|
Lamster IB, Formicola AJ. Lamster and Formicola Respond. Am J Public Health 2012. [DOI: 10.2105/ajph.2012.300678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Ira B. Lamster
- Ira B. Lamster and Allan J. Formicola are with the College of Dental Medicine, Columbia University, New York, NY
| | - Allan J. Formicola
- Ira B. Lamster and Allan J. Formicola are with the College of Dental Medicine, Columbia University, New York, NY
| |
Collapse
|
22
|
Albino JE, Inglehart MR, Tedesco LA. Dental Education and Changing Oral Health Care Needs: Disparities and Demands. J Dent Educ 2012. [DOI: 10.1002/j.0022-0337.2012.76.1.tb05236.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
| | - Marita R. Inglehart
- Department of Periodontics and Oral Medicine; School of Dentistry University of Michigan
| | - Lisa A. Tedesco
- Dean of the James T. Laney School of Graduate Studies; Emory University
| |
Collapse
|