Florida Oral Health Conference PowerPoint Presentation, PPT - DocSlides

Florida Oral Health Conference PowerPoint Presentation, PPT - DocSlides

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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 – . ID: 530734

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Slide1

Florida Oral Health Conference

August 2012

Ron Nagel DDS MPH

CAPT USPHS (ret)

Slide2

Barriers to Access

Geographic (distribution)Economic (capacity)Cultural (social)

Slide3

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

Slide4

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

Slide5

Clinical Guidance

Slide6

AFHCAN CartAlaska Federal Health Care Access Network

Wireless NetworkingTouchscreenMobile – CustomizedConsultationPatient educationProvider educationWWW. AFHCAN.ORG

Slide7

Slide8

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

Slide9

“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

Slide10

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

Slide11

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

Slide12

DENTEX Training Program

University of Washington MEDEX NorthwestTwo year program based on NZ, Canadian, and other modelsIntegration into community based prevention programs throughout trainingA new mix of skills that includes the behavioral and public health skills needed to affect changeThe use of simulation and extensive patient contact to develop a high level of skill

Slide13

Alaska DHAT training program information:

First year: 40 weeks Second year: 39 weeksTotal: 79 weeks (3160 hours)

Curriculum Break-down first yearBiological Science: 30%Social Science: 10%Pre-clinic: 40%Clinic: 20%

Curriculum Break-down second yearBiological 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)

Slide14

2 year vs. 3 year combined RDH programs

CostInfrastructureCareer opportunitiesProvider Demographics

Slide15

The truth about motivation and changing behavior…

Motivated

by

information

Not going to

be motivatedright now

Motivated by how I interact with provider over time

10 %

10 %

Miller & Rollnick, Motivational Interviewing, 2002

80 %

Slide16

Foundations for Great Primary Care

Effective Relationships = Empanelment + Access + Continuity

Slide17

Slide18

What should new providers look like?

Slide19

Slide20

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.

Slide21

"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


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