Indian Country Leads National Movement to Knock Down Barriers to Oral Health Equity.

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.

Profile: Joseph Marek: 2016-17 ASCP President.

It was four months in Alaska, in the middle of winter, that changed Joseph Marek's view of what it means to be a pharmacist. Marek was on his last rotation in pharmacy school when he experienced the kind of practice that he wanted for himself. He found that kind of practice as a consultant pharmacist, and next month, Marek, 49, will become the 2016-2017 president of the American Society of Consulting Pharmacists. Working at the Public Health Service (PHS) in the Arctic Circle in 1990, he dispensed and carried out clinical duties with the chief pharmacist and provided care to the native Inuit population through the Indian Health Service. "PHS had a walk-in clinic where the physicians worked closely with the pharmacist to do medication management for the patients," he said. The pharmacists also provided medications to the surrounding villages (50,000 square miles) and had to coordinate the dispensing/delivery of these medications when the physicians visited them. "The doctors highly valued the pharmacists' clinical knowledge, and it was a great environment to learn how to collaborate with the medical/health care team to benefit the Inuits," he said. "Everyone worked together and you could see the outcomes quickly."

A history of the Alaska physician assistant, 1970-1980.

The introduction of physician assistants (PAs) into Alaska began in 1971 with seven MEDEX Northwest students, who were paired with physician preceptors for 12 months. Scores of PAs were recruited as health officers on the Trans-Alaska Pipeline System starting in 1974, and by 1977 the state had 200 PAs. In 1979, the Alaska Board of Medical Examiners ratified the first set of regulations and began issuing licenses the following year. Throughout the 1970s and following pipeline completion, more PAs were employed by private, state, and federal agencies to meet the needs of a growing population. Forty years later, Alaska has one of the richest legacies in PA deployment of any state. This article is based on the authors' memories, communications with those involved in the program, and historical documents archived at the MEDEX Northwest Physician Assistant Program at the University of Washington in Seattle, along with Alaskan archival sources.

Size and perspective in Alaska.

By far America's largest state, Alaska has only 350 members, so effective communication matters in overcoming distance. Alaska has led the way in direct reimbursement, diversity in leadership, member involvement, and a distinctive lifestyle for its practitioners. The tripartite structure of organized dentistry is crucial in building understanding the issues involved in providing oral health care to the members of this vast state.

Occupational homicide--Alaska, 1993.

During 1980-1992, approximately two homicides occurred at work each year in Alaska; however, in 1993, homicide was the third most frequent cause of occupational fatality (n = 11), following aircraft crash (n = 23) and drowning (n = 20). This report summarizes the 10 incidents resulting in these 11 occupational deaths in 1993.

Provision of health care in a frontier setting: an Alaskan perspective.

The Community Health Aide Program is the Indian Health Service's answer to to the provision of care to 45,000 Alaska Native people living in remote areas of the state. Community health aides are local people who live and work in their villages. They offer health services from emergency to preventative care with the help of their referral physician, who may be up to 1,300 miles away. Nurse practitioners play an important role in the training and supervision of community health aides. This article gives an overview of the program, its successes and problems, with implications as a health care delivery model for care in other underserved areas of the United States.