Impact of an Interprofessional Education Intervention and Collaborative Practice Agreements of Expanded Practice Dental Hygienists in Oregon.

Purpose: The state of Oregon developed the expanded practice dental hygienist (EPDH), to address oral health care disparities. The establishment of collaborative practice agreements between dental hygienists (DH) and physician assistants (PA), has created a need for interprofessional education (IPE) for future interprofessional collaboration with EPDHs. The purpose of this study was to assess the impact of an IPE intervention on future interest in collaborative practice agreements.Methods: Current and former DH and PA students from Pacific University Oregon (n=420) were invited to participate in an electronic survey. The 39-item survey included questions related to an annual IPE activity and questions related to collaborative practice agreements between PAs and EPDHs. Descriptive statistics were used to analyze the data.Results: A total of 80 DHs and PAs completed the survey for a response rate of 19%. There were high levels of agreement between DHs and PAs in regards to valuing the expertise of other health care providers, teamworking skills and interprofessional collaboration for a better understanding of a patient's condition. Only 18.9% (n=7) of the DH respondents and 25.6% of the PA respondents (n=11) were aware of the collaborative practice agreements for Oregon EPDHs.Conclusion: Participants from DH and PA disciplines agreed patient care is improved by collaborative practice fostered through interprofessional education activities. Multiple approaches may be needed to increase knowledge on the EPDH collaborative practice agreements with PAs in Oregon.

Practice Patterns and Attitudes of Expanded Function Dental Auxiliaries in the State of Maine.

Purpose: Various workforce models, including the expanded function dental auxiliary (EFDA), have been created as a means to address the crisis in oral health access. Limited assessments have been conducted regarding the effectiveness of the EFDA. The purpose of the study was to assess the implementation, geographic practice patterns and attitudes regarding the education of EFDAs in the state of Maine.Methods: Licensure information on the Expanded Function Dental Auxiliaries (EFDA) in Maine was obtained from the Board of Dental Practice. A 19-item survey consisting of closed and open-ended questions pertaining to practice demographics, settings, procedures and attitudes towards basic and ongoing continuing education was sent both via email and traditional mail to all EFDAs licensed in Maine (n=75). Descriptive statistics were used to analyze the data.Results: A response rate of 59% (n=43) was achieved. A majority of EFDAs (60%, n=26) were employed in private dental practices; 12% (n=5) practiced in a community/public health setting. Regarding access to care, 51% (n=22) stated that their practice did not accept Medicaid coverage. However, over half indicated feeling that they were making moderate to significant impact on increasing access. A little more than one third (35%, n=17) reported working in Penobscot County, which is not a designated provider shortage area. A majority of respondents reported less than half of their continuing education courses were relevant to EFDA practice.Conclusions: EFDA practitioners are providing needed oral health care services, however they may not be providing access to care for the intended at-risk and underserved populations in designated geographic areas. Practice patterns of EFDAs in Maine should be assessed in greater depth.

Attitudes and Access Patterns of Michigan Veterans Ineligible for Oral Healthcare Benefits: A cross-sectional study.

Purpose: Strict eligibility criteria exclude a majority of the veteran population from receiving oral healthcare benefits through the Veterans' Administration Dental Care program (VADC). The purpose of this study was to examine perceptions of oral health status, and access/barriers to dental care of veterans who are ineligible for VADC benefits.Methods: This cross-sectional study was conducted using a 24-item paper survey, disseminated in person to 227 veterans across the state of Michigan over a period of two months. Items included socio-demographic information, questions regarding perceptions of oral health, access to dental care, and perceived barriers. Descriptive statistics were collected to provide an overview of the data.Results: A response rate of 80% (n=182) was achieved. Veterans who perceived themselves as having a poor oral health status were less likely to have a dental home (p=.000) or receive dental care (p=.001). Respondents were more likely to report cost as a barrier (p=.000), and to report having had a toothache during the past 12-months (p=.000).Conclusion: Results from this study indicate that while veterans in general value the importance of oral healthcare, cost and time are significant barriers to accessing dental care for individual's ineligible for VADC benefits. Veterans who perceive themselves as having poor oral health are more likely to report oral health disparities. Further research is needed to impact Veterans Administration policy and decrease oral health disparities.

Interprofessional Education in U.S. Dental Hygiene Programs: Program Director Responses Before and After Introduction of CODA Standard 2-15.

A 2014 survey found that dental hygiene program directors perceived interprofessional education (IPE) as a priority for themselves and the dental hygiene profession in the U.S. The aim of this study was to explore whether IPE collaborations in dental hygiene programs and program directors' attitudes changed from 2014 to 2017 since the Commission on Dental Accreditation (CODA) Standard 2-15 on IPE was introduced in August 2016. In May 2017, directors of all 325 U.S. dental hygiene programs were invited to participate in a web-based survey. A total of 117 directors responded, for a 38% response rate, and their responses were then compared with the responses in 2014 (that survey had a 33% response rate). The results showed that, while the percentage of responding dental hygiene programs with a nursing program on campus had decreased (90% to 80%; p<0.022), the likelihood of having other health care-related programs on campus did not change. In 2017 as compared to 2014, the programs were still most likely to collaborate with nursing (50% vs. 46%) and other allied health professions (44% vs. 56%) and in intraprofessional education with dental assisting programs (41% vs. 41%). IPE was still most likely to occur in volunteer activities (68% vs. 73%), basic science courses (65% vs. 60%), and communications training (63% vs. 63%). In 2017, program directors rated IPE as less challenging for programs to manage than in 2014 (on five-point scale with 1=not at all challenging: 3.31 vs. 3.62; p=0.022). However, the responding directors did not view IPE as being as important to the profession in 2017 as the respondents reported in 2014 (3.29 vs. 3.88; p<0.001). The majority in 2017 agreed/strongly agreed that Standard 2-15 will improve the profile of dental hygiene as part of the health care team (77%) and contribute to integrating dental hygiene into interprofessional care (IPC) teams (78%). Overall, this study found that the introduction of an explicit IPE dental hygiene CODA standard in 2016 had already resulted in changes after only one year. However, the responding program directors' lower agreement with statements concerning their graduates' IPC-related competence deserves further attention.

Interprofessional Education in Dental Hygiene Programs and CODA Standards: Dental Hygiene Program Directors' Perspectives.

Purpose: The Patient Protection and Affordable Care Act changed the paradigm of health care delivery by addressing interprofessional education (IPE) and care (IPC). These considerations, combined with evolving dental hygiene (DH) workforce models, challenge DH educators and clinicians alike to embrace IPE and IPC. The objectives of this study were to determine DH program directors' perceptions of the importance of IPE, to assess current and planned activities related to Commission on Dental Accreditation (CODA) standards that imply competency in IPE, and assessment of outcomes.Methods: Email addresses of the 322 entry-level, DH program directors in the United States were obtained from the American Dental Hygienists' Association and a web-based survey was developed based on the American Dental Education Association Team Study Group on Interprofessional Education. Descriptive statistics were computed for the responses to the closed ended questions and answers to open-ended questions were transcribed and thematically coded.Results: A response rate of 30% (N = 102) was obtained from the DH program directors. While the respondents indicated that they personally considered IPE to be important, one-third reported that IPE was not a priority for their academic institution. The majority of current IPE activities related to the 2014 CODA Standards 2-17, 2-26 and 2-19 were clinic-based (Standards 2-17 and 2-19: N=49; Standard 2-19: N=64). Fewer classroom-based activities were reported (N=12 vs. N=25). The respondents planned 27 clinic-based, 9 classroom-based and 51 other future IPE-related activities. Competency assessment was mostly determined with clinic-based activities (N=43) and other activities such as rubrics (N=16) and the development of IPE assessment tools (N=10). Thirty-three respondents named positive aspects of IPE and 13 saw IPE as relevant for the dental hygiene profession.Conclusion: Accountable accreditation standards have been identified as the driver of change for incorporating IPE, making an explicit IPE standard for dental hygiene education an important agenda item for the profession.

Factors Associated with the Economic Sustainability of the Registered Dental Hygienist in Alternative Practice.

Purpose: The purpose of this study was to investigate key factors associated with the economic sustainability of the Registered Dental Hygienist in Alternative Practice (RDHAP).Methods: An invitation to participate in a 38-question electronic survey was sent via postal mail to 440 RDHAP licentiate addressees obtained through the Dental Hygiene Committee of California (DHCC). Legal restrictions did not allow for obtaining the RDHAP licentiate email addresses from the DHCC. The survey was disseminated via email to the 254 RDHAPs who were members of the California Dental Hygienists' Association. Additional invitations to participate were made via flyer distribution at an RDHAP symposium, and on RDHAP only social media sites.Results: The response rate was an estimated 16%. While 44% of the RDHAPs reported some employment in a traditional dental practice, given the opportunity, 61% of these respondents indicated that they would practice exclusively as an RDHAP. With regard to practice strategic planning and alliances, 31% felt that dentists lacked knowledge of the RDHAP, and 25% indicated dentists were resistant to this workforce model. Regarding RDHAP practice staffing patterns, 75% indicated not having any employees. When asked about business systems, 64% had solo, portable practices and 16% had standalone practices. Economic sustainability challenges included practice business/equipment expenses (29%), insurance/reimbursement issues (21%), patient flow (19%) and RDHAP visibility (14%).Conclusions: RDHAP practices face challenges including the need for strategic planning and intra- and inter-professional alliances, efficient and effective patient flow, optimal staffing patterns and effective business systems. Focus on enhancing RDHAP visibility within the dental and medical communities should be a priority. In addition, further research should explore RDHAPs aligning with community-based clinics, Federally Qualified Health Centers and Dental Support Organizations (DSOs) with a commitment to disease prevention in addition to the financial resources and staff to manage practice business systems.

Interprofessional Education in U.S. Dental Hygiene Programs: A National Survey.

Although there are many benefits of interprofessional health care, no previous research has sought to define the status of interprofessional education (IPE) in U.S. dental hygiene programs. The aims of this study were to assess how these programs engage in IPE, the challenges they encounter, and the value they place on IPE. Additionally, the study explored how program characteristics are related to IPE. Data were collected with a web-based survey sent to all 322 U.S. dental hygiene program directors (response rate: 33% of the 305 successfully contacted). The majority of the responding programs were located at institutions with nursing (90%) and other allied health programs (85%). They were likely to collaborate with nursing (50%), other allied health (44%), and dental assisting programs (41%), but were less likely to collaborate with dental schools (28%). IPE was most likely to occur in volunteer activities (68%), basic science courses (65%), and communication training/behavioral science courses (63%/59%). The most frequently reported challenges for IPE were schedule coordination (92%) and curriculum overload (76%). The majority of the respondents agreed that IPE was a priority for the dental hygiene profession in the U.S. (59%) and for the program directors personally (56%). Programs granting bachelor degrees were more likely to have IPE as a priority than programs that did not grant such degrees (scale of 1-5 with 5=most important: 3.81 vs. 2.88; p<0.01). The longer the students spent in the programs, the more those programs engaged in IPE (r=0.21; p<0.05). The data collected in this study can contribute to future efforts to help dental hygiene programs engage in meaningful IPE and contribute to developing interprofessional care in the U.S. health care system.

Accuracy of digital arm and wrist manometers: clinical implications for the dental hygienist.

PURPOSE: Utilization of digital manometers chairside is fast becoming a standard of care in dental hygiene education. It is imperative to ensure accurate blood pressure measurements regardless of modality to avoid medical emergencies in the dental chair. This study sought to determine the accuracy of the automated digital arm and wrist cuffs utilized by students in the University of Maine at Augusta, Bangor Campus Dental Health Programs' dental hygiene clinic. METHODS: After institutional review board approval, 121 subjects were recruited, with 21 excluded for a total of 100 subjects. Subjects were randomly assigned to different test modalities upon check-in. Initial blood pressure measurements were taken with a calibrated aneroid control device by a principal investigator. A second measurement was taken with the randomized arm or wrist manometer 5 minutes later. Investigators were blinded to the modality of test manometer and measurements obtained from the second reading. All readings were taken according to manufacturers' instructions to ensure technique consistency. RESULTS: Data indicated lower readings for each modality from the control for both systolic and diastolic measurements. The differences in the systolic and diastolic readings for the wrist modality were significantly lower than the control with (p= 0.000) and (p=0.000), respectively. CONCLUSION: Automated digital manometers should be used with caution as a screening tool in the dental setting, particularly when administration of pharmacological agents such as local anesthesia may be used during the course of treatment. These automated modalities should not be used for patients with cardiac or hypertensive conditions.

The role of the student professional association in mentoring dental hygiene students for the future.

The purpose of this study was to determine the role of the Student American Dental Hygienists' Association (SADHA) in mentoring/developing dental hygiene students for the future. This project also assessed attitudes and practices of SADHA advisors towards the utilization of SADHA as a mechanism for mentoring dental hygiene students' professional development to meet the oral health needs of the public, and the goals of the ADHA. These goals include promotion of education beyond the baccalaureate level to develop qualified faculty, encouraging dental hygiene research, and promoting leadership. The study also evaluated if geographic region and academic setting impacted the utilization of SADHA. After IRB exemption, a pilot-tested questionnaire was administered using Survey Monkey, an online survey website, to 277 individual contacts at Commission on Dental Accreditation (CODA) accredited dental hygiene programs. A response rate of 68% was achieved with 186 individual responses. Eighty percent of respondents indicated offering no mentoring opportunities outside of the curriculum, while incongruously, 58.3% felt they actively mentor through SADHA. When asked what the main focus of SADHA should be, SADHA advisors ranked community service/philanthropy as number one. SADHA chapters at institutions that offer a Bachelor of Science in Dental Hygiene (BSDH) degree completion program offer more mentoring opportunities (p= or <.001). Programs offering the BSDH offer a wider variety of topics from guest speakers (p=.038). SADHA chapters in Western states have a higher graduate membership conversion rate than other regions (p=.018). SADHA advisors do not agree on how SADHA should be utilized. The majority of SADHA chapters are not offering mentoring opportunities outside of the traditional curriculum for leadership and career development. What is clear is that both students and advisors desire more interaction with the local ADHA components and constituents. In order to address these issues, efforts should be made to provide networking support among SADHA advisors and increase faculty perception of the importance of the professional association and the role of students in its future. The ADHA should consider developing a mentoring program that builds strong partnerships among all state constituent and components and SADHA.