The New Providers WA State. Important State Document. Hospital ER Visits: Washington State

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1 The New Providers WA State Professor Rebecca L. Stolberg, RDH, BSDH, MSDH Important State Document Washington State s Oral Health Workforce (December 2009) The size of the workforce may not keep pace with the increasing oral health needs of the state s population. Workforce must respond to the rising rate of childhood caries and also provide dental care for the elderly who are retaining more of their own teeth. Washington s population is expected to grow 24% between and 80% for seniors during this time frame. The state needs to explore new alternative dental providers ½ of the current dentists may retire within 15 years The traditional dental team lacks a provider similar to the medical profession s nurse practitioner or physician assistant. Hospital ER Visits: Washington State ERs throughout the state are seeing thousands of repeat patients with unresolved dental problems due to lack of access to dental care Spokane County: the number of ER visits for a dentalrelated diagnosis has more than doubled over the last five years, from 2,183 visits in 2005 to 4,676 in 2009 Cost is 4.1 million per year/$778 per visit year olds visit the most 26% same person more than 3 times! Wallace Liz. Oral health ER data results Presentation at the Spokane Oral Health Coalition. April 16,

2 WA Lack of Dental Access One third (25-35%) all adults in Washington State did not have a dental visit in the last year. Fifty percent (50%) of those who did not have a visit indicated economic factors as the reason the remaining cited reasons which include: physically compromised, institutionalization, living in remote areas without access to dentistry. (ADA 2009) Washington Dental Access Campaign? Multi-member coalition of dental and policy advocacy groups WSDHA is a member, along with the Children s Alliance, Washington Community Action Network (WACAN), SeaMar Community Health Clinic, Indian Health Services Board, Senior Coalition, WA State Emergency Room Physicians, and others TWO Different Providers Proposed Dental Practitioner Dental Hygiene Practitioner 2

3 Dental Practitioner Possess a high school education Complete a dental health aide therapist education program (Alaska model) Complete 400 hours preceptorship under the supervision of a dentist Pass an exam Dental Hygiene Practitioner License in good standing as a dental hygienist Complete post-baccalaureate education program at an accredited institution Complete 250 hours of advanced dental therapy clinical practice under the supervision of a dentist Pass an exam Dental hygiene scope of practice plus additional restorative procedures Written Practice Plan Contract The contract must specify: Practice settings Limitations on the services or procedures that are provided Age and procedure-specific practice protocols Procedures for creating and maintaining patient records A plan to manage medical emergencies A quality assurance plan for monitoring medical emergencies Protocols for administering and dispensing medications Criteria relating to the provision of care to medically fragile patients Written protocols when patient requires treatment beyond scope of practice 3

4 Contract continued Contract must be filed with the Dept. of Health annually 1 dentist may enter into contract with maximum of 5 dental practitioners/dental hygiene practitioners Bills in both House and Senate House Bill had 9 sponsors Senate Bill had 5 sponsors Duties allowed: Fabrication of athletic mouth guards Placement of temporary restorations Fabrication of soft occlusal guards Tissue conditioning and soft reline Atraumatic restorative therapy Dressing changes Tooth reimplantation Administration of local anesthetic Administration of nitrous oxide Emergency palliative treatment of dental pain 4

5 More Duties The placement and removal of space maintainers Cavity preparation Restoration of primary and permanent teeth Placement of temporary crowns Preparation and placement of preformed crowns Pulpotomies on primary teeth Indirect and direct pulp capping on primary and permanent teeth Stabilization of reimplanted teeth Extractions of primary teeth More duties Suture removal Repair of defective prosthetic devices Recementing of permanent crowns Oral evaluation and assessment of dental disease and the formulation of an individualized treatment plan The supervision of expanded function dental auxiliaries and dental assistants Nonsurgical extractions of periodontally diseased permanent teeth with tooth mobility of plus 3 to plus 4 if the teeth are not unerupted, are not impacted, are not fractured, and do not need to be sectioned for removal More duties The dispensation and administration of the following drugs: analgesics anti-inflammatories preventive medicaments antibiotics 5

6 Curriculum includes Leadership Practice Management Special Needs Populations Issues in Health Care Delivery Systems Pain Management Restorative Advanced Diagnosis Research and Grant Writing Disease Prevention and Epidemiology EWU Curriculum Layout Suggested Post Baccalaureate Graduate Certificate in Dental Hygiene: Possible Title: ADVANCED DENTAL HYGIENE THERAPIST Summer Quarter (required for those students not passing admissions competency exam) Fall Quarter Winter Quarter Spring Quarter Summer Quarter DNHY 557 DNHY 560 Intro to DNHY 575 DNHY 661 Community Based Advanced Anesthesia Operative Dentistry Pharmacological Primary Oral Healthcare II (3) (1) Technique (5) Principles of Clinical Therapeutics (4) DNHY 559 Basic DNHY 570 DNHY 660 Community DNHY 675 Advanced Specialty DNHY 680 Supervised Restorative Advanced Health Based Primary Oral Fieldwork (3) Community Externship (3) Procedures (5) Assessment and Healthcare I (3) Followed by 1,000 hour Diagnostic Reasoning externship requirement in (3) order to be un-supervised. Externship required at an Indian Tribal Clinic or other Public Health type clinic that is identical to where they will be working DNHY 670 Management of Dental Emergencies and Urgent Care (2) Total Credits: 26 credits (+5-6 if competency needs to be obtained in basic restorative and anesthesia procedures) Admissions 1,000 hours of clinical dental hygiene practice Undergraduate dental hygiene curriculum must document completion of courses in local anesthesia and restorative dentistry Bachelor of Science Degree in dental hygiene or a health-related field 3.0 undergraduate GPA Current dental hygiene license in the U.S. (must meet Washington requirements including nitrous oxide, local anesthesia and restorative) Pass a competency in placement and carving of both amalgam and composite restorations Personal interview Personal narrative 6

7 2013 Legislative Efforts This is our 3 rd year trying Both House and Senate bills didn t make it out of health care committees mid-february Major Accomplishments: -More coalition members than ever: 5 to 65 -More Senator and Representative backers -State dental association not viewed favorably in state capital -Survey of public for title use word practitioner -Learned from nurse practitioners quit comparing to them Other successes: Able to work collaboratively with the dental association to pass rule definitions on the use of topical anesthetic This was key to over 50+ lawsuits against senior center/nursing home dental hygienists who were using topical without the direct supervision of a dentist Questions? 7

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