Increasing access to emergency contraceptive pills through state law enabled dependent pharmacist prescribers.

Emergency contraceptive pills ("ECPs"), a form of contraception which has a 75% chance of preventing pregnancy when taken within 72 hours after unprotected intercourse, are currently available only by prescription. Increasing access to ECPs will help to reduce unintended pregnancies and abortions and will help to provide women with an extra level of control over their reproductive futures. Private access initiatives, while helpful, are insufficient to address the access problem; federal level solutions are unlikely to be implemented soon. Thus, this Article proposes that all states adopt the Washington model for dependent pharmacist prescribers, whereby state law enables physicians to create collaborative agreements with pharmacists, pursuant to which the physician can effectively delegate to a pharmacist in a retail setting the power to prescribe ECPs. Dependent pharmacist prescribing of ECPs increases access to contraception, increases patient satisfaction and decreasing cost, while preserving patient safety through screening mechanisms and the good safety profile of ECPs. A state-by-state analysis of pharmacy law reveals that while there is a national trend expanding the scope of pharmacy practice, states vary widely in the amount of prescribing power allowed to pharmacists. However, dependent pharmacist prescribing of ECPs is currently feasible in a few states and close in a number of others, and implementation of dependent pharmacist prescribing in some states may lead to greater nationwide acceptance of both dependent pharmacist prescribing and of ECPs.

Dental health findings in a Native American settlement.

In 1951, A. Dahlberg took casts of 82 children aged 8-17 who lived in the Sac-Fox Settlement near Tama, Iowa. In 1990, the Indian Health Service supported a survey of 44 survivors from the 1951 study. All were contacted and 23 were examined. The findings from this study were compared with findings from similar aged Sac-Fox residents surveyed in 1982, and with the residents of Iowa of a similar age surveyed in 1980. The DMFS score of the 1990 Sac-Fox samples was larger (92.4) than that for the Iowa Survey (75.3). The periodontal findings were similar in the three samples, with one exception, the category 6+mm pockets were seen more frequently in the 1990 Sac-Fox sample (13.0%) than in the 1982 Sac-Fox (8.7%) and 1980 Iowa (2.9%) samples. Mucosal lesions were observed much more frequently in the Sac-Fox 1990 (69.6%) and 1982 (65.2%) samples, compared to the 1980 sample (8.6%). The frequency of totally edentulous persons was also much greater in the Sac-Fox samples, as compared to the Iowa Sample. It appears that the 1982 recommendations for making preventive procedures available to Sac-Fox adults is still appropriate in 1990.

Dentists who practice with spouses or relatives: a pilot study of practitioners in Iowa.

Of 130 practicing dentists in Iowa surveyed, 73, or 6% of the practicing dentists in that state, responded that they worked with a total of 108 relatives. Half of the relatives were the dentists' spouses. One to ten relatives worked in each office. Overall, the dentists were satisfied with the associations and expected them to continue. Most dentists had informally defined associations, and 10% had written contracts. Dentists named "office policy and organization" most often and "finances" least often as motives behind the associations and "personal growth" most often and "recognition" least often as a satisfaction with the association. The respondents suggested 567 ideas for other dentists considering such associations.

Prevalence of root and coronal caries in a noninstitutionalized older population.

This paper describes the prevalence of coronal caries and root caries in a sample of 520 people representative of the noninstitutionalized, dentate population older than age 65 in two rural Iowa counties. The subjects were examined in their homes by trained dental examiners. All prevalence rates were age- and gender-adjusted. Both types of caries were prevalent in the population age 65 and older. If projections of increased numbers of older people and increased retention of teeth are reasonably accurate, caries in older populations may become a significantly greater dental problem, and increased prevention and treatment of caries will be needed for these people.

Risk factors for various levels of periodontal disease and treatment needs in Iowa.

A cross-sectional study of the non-institutionalized population of the State of Iowa was completed in 1980. Persons were interviewed by telephone and a follow-up dental examination was conducted in the home. Periodontal treatment needs were measured using the WHO-621 Index of Periodontal Treatment Needs which has been modified and is now known as the Community Periodontal Index of Treatment Needs. Findings were consistent with other recent studies, which have shown a relatively high proportion of gingival bleeding and calculus. Although moderate pocket formation (3-6 mm) occurs in approximately 30% of the adult population, complex treatment needs (pockets 6 mm or greater) occurred in only 1.3% of the population. While sex did not significantly affect the distribution of periodontal needs; age, recency of visit to the dentist and income are possible risk factors for serious periodontal disease.

Pilot results of DMF treatment time index.

The DMF Index and its components have been utilized by various researchers to measure aspects of the caries process ranging from prevalence of carious lesions to the amount of dental care needed. It is generally recognized that DMF Teeth (T) measures life-time caries experience and is not a good predictor of the amount of treatment time needed in population groups. The purpose of this study is to evaluate the ability of certain modifications of the DMFT components to predict the amount of treatment time needed. In a sample of 109 adult cases, normal and diseased conditions were coded along with the usual DMFT measures and the number of missing teeth needing replacement (NR). Corresponding treatment procedures related to caries (periodontal treatment was not coded) were recorded and then converted to treatment times using the Relative Productivity Unit (RPU). Stepwise multiple regression and discriminant analysis procedures were used. The number of D teeth was linearly related to treatment time, but the number of NR and M teeth were not. Regression procedures indicated that the square root values of D and NR were the best predictors of treatment time (RPU) and produced a multipler of 0.69. When patients were classified into categories of treatment time (low, medium, high), the DMF Treatment Time Index was able to correctly classify 70% of the cases into their appropriate treatment time category.

Dental needs and costs for patients from three social agencies.

This study indicates that for these patients studied from Johnson County, Iowa, the County Home residents have more unmet basic dental needs than do patients from Goodwill Industries or Community Action programs. The mean cost of treating the dental needs of a County home resident was found to be approximately twice that of providing dental services to the other two social service agencies. This cost differential comes about as a result of two major factors: (1) the County Home residents seen have more unmet basic dental needs, and (2) they have proportionately more unmet dental needs in specialty areas that cost more per unit of treatment (i.e. periodontics, fixed prosthodontics, and removable prosthodontics). The mean treatment cost per patient seen from each of these agencies is $851.77 for County Home residents, $407.97 for Goodwill Industry clients, and $341.21 for Community Action clients. A follow-up of this study in regard to specific circumstances that contribute to the higher incidence of dental treatment needs of the Johnson County Home residents is recommended. Such additional information would be helpful to the effective design of dental health programs for implementation at the community level.

Dentistry and the county home resident: a statewide survey.

A flow chart (illustration) depicts the delivery process whereby county home residents either receive or do not receive dental treatment. Also included are the major findings of the survey, given in triangles A, B, and C. The initial step involved in this delivery process is that of recognizing a need. If the need is not recognized, it remains unmet and the patient receives no treatment (terminate). If the need is recognized, a treatment decision is required. If the decision is negative, the need remains unmet and the patient receives no treatment. If the decision is positive, the patient proceeds toward the goal of receiving dental treatment. However, potential delivery problems exist and the patient may have to overcome one or more of these before proceeding toward the goal. If problems do exist and are not resolved, the patient either does not receive treatment or treatment is delayed until satisfactory solutions are found. The first finding, A, shows that more than 72% of dental needs were identified because of some dental emergency experienced by the patient, 39.3% of needs were identified through routine checkups, 16.4% by a county home requirement, 14.8% through a state requirement, and 4.9%, "other." The second finding, B, shows that the county home steward makes the decision about whether dental treatment should be rendered in more than 85% of the homes. Physicians made 54.1% of the dental treatment decisions; nurses, 31.1%; dentists, 26.2%; patients, 24.6%; patient's family, 13.1%; supervisor or trustee, 4.9%; and "other," 3.3%. The third finding, C, represents delivery problems. More than 44% of the stewards said that the patient's mental or physical disabilities were a delivery problem; 39.3% indicated availability of dentists; 36.1% said reluctance of patient; 19.7% responded inadequate funding; and 14.8% indicated "other." A hypothetical county home resident can be dentally characterized as an emergency patient whose need for treatment is determined by a county home steward, and the main problem in obtaining treatment, according to the steward, is the patient's own inability to receive treatment because of mental or physical disabilities, or both.