Safety net patients' satisfaction with oral health services by provider type and intent to return for more care.

OBJECTIVES: This study examined patients' satisfaction with services provided by different oral health providers, their intent to return for additional care, and associations with patients' demographics and service characteristics. METHODS: Descriptive analyses and multivariable ordinal logistic regressions were conducted using survey data from 898 patients who received care at Apple Tree Dental (ATD) in Minnesota during 2021. The questionnaire included 12 statements on patient satisfaction with the clinician's ability to explain the dental diagnosis and treatment options, to be considerate of the patient's needs and dental anxiety, and to provide technically competent services. RESULTS: In general, patients reported high satisfaction with dental care and a strong intent to return to ATD for future services. No significant differences in patient satisfaction were observed by provider type. Patients' intent to return was higher among non-White respondents (OR = 1.76; 95% CI = 1.06-2.92) and patients who were more satisfied with their providers' technical competence/treatment (OR = 1.47; 95% CI = 1.37-1.57). The association between intent to return and patient satisfaction with providers' information/communication was stronger for patients treated by dental hygienists. The association between intent to return and patient satisfaction with providers' technical competence/treatment was also stronger for patients who were more satisfied with providers' information/communication and understanding/acceptance, and for those treated by their desired or usual provider. CONCLUSIONS: The study underscores the benefits of introducing dental therapists to the oral healthcare team, showing that this can be achieved without sacrificing either the quality of patient care or patient satisfaction.

The Impact of Pandemic Concerns on Consumers' Teledentistry Use During the First Months of the COVID-19 Pandemic.

OBJECTIVES: The COVID-19 pandemic affected consumers' access to oral health care. This study evaluated factors associated with teledentistry use among US adults from June 2019 through June 2020. METHODS: We used data from a nationally representative survey of 3500 consumers. We estimated teledentistry use and adjusted associations with respondents' concerns about the impacts of the pandemic on health and welfare and with their sociodemographic characteristics using Poisson regression models. We also analyzed teledentistry use across 5 teledentistry modalities (email, telephone, text, video conferencing, and mobile application). RESULTS: Overall, 29% of respondents used teledentistry, and 68% of teledentistry users reported doing so for the first time because of the COVID-19 pandemic. First-time teledentistry use was positively associated with a high level of pandemic concerns (relative risk [RR] = 5.02; 95% CI, 3.49-7.20), age 35-44 years (RR = 4.22; 95% CI, 2.89-6.17), and annual household income $100 000-$124 999 (RR = 2.10; 95% CI, 1.55-2.84) and negatively associated with rural residence (RR = 0.68; 95% CI, 0.50-0.94). Having a high level of pandemic concerns (RR = 3.42; 95% CI, 2.30-5.08), young age (age 25-34 years: RR = 5.05; 95% CI, 3.23-7.90), and higher level of education (some college: RR = 1.59; 95% CI, 1.22-2.07) were strongly associated with teledentistry use for all "other" users (ie, existing or first-time use because of reasons unrelated to the pandemic). Most first-time teledentistry users used email (74.2%) and mobile applications (73.9%), whereas "other" teledentistry users used telephone communication (41.3%). CONCLUSIONS: Teledentistry use during the pandemic was higher in the general population than among those for whom teledentistry programs were originally designed (eg, low-income, rural populations). Favorable regulatory changes to teledentistry should be expanded to meet patient needs beyond the pandemic.

Parental Perspectives on Barriers to Pediatric Oral Health Care: Associations with Children's And Families' Characteristics.

PURPOSE: The purpose of this study was to identify barriers to oral health services experienced by children and evaluate variation across demographic and socioeconomic population groups. METHODS: The data were collected from 1,745 parents/legal guardians who responded to a web-based survey regarding their children's access to health services in 2019. Descriptive statistics and binary and multinomial logistic models were used to examine barriers to needed dental care and factors contributing to differential experiences with those barriers. RESULTS: A quarter of children of responding parents experienced at least one barrier to oral health care, most commonly cost-related barriers. Child-guardian relationship type, having a pre-existing health condition, and dental insurance type increased the risk of encountering certain barriers two-to four-fold. Children with a diagnosed emotional, developmental, or behavioral condition (odds ratio [OR] equals 1.77, dental anxiety; OR equals 4.09, unavailability of needed services) and those with a Hispanic parent/guardian (OR equals 2.44, lack of insurance; OR equals 3.03, insurance not paying for needed services) were more likely to encounter various barriers than other children. The number of siblings, parent/guardian's age, education level, and oral health literacy were also associated with different barriers. The likelihood of encountering multiple barriers was over three times higher for children with a pre-existing health condition (OR equals 3.56; 95 percent confidence interval equals 2.30 to 5.50). CONCLUSIONS: This study highlighted the significance of cost-related barriers to oral health care and suggested disparities in access among children with disparate personal and family backgrounds.

Exploring the impact of household, personal, and employment characteristics on dentistry's income gap between men and women.

BACKGROUND: This study provides an update on the income gap between men and women in dentistry, evaluating the impact of dentists' household, personal, and employment characteristics on income differences. METHODS: This cross-sectional study used data from the US Census Bureau's 5-year American Community Survey (2014-2018). Data were analyzed using descriptive statistics and regression analysis (ordinary least squares regressions, Oaxaca-Blinder regression decomposition on logged personal income). RESULTS: Female dentists were less likely to be White and born in the United States and more likely to be bilingual than male dentists. Adjusted estimates indicated that male dentists earned 22% more than female dentists (risk ratio, 1.22; 95% CI, 1.15 to 1.29). Black dentists earned 24% less (risk ratio, 0.76; 95% CI, 0.68 to 0.85) and other race non-Hispanic dentists earned 17% less (risk ratio, 0.83; 95% CI, 0.70 to 0.97) than non-Hispanic White dentists, after adjustment for covariates. Dentists with a nondentist partner or spouse earned more than those without a partner or spouse, and dentists with 3 or more children earned 19% more than those who were childless (P < .001; 95% CI, 1.09 to 1.31). The income gap between sexes was $51,784 (in 2018 dollars); 27.2% of this gap was explained by observable personal (that is, race and ethnicity, bilingualism), employment (for example, hours worked and employee or ownership status), and household (for example, partner or spouse occupation and education) characteristics. CONCLUSIONS: The dental workforce is diversifying, but sex and racial disparities in income persist. The income gap between sexes, although reduced over time, is now less explainable than in the past. PRACTICAL IMPLICATIONS: The diversification of the dental workforce is a promising sign for an increasingly diverse population's present and future oral health, but it is important that existing income gaps between men and women are addressed.

Teledentistry: Increasing utilisation of oral-health services for children in rural areas.

INTRODUCTION: The objective of this study was to evaluate factors influencing utilisation of follow-up oral-health services in general dentistry clinics among children subsequent to a teledentistry consultation and treatment with a paediatric dental specialist. METHODS: Conducted in 2017, the study included 144 children living in rural upstate New York who experienced a teledentistry consultation in 2015-2016 at one of several local general dentistry clinics. A remotely located paediatric dental specialist provided consultation services in the teledentistry visit and treatment services in the specialty dental clinic. Associations between follow-up services at the general dentistry clinics and patients' characteristics, specialty treatment recommendations, case-management services, timeliness of treatments and travel distances were evaluated. RESULTS: The study results indicated that most children completed a treatment plan (97.2%) at the specialty clinic and subsequently accessed follow-up oral-health services at one of the local general dentistry clinics (77.1%) where teledentistry services were provided. Children's utilisation of follow-up services in general dentistry clinics was associated with a shorter time to specialty treatment (p = 0.013) and fewer case-management contacts (p = 0.004). Children who had a longer time to treatment initiation (p < 0.001) or completion (p = 0.043) required significantly more case-management services than other children. DISCUSSION: The study found that case severity and compliance with treatment were predictors of utilisation of oral-health services in general dentistry clinics. An additional finding was that case-management interventions were important in facilitating specialty dental care.

Dental Therapists in the United States: Health Equity, Advancing.

BACKGROUND: Dental therapists (DTs) are primary care dental providers, used globally, and were introduced in the United States (US) in 2005. DTs have now been adopted in 13 states and several Tribal nations. OBJECTIVES: The objective of this study is to qualitatively examine the drivers and outcomes of the US dental therapy movement through a health equity lens, including community engagement, implementation and dissemination, and access to oral health care. METHODS: The study compiled a comprehensive document library on the dental therapy movement including literature, grant documents, media and press, and gray literature. Key stakeholder interviews were conducted across the spectrum of engagement in the movement. Dedoose software was used for qualitative coding. Themes were assessed within a holistic model of oral health equity. FINDINGS: Health equity is a driving force for dental therapy adoption. Community engagement has been evident in diverse statewide coalitions. National accreditation standards for education programs that can be deployed in 3 years without an advanced degree reduces educational barriers for improving workforce diversity. Safe, high-quality care, improvements in access, and patient acceptability have been well documented for DTs in practice. CONCLUSION: Having firmly taken root politically, the impact of the dental therapy movement in the US, and the long-term health impacts, will depend on the path of implementation and a sustained commitment to the health equity principle.

Does Education in Oral Health Competencies in Physician Assistant Education Programs Translate to Delivery of Oral Health Services in Clinical Practice?

PURPOSE: The purpose of this study was to determine the extent to which physician assistants (PAs) are educated in oral health competencies and the relationship of education to providing oral health services to patients. METHODS: The study was conducted in 2016 by administering an Internet-based survey to a nationwide sample of 2014 graduates of programs accredited by the Accreditation Review Commission on Education for the Physician Assistant. The survey response rate was 12.7% (N = 304). RESULTS: More than half of the PAs who received education in oral health in their professional education programs indicated that oral health curricula were either integrated into one or several topical areas in the base curriculum or delivered in stand-alone lectures. The majority of PA respondents rated their educational preparation as good or excellent in helping them provide oral health education to their patients (54.8%), make appropriate referrals to oral health providers (53.7%), and provide preventive oral health services (51.2%), while more than 40% rated their preparation as good or excellent in helping them identify oral diseases, conditions, and intervention strategies. More than one-third (35.7%) of all PA respondents reported that they provided oral health services in their clinical practices. PAs who received instruction in oral health competencies through the PA education curriculum or from other sources were 2.82 times more likely to provide oral health assessment and screening services to their patients (95% confidence interval, 1.19-6.67). The PA respondents' provision of oral health services was also significantly associated with working in primary medicine or urgent care practice specialties but not with the work setting. CONCLUSIONS: PAs educated in oral health competencies are more likely to provide such services to patients, especially in primary medicine or urgent care settings.

Regulating health professional scopes of practice: comparing institutional arrangements and approaches in the US, Canada, Australia and the UK.

BACKGROUND: Fundamentally, the goal of health professional regulatory regimes is to ensure the highest quality of care to the public. Part of that task is to control what health professionals do, or their scope of practice. Ideally, this involves the application of evidence-based professional standards of practice to the tasks for which health professional have received training. There are different jurisdictional approaches to achieving these goals. METHODS: Using a comparative case study approach and similar systems policy analysis design, we present and discuss four different regulatory approaches from the US, Canada, Australia and the UK. For each case, we highlight the jurisdictional differences in how these countries regulate health professional scopes of practice in the interest of the public. Our comparative Strengths, Weaknesses, Opportunities, Threats (SWOT) analysis is based on archival research carried out by the authors wherein we describe the evolution of the institutional arrangements for form of regulatory approach, with specific reference to scope of practice. RESULTS/CONCLUSIONS: Our comparative examination finds that the different regulatory approaches in these countries have emerged in response to similar challenges. In some cases, 'tasks' or 'activities' are the basis of regulation, whereas in other contexts protected 'titles' are regulated, and in some cases both. From our results and the jurisdiction-specific SWOT analyses, we have conceptualized a synthesized table of leading practices related to regulating scopes of practice mapped to specific regulatory principles. We discuss the implications for how these different approaches achieve positive outcomes for the public, but also for health professionals and the system more broadly in terms of workforce optimization.

The Physiatry Workforce in 2019 and Beyond, Part 1: Results From a Cross-sectional Survey.

OBJECTIVE: The aim of the study was to describe the current physiatrist workforce in the United States. DESIGN: An online, cross-sectional survey of board-certified physiatrists in 2019 (N = 616 completed, 30.1% response) collected information about demographic and practice characteristics, including age, sex, practice area, practice setting, hours worked, patient characteristics, staffing, and work responsibilities. Physiatrists were stratified by substantive practice patterns using a cluster analysis approach. Survey responses were arrayed across the practice patterns and differences noted. RESULTS: The practice patterns identified included musculoskeletal/pain medicine, general/neurological rehabilitation, academic practice, pediatric rehabilitation, orthopedic/complex conditions rehabilitation, and disability/occupational rehabilitation. Many differences were observed across these practice patterns. Notably, primary practice setting and the extent and ways in which other healthcare staff are used in physiatry practices differed across practice patterns. Physiatrists working in musculoskeletal/pain medicine and disability/occupational rehabilitation were least likely to work with nurse practitioners and physician assistants. Physiatrists working in academic practice, general/neurological rehabilitation, and pediatric rehabilitation were most likely to have primary practice settings in hospitals. CONCLUSIONS: Physiatry is an evolving medical specialty affected by many of the same trends as other medical specialties. The results of this survey can inform policy discussions and further research on the effects of these trends on physiatrists and physiatry practice in the future.

Dental Workforce Trends: A National Study of Gender Diversity and Practice Patterns.

The dental workforce is increasingly gender diverse. This study analyzed gender differences in dental practice using the American Dental Association's 2010-2016 Masterfile and the 2017 Survey of Dental Practice. Between 2010 and 2016, the proportion of women working in dentistry increased from 24.5% to 29.8%. Overall, female dentists were more racially/ethnically diverse, more likely to be foreign-trained, and more likely to work in pediatric dentistry than male dentists. The likelihood of female dentists working as employees, part-time, and/or in metropolitan areas was 1.2 to 4.2 times greater compared with male dentists. Female solo practitioners were 1.2 to 1.8 times more likely to provide services to children and patients covered by public insurance than male solo practitioners. Gender diversification in dentistry and other factors, including generational differences and changes in the dental service delivery system and public policy, will continue to reshape the delivery of oral health services.

The Physiatry Workforce in 2019 and Beyond, Part 2: Modeling Results.

OBJECTIVE: The aim of this study was to assess the current and future adequacy of physiatrist supply in the United States. DESIGN: A 2019 online survey of board-certified physiatrists (n = 616 completed, 30.1% response) collected information about demographics, practice characteristics, hours worked, and retirement intentions. Microsimulation models projected future physiatrist supply and demand using data from the American Board of Physical Medicine and Rehabilitation, national and state population projections, American Community Survey, Behavioral Risk Factor Surveillance System, Medical Expenditure Panel Survey, and other sources. RESULTS: Approximately 37% of 8853 active physiatrists indicate that their workload exceeds capacity, 59% indicate that workload is at capacity, and 4% indicate under capacity. These findings suggest a national shortfall of 940 (10.6%) physiatrists in 2017, with substantial geographic variation in supply adequacy. Projected growth in physiatrist supply from 2017 to 2030 approximately equals demand growth (2250 vs. 2390), suggesting that without changes in care delivery, the shortfall of physiatrists will persist, with a 1080 (9.7%) physiatrist shortfall in 2030. CONCLUSION: Without an increase in physiatry residency positions, the current national shortfall of physiatrists is projected to persist. Although a projected increase in physiatrists' use of advanced practice providers may help preserve access to comprehensive physiatry care, it is not expected to eliminate the shortfall.

The pediatric dental workforce in 2016 and beyond.

BACKGROUND: Childhood caries is a major oral and general health problem, particularly in certain populations. In this study, the authors aimed to evaluate the adequacy of the supply of pediatric dentists. METHODS: The authors collected baseline practice information from 2,546 pediatric dentists through an online survey (39.1% response rate) in 2017. The authors used a workforce simulation model by using data from the survey and other sources to produce estimates under several scenarios to anticipate future supply and demand for pediatric dentists. RESULTS: If production of new pediatric dentists and use and delivery of oral health care continue at current rates, the pediatric dentist supply will increase by 4,030 full-time equivalent (FTE) dentists by 2030, whereas demand will increase by 140 FTE dentists by 2030. Supply growth was higher under hypothetical scenarios with an increased number of graduates (4,690 FTEs) and delayed retirement (4,320 FTEs). If children who are underserved experience greater access to care or if pediatric dentists provide a larger portion of services for children, demand could grow by 2,100 FTE dentists or by 10,470 FTE dentists, respectively. CONCLUSIONS: The study results suggest that the supply of pediatric dentists is growing more rapidly than is the demand. Growth in demand could increase if pediatric dentists captured a larger share of pediatric dental services or if children who are underserved had oral health care use patterns similar to those of the population with fewer access barriers. PRACTICAL IMPLICATIONS: It is important to encourage policy changes to reduce barriers to accessing oral health care, to continue pediatric dentists' participation with Medicaid programs, and to urge early dental services for children.

Expanded Scopes Of Practice For Dental Hygienists Associated With Improved Oral Health Outcomes For Adults.

Dental hygienists are important members of the oral health care team, providing preventive and prophylactic services and oral health education. However, scope-of-practice parameters in some states limit their ability to provide needed services effectively. In 2001 we developed the Dental Hygiene Professional Practice Index, a numerical tool to measure the state-level professional practice environment for dental hygienists. We used the index to score state-level scopes of practice in all fifty states and the District of Columbia in 2001 and 2014. The mean composite score on the index increased from 43.5 in 2001 to 57.6 in 2014, on a 100-point scale. We also analyzed the association of each state's composite score with an oral health outcome: tooth extractions among the adult population because of decay or disease. After we controlled for individual- and state-level factors, we found in multilevel modeling that more autonomous dental hygienist scope of practice had a positive and significant association with population oral health in both 2001 and 2014.

Adoption of oral health curriculum by physician assistant education programs in 2014.

PURPOSE: The purpose of the study was to describe inclusion of didactic and clinical instruction in oral health in physician assistant (PA) education programs in 2014. A previous study in 2008 found that PA education program directors generally understood the importance of teaching about the linkage of oral health with systemic health; yet, few programs had actually integrated oral health instruction into the PA curriculum. This study was undertaken to ascertain the number of PA programs teaching oral health topics and to evaluate the content of instruction and implementation strategies. METHODS: The study used a Web-based survey using a skip logic design that branched respondents based on inclusion or the absence of an oral health curriculum in the PA education program. The questions included predefined response options with the opportunity for narrative responses and comments. Analysis of survey data was completed using SPSS (IBM) and SAS (SAS Institute, Inc) and consisted mainly of frequencies and cross tabulations. RESULTS: There was greater inclusion of oral health curriculum in 2014 than in 2008 with most PA programs now providing didactic and clinical training in oral health. Stakeholders' efforts to engage PA program faculty with integration of oral health subject matter into core curriculum have resulted in wider availability of training for PA students in oral health promotion and prevention services. CONCLUSIONS: Efforts to equip PA faculty to teach oral health topics and clinical skills should continue as past efforts have resulted in wider integration of oral health subject matter into core PA curriculum.

It is time to restructure health professions scope-of-practice regulations to remove barriers to care.

Regulation and licensure of health professionals--nurses, physicians, pharmacists, and others--currently falls to the states. State laws and regulations define legal scopes of practice for these practitioners. Concern is growing that this system cannot support workforce innovations needed for an evolving health care system or for successful implementation of the Affordable Care Act. Existing state-based laws and regulations limit the effective and efficient use of the health workforce by creating mismatches between professional competence and legal scope-of-practice laws and by perpetuating a lack of uniformity in these laws and regulations across states. State laws limit needed overlap in scopes of practice among professions that often share some tasks and responsibilities, and the process for changing the laws is slow and adversarial. We highlight reforms needed to strengthen health professions regulation, including aligning scopes of practice with professional competence for each profession in all states; assuring the regulatory flexibility needed to recognize emerging and overlapping roles for health professionals; increasing the input of consumers; basing decisions on the best available evidence and allowing demonstration programs; and establishing a national clearinghouse for scope-of-practice information.

The certified diabetes educator workforce in New York: findings from a statewide survey.

More than 1.8 million New York residents have diabetes, and diabetes prevalence in the state has doubled in the last decade. As part of its $35 million five-year campaign to reverse the diabetes epidemic in New York, the New York State Health Foundation's Diabetes Policy Center partnered with the Center for Health Workforce Studies at the School of Public Health, University at Albany, State University of New York, to conduct a workforce study of certified diabetes educators (CDEs) in New York and develop recommendations for improving access to diabetes self-management education. The findings from this study suggest that providers of diabetes services must identify new ways to use the existing supply of CDE more effectively. With their small numbers and uneven distribution across New York, creative strategies are needed to maximize the impact of CDEs in helping patients effectively manage diabetes and prevent its occurrence.

Workforce shortages in breast imaging: impact on mammography utilization.

OBJECTIVE: The objective of this study was to develop reliable forecasts of the future supply of radiologists and radiologic technologists practicing mammography under different assumptions about future introduction of new practitioners. In addition, this article includes basic mammography workforce statistics to provide a context for the forecasts. MATERIALS AND METHODS: The forecasts were developed using an age cohort flow model based on data provided by the American College of Radiology (ACR) on the numbers and age distribution of radiologists and on data provided by the American Society of Radiologic Technologists (ASRT) on radiologic technologists providing mammography services. RESULTS: The forecasts show that the current rates of production of new mammography professionals will result in dramatic reductions in mammography professionals per woman age 40 years old and older over the next 15-20 years. CONCLUSION: Unless the number of new mammography professionals entering practice every year increases beyond the current levels, there will be a growing gap between the supply of and demand for mammography professionals over the next two decades.

A Dental Hygiene Professional Practice Index (DHPPI) and access to oral health status and service use in the United States.

PURPOSE: The purpose of this article is to summarize a larger study that developed a statistical index that defines the professional practice environment of dental hygienists (DHs) in the United States, and to determine the extent to which the index scores are related to the number of DHs and dentists, the utilization of dental services, and selected oral health outcomes across the 50 states. METHODS: A Dental Hygiene Professional Practice Index (DHPPI) defines the professional status, supervision requirements, tasks permitted, and reimbursement options for DHs in each of the 50 states and the District of Columbia, as of December 31, 2001. Spearman rank order correlations between the DHPPI and numbers of oral health professionals, utilization of oral health services, and oral health outcomes in the 50 states are also presented. RESULTS: The analyses revealed that: There are significant differences in the legal practice environments (as reflected in the DHPPI) across the 50 states and the District of Columbia. Between 1990 and 2001, the number of DHs per capita increased by 46% in the United States, while the number of dentists per 100,000 population increased by only 10%. The DHPPI was not significantly correlated with the number of DHs or dentists in the 50 states in 2001. The DHPPI was significantly positively correlated with the salaries of DHs in 2001. The DHPPI was also significantly and positively correlated with a number of indicators of utilization of oral health services and oral health outcomes. CONCLUSIONS: Both access to oral health services and oral health outcomes are positively correlated with the DHPPI. This suggests that states with low DHPPI scores would be logical candidates for revised DH practice statutes and regulations to accomplish these objectives.