The HMPP pilot participants became eligible for licensure when the law went into effect in ; however, no formal education was available until , hence the lack of licensees between Of the survey respondents, Residences of the homebound and skilled-nursing facilities are also common work settings for RDHAPs with patients who have even fewer other options for care. Figure 1 shows the number of active licenses by year granted. The project required hours of classroom training in management and business, as well as an update on dental hygiene procedures and practices, hours of a supervised residency, and, finally, 52 hours of in-service management practice.
This data provides the first indication that RDHAP practices were improving access to care, particularly for minority, medically compromised, and disabled populations. Data point for only represents licenses awarded up until May. One provision of the law that established the RDAHP license category was the requirement that candidates for the license complete a hour dental board-approved course. Today, a dental hygienist licensed in California with a baccalaureate degree or the equivalent can, after completing a board-approved continuing education course and passing a state licensure examination, practice independently in underserved settings. The rules that regulate RDHAPs mandate where they can practice, essentially limiting their options to special and underserved populations. Department of Health and Human Services. The alternative practice of dental hygiene in California has proven to be an important innovation in successfully improving access to preventive dental care services, case management, and referral for a wide range of underserved populations in California.
While the mobile equipment can be adjusted in some cases, some of the work RDHAPs do simply cannot be done on a full-time basis due to the physical demands it places on the individual provider. Mertz E, Bates T. Finally, what evidence is available regarding patient access to care under this model? McKinnon M, Luke G, et al.
Mertz E, Finocchio L.
After decades of struggling with these issues, policymakers and the professions are considering workforce rhdap as a primary strategy for improving access to care with the hope rdahp workforce innovations may reduce disparities in both utilization and oral health outcomes. Characteristics of patients seeking care from independent dental hygienist practices; pp.
As a result, the individuals attracted to train and become licensed as RDHAPs are experienced, entrepreneurial, and driven by a mission to serve the underserved and improve rdbap to care. For example, in the Board of Dental Examiners BDE adopted regulations allowing auxiliaries trained in the pilot programs to practice extended functions advanced procedures not formerly in their scope of practice.
If an RDHAP continues to provide services to that patient he or she is required to obtain written verification that the patient has been examined by a dentist or physician licensed to practice in the state. The financing for this model of care reported in our survey is primarily from Denti-Cal, both in patient percentages and in overall revenue, although private insurance and self-pay also contribute.
A large body of literature exists that tracks the supply, demand, and distribution of plam dental workforce over time. Mertz E, Mouradian W.
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Inthe accreditation laws were changed to allow for educational preparation of expanded-duty dental assistants EDDAsbusinesx bya number of educational programs for teaching expanded duties to dental assistants and hygienists were in place. Discussion As a new practice model, alternative practice dental hygiene is quite different than traditional dental hygiene practice and traditional dental practice.
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Designing, testing and implementing a new practice model for dental hygienists took 23 years. The 16 pilot rdhxp became eligible for licensure when the law went into effect in In the first decade of the HMPPthere were 27 dental auxiliary pilots proposed. Each provider type has evolved over time, and together dental providers have developed practices that span a wide number of arrangements. J Am Dent Assoc.
The same year, the California Dental Hygienists Association CDHA created a fund and issued a request for proposals to support the development of an online education program. However, very few studies document changes in access to care over time as the result of the implementation of a new model of care delivery.
While differences of opinion about the RDHAP still exist, both the dental and dental hygiene associations have expressed formal support of RDHAP providers and a commitment to collaborating to ensure access to high quality dental care for patients.
The alternative practice of busoness hygiene in California has proven to be an important innovation in successfully improving access to preventive plab care services, case management, and referral for a wide range of underserved populations in California. Oral health in America: The HMPP evaluation was done by a team consisting of two dentists responsible for on-site quality assurance, a dental hygiene educator, a dental school faculty member, and a health economist who managed and published the full HMPP No.
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How do we measure shortages of dental hygienists and dental assistants? The motivation was to expand the educational opportunity to dental hygienists who could not travel and attend multiple in-person sessions by offering a primarily on-line program that could be completed by hygienists on a flexible schedule and wherever they were located.
One provision of the law that established the RDAHP license category was the requirement that candidates for the license complete a hour dental board-approved course.
Second, what are the dimensions of the RDHAP practice model including what is working and what is not?
These indicators show that RDHAPs paln expanding access to preventive care through their patient care activities, as well as expanding access to restorative care through their case management and referral activities. An understanding of the current and future issues facing practitioners working in this new practice model comes from a qualitative study of RDHAPs and related stakeholders conducted by the authors in This is compounded by difficulties with payers who often refuse to recognize rdhp as providers although they are legal billable providers and low fee payment streams for underserved patients.
It is clear there is not a single pathway for RDHAP practice; rather, licensees can pursue a variety of employment opportunities in addition to becoming a sole practitioner.
The California demonstration project in independent practice. Dugoni School of Dentistry in San Francisco.