Division of Dental Hygiene, University of Missouri-Kansas City School of Dentistry, Kansas City, MO, USA
Contributor, Oral Health in America: Advances and Challenges, National Institutes of Health, Bethesda, MD, USA.
J Dent Hyg. 2023 Oct;97(5):24-34.
The American Dental Hygienists' Association (ADHA) defines direct access as the ability of a dental hygienist to initiate treatment based on their assessment of patient's needs without the specific authorization of a dentist, treat the patient without the physical presence of a dentist, and maintain a provider-patient relationship. In 2000 there were nine direct access states; currently there are 42 states that have authorized some form of direct access. The ADHA has been instrumental in these legislative initiatives through strong advocacy efforts. While research and data support the benefits of direct preventive/therapeutic care provided by dental hygienists, many barriers remain. This paper chronicles key partnerships which have influenced and advocated for direct access and the recognition of dental hygienists as primary health care providers. The National Governors Association (NGA) released a report in 2014 suggesting that dental hygienists be "deployed" outside of dental offices as one strategy to increase access to oral health care along with reducing restrictive dental practice acts and increasing the scope of practice for dental hygienists. The December 2021 release of the National Institutes of Health report, Oral Health in America, further supports greater access to dental hygiene preventive/therapeutic care. This paper also reflects on opportunities and barriers as they relate to workforce policy, provides examples of effective state policies, and illustrates an educational curriculum specifically created to prepare dental hygienists to provide oral health services in settings outside of the dental office. Dental hygiene education must ensure that graduates are future-ready as essential health care providers, prepared to deliver direct access to dental hygiene care.
美国牙科保健师协会 (ADHA) 将直接访问定义为牙科保健师根据患者需求的评估，无需牙医的具体授权即可启动治疗，在没有牙医实际在场的情况下治疗患者，并维持医患关系的能力。2000 年有九个直接访问州；目前，有 42 个州已经授权某种形式的直接访问。ADHA 通过强有力的宣传努力，在这些立法倡议中发挥了重要作用。虽然研究和数据支持牙科保健师提供直接预防/治疗护理的好处，但仍存在许多障碍。本文记录了影响和倡导直接访问以及承认牙科保健师为初级卫生保健提供者的关键伙伴关系。国家州长协会 (NGA) 于 2014 年发布了一份报告，建议将牙科保健师“部署”在牙科诊所之外，作为增加口腔保健服务的获取途径的策略之一，同时减少限制牙科实践法案并扩大牙科保健师的实践范围。2021 年 12 月发布的美国国立卫生研究院报告《美国口腔健康状况》进一步支持增加牙科保健预防/治疗护理的机会。本文还反映了与劳动力政策相关的机会和障碍，提供了有效州政策的示例，并说明了专门为准备牙科保健师在牙科诊所之外的环境中提供口腔健康服务而创建的教育课程。牙科保健教育必须确保毕业生作为基本医疗保健提供者具备未来准备，能够提供直接的牙科保健服务。
