Expanding Access to Care: Scope of Practice Laws

Abstract

Allied health professionals play an integral role in providing safe, affordable care to communities in need. Laws that define the permissible scope of practice for these professionals may take full advantage of these providers and may unnecessarily restrict safe and effective care. Nurse practitioners in many states may provide care independent of a physician; research reveals that this care is safe, affordable and accessible. Yet hurdles exist that prevent communities from securing the full benefit of NPs in independent practice. The scope of independent practice for allied dental providers varies greatly across the country, often including stringent supervision requirements. Emerging approaches to allowing allied dental providers to practice independently in certain settings or with dentist supervision via telemedicine and creating the intermediate provider, the dental therapist, may increase access to safe, affordable dental care. Research on the impact of laws that allow broader independent practice by NPs to ferret out the hurdles to full implementation of the spirit of such laws is needed. That research could support expanded independent scope for allied dental providers and other allied health care providers.

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References

Thompson and

Hexem , “National Nurse-Led Care Consortium,” Nurse Practitioner Prescribing Laws, available at <http://legacy.lawatlas.org/query?dataset=np> (last visited January 11, 2017).

National Governors Association, NGA Paper: The Role of Nurse Practitioners in Meeting Increasing Demand for Primary Care (2012).

Federal Trade Commission Staff, Policy Perspectives: Competition and the Regulation of Advanced Practice Nurses (2014).

Newhouse

et al ., “Advanced Practice Nurse Outcomes 1999-2008: A Systematic Review,” Nursing Economics 29, no. 5 (2011): 1-22; Office of Technology Assessment, The Cost and Effectiveness of Nurse Practitioners (Washington, D.C.: US Government Printing Office, 1981).

See

J. A.

Coddington and

L. P.

Sands , “Cost of Health Care and Quality Outcomes of Patients at Nurse-Managed Clinics,” Nursing Economic$ 26 no. 2 (2008): 75-83.

T. S.

Bodenheimer and

M. D.

Smith , “Primary Care: Proposed Solutions to the Physician Shortage without Training More Physicians,” Health Affairs (Project Hope) 32, no. 11 (2013): 1881-1186; D. I. Auerbach, “Nurse-Managed Health Centers and Patient-Centered Medical Homes Could Mitigate Expected Primary Care Physician Shortage,” Health Affairs 32 no. 11 (2013): 1933-1941; Institute of Medicine (IOM), The Future of Nursing: Leading Change, Advancing Health (Washington, D.C.: The National Academies Press, 2011); Health Resources and Services Administration, Department of Health and Human Services, Projecting the Supply and Demand for Primary Care Practitioners through 2020 (November 2013).

Y.-F.

Kuo

et al ., “States with the Least Restrictive Regulations Experienced the Largest Increase in Patients Seen by Nurse Practitioners,” Health Affairs (Project Hope) 32, no. 7 (2013) 1236-12343.

Institute of Medicine and National Research Council, Committee on Oral Health Access to Services, Board on Children, Youth, and Families, Board on Health Care Services, Improving Access to Oral Health Care for Vulnerable and Underserved Populations, HRSA.gov. 2011, available at <http://www.hrsa.gov/publichealth/clinical/oralhealth/improvingaccess.pdf> (last visited January 12, 2017).

National Governors Association, The Role of Dental Hygienists in Providing Access to Oral Health Care, NGA.org. 2016 [cited 1 July 2016], available at <http://www.nga.org/files/live/sites/NGA/files/pdf/2014/1401DentalHealthCare.pdf> (last visited January 12, 2017).

10.

Doescher , Keppel

Dentist Supply, Dental Care Utilization, and Oral Health among Rural and Urban U.S. Residents (Seattle, WA: WWAMI Rural Health Research Center, University of Washington, 2015); K. Bell, “Evaluating the Impact of Expanded Practice Dental Hygienists in Oregon: An Outcomes Assessment,” Journal of Dental Hygiene 89, no. 1 (2015): 17–25

11.

The Network for Public Health Law, “Dental Auxiliary Scope of Practice Laws,” Networkforphl.org, 2014, available at <https://www.networkforphl.org/resources_collection/2014/11/14/518/dental_auxiliary_scope_of_practice_laws/> (last visited January 13, 2017).

12.

Beatty

, Community Oral Health Practice for the Dental Hygienist, 4th ed. (St. Louis: Elsevier, Inc.; 2016).

13.

Hernandez

, “California to Launch Medicaid-Funded Tele-dentistry,” September 29, 2014, available at <http://khn.org/news/california-to-launch-medicaid-funded-teledentistry/> (last visited January 13, 2017).

14.

Del. Code Ann. tit. 24, § 1101; Ariz. Rev. Stat. Ann. § 36-3601.

15.

225 Ill. Comp. Stat. Ann. 25/4.

16.

Md. Code Ann., Health Occ. § 4-308.

17.

Ariz. Rev. Stat. Ann. § 32-1281/

18.

Commission on Dental Accreditation, Accreditation Standards for Dental Therapy Education Programs (2016), available at <http://www.ada.org/~/media/CODA/Files/dt.pdf?la=en> (last visited January 13, 2017).

19.

W.K. Kellog Foundation, Innovation in Alaska & Minnesota: Take a Look at Two Innovative Approaches Utilizing Mid-Level Dental Provider Models, available at <https://www.wkkf.org/what-we-do/healthy-kids/oral-health/innovation-in-alaska-minnesota> (last visited January 13, 2017).

20.

ADHA, Dental Therapists Now Recognized in Vermont, Press Release, 2016, available at <https://www.adha.org/resources-docs/adha_dental_therapists_now_recognized_in_vermont_press_release_6-20-2016.pdf> (last visited January 13, 2017).