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WINTER

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DIRECTOR'S COLUMN

photo of Mark Schoenbaum
Mark Schoenbaum

PRIORITIES FOR A TRANSFORMING RURAL HEALTH SYSTEM

In these times of constant change in health care, how can public sector leaders keep up with changing priorities? Especially when it comes to rural health—with the nuances citizens, communities and health care organizations need to balance—policymakers can respond best when they get informed insights from those working directly with rural health issues every day.

Minnesota’s Rural Health Advisory Committee, appointed by the Governor to advise the commissioner of health and other state agencies, takes seriously its responsibility to assess rural needs and communicate rural priorities to decision makers. The committee comprises 15 members: three consumers, four legislators, a higher education member and seven members representing various health care sectors, all from rural Minnesota. Regular readers of the Quarterly have seen profiles of new Rural Health Advisory Committee members; this issue interviews legislative member Representative Larry Hosch.

The Rural Health Advisory Committee has a pretty good track record. Its past work has influenced policy in areas such as health reform, new models of care, rural mental health needs and small hospital stability.

Every other year the Rural Health Advisory Committee sets two-year priorities and responds to each with a combination of research, analysis and rural involvement to develop recommendations for the commissioner and other policymakers. The members review current issues and challenges in rural health, add what among them is a broad and diverse set of perspectives, and produce a work plan for the coming two years. The committee’s recently developed priorities are:

1. Rural Obstetric Services
2. Rural Health System Growth and Consolidation
3. Health Reform Implementation and Rural Implications
4. Dementia-Related Issues, Elder Housing And Long Term Care
5. Better Responses to Rural Mental/Behavioral Health Emergencies
6. Medication Therapy Management and the Role of Rural Pharmacists
7. Leadership for Rural EMS Policy and Systems Development
8. Early Successes with Community Paramedic Model.

Many of these issues may seem prevalent throughout the health system. For each one, the Rural Health Advisory Committee has asked and answered what’s uniquely rural. Details can be found on the Rural Health Advisory Committee web page. The committee’s initial project in this cycle is underway; it’s established a workgroup to develop recommendations to assure access to obstetric services for rural Minnesota.

The Rural Health Advisory Committee, and those of us in the Office of Rural Health and Primary Care who staff it, always welcome involvement. If you’re interested in any of the priorities above, feel free to contact me or committee staff Kristen Tharaldson.

With this issue, we say goodbye to our editor, Mary Ann Radigan, as she exuberantly heads off to begin retirement. Mary Ann has edited both our monthly and quarterly publications for seven years with creativity, professionalism, patience and good humor. Mary Ann is the person who actually earned the kudos I get on our publications, and we wish her the very best.

Mark Schoenbaum is director of the Office of Rural Health and Primary Care and can be reached at mark.schoenbaum@state.mn.us or 651-201-3859.

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PARTNER FOCUS

dental

EXPANDING ORAL HEALTH CARE

by Leslie Nordgren, R.D.H., M.P.H., Ph.D., Research Specialist, Minnesota Office of Rural Health and Primary Care

In 2011, Minnesota became the first state to license a new member of the dental team: dental therapists. Dental therapists are educated to provide basic preventive and restorative procedures services that previously only a licensed dentist could perform. They serve patients who have low incomes, are uninsured and underserved, and patients in dental health professional shortage areas. They practice in dental offices, nursing homes, schools, group homes and other alternative settings.

Dental therapists graduate from an approved education program and pass a board-approved licensure examination.

The state also authorized certification of an “advanced” dental therapist. Advanced dental therapists must be licensed as a dental therapist, complete 2,000 hours of dental therapy clinical practice, graduate from an approved advanced dental therapy education program, and pass a board-approved certification examination.  

Dental Therapists

Licensed dental therapists treat patients under the supervision of a Minnesota-licensed dentist. The scope of services to be provided is defined in a written collaborative management agreement between the dental therapist and supervising dentist. Dental therapists may supervise up to four dental assistants. They also dispense and administer analgesic, anti-inflammatory and antibiotic drugs within their scope of practice and the parameters of their collaborative management agreement.

Under general supervision, unless restricted or prohibited in their collaborative management agreement, dental therapists may perform the following services:

  • Oral health instruction and disease prevention education, including nutritional counseling and dietary analysis
  • Preliminary charting of the oral cavity
  • Radiographs
  • Mechanical polishing
  • Topical preventive or prophylactic agent application, including fluoride varnishes and pit and fissure sealants
  • Pulp vitality testing
  • Desensitizing medication or resin application
  • Athletic mouth guard fabrication
  • Soft occlusal guard fabrication
  • Temporary restoration placement
  • Tissue conditioning and soft reline
  •  Atraumatic restorative therapy
  •  Dressing changes
  •  Tooth reimplantation
  •  Local anesthetic and nitrous oxide administration.

Licensed dental therapists under indirect supervision may perform the following services, unless restricted in their collaborative management agreements:

  • Emergency palliative treatment of dental pain
  •  Placement and removal of space maintainers
  •  Cavity preparation
  •  Restoration of primary and permanent teeth
  •  Placement of temporary crowns
  •  Preparation and placement of preformed crowns
  •  Pulpotomies on primary teeth
  •  Indirect and direct pulp capping on primary and permanent teeth
  •  Stabilization of reimplanted teeth
  •  Extractions of primary teeth
  •  Suture removal
  •  Brush biopsies
  •  Defective prosthetic device repair
  •  Permanent crown recementing.

Advanced Dental Therapists

Advanced dental therapists enter into a written collaborative management agreement with a Minnesota-licensed dentist, which specifies the services they may provide. These may include all services within the scope of dental therapy practice, plus the following services under general supervision:

  • An oral evaluation and assessment of dental disease and the formulation of an individual treatment plan authorized by the collaborating dentist;

  • Specific nonsurgical extractions of periodontally diseased permanent teeth

  • And provide, dispense and administer analgesic, anti-inflammatory and antibiotic drugs.

Education Requirements

Minnesota law establishes the requirements for licensure and mandates that institutions educate students to the necessary level of competency. It does not dictate to the educational institutions what their admission requirements should be or how to structure their programs. In Minnesota, Metropolitan State University is educating students to be eligible for certification as an advanced dental therapist and the University of Minnesota is educating students for licensure as a dental therapist.

Metropolitan State University, Advanced Dental Therapy Program
Metropolitan State University, in partnership with Normandale Community College, was the first school in the United States to offer a Master's of Science in Oral Health Practitioner degree. Students must be licensed dental hygienists to be admitted to the program. Upon graduation they meet licensure requirements for dental therapy and credentialing for advanced dental therapy and they may continue to practice their full scope of dental hygiene.  

The first seven students graduated from Metropolitan State University in the summer of 2011. Early adopters of this new dental team member include Apple Tree Dental, Children’s Dental Services and Hennepin County Medical Center, where graduates are providing dental hygiene services and working on the 2,000 hours of providing dental therapy services required for advanced dental therapist certification. The second cohort of four students will graduate in April 2013.

For information about the Oral Health Care Practitioner Program, contact Suzanne Beatty, D.D.S. at suzanne.beatty@metrostate.edu

University of Minnesota School of Dentistry, Dental Therapy Program
The University of Minnesota School of Dentistry is the only dental school in the country that educates dental therapists and the only Minnesota institution that is accredited to teach dentistry procedures. The school offers two tracks: The Bachelor of Science Program is for students who have completed at least one year of prerequisite college course work and the Master of Dental Therapy Program is for students who have already completed a baccalaureate degree.

In December 2011, the school awarded one bachelor’s degree and seven master’s degrees in dental therapy. A ninth student will graduate in May 2012, after an extension provided to accommodate a personal leave earlier in her education program. One graduate is a dental therapist working for a private practice in Montevideo, Minnesota; another is employed as a dental therapist by Health Partners.. The University’s second class of nine students—four on the bachelor’s degree track and five on the master’s degree track—will graduate in December 2012. In September 2011, the School of Dentistry admitted 10 students into its third class, and these students will graduate in December 2013. School of Dentistry dental therapy classes have included students from rural and urban areas in Arizona, California, Florida, Minnesota, South Dakota and Wisconsin.

For information about the Program in Dental Therapy, contact the Division of Dental Therapy at 612-625-4310 or atki0094@umn.edu.

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SPECIAL FEATURE

 

 

 

 

RHAC MEMBER PROFILE

 

photo rep. hosch

 

ORHPC TALKS WITH RURAL HEALTH ADVISORY COMMITTEE (RHAC) MEMBER REP. LARRY HOSCH

Please explain your professional work to us.

I work in two different capacities—one as a state legislator and the other as a social worker. 

I am serving my fourth term as a state representative from central Minnesota and I am a minority whip. I serve on the Health and Human Services Reform Committee, the Health and Human Services Finance Committee, and the Agriculture Committee. My policy areas of interest include health care, long term care, mental health and disability services. 

Outside of the legislature, I am an independent living specialist. I work with people in Isanti, Mille Lacs, Sherburne, Stearns and Wright counties who have cognitive, physical and mental disabilities.

And your life away from work?

My wife and I live in St. Joseph with our one-year-old and four-year-old boys and a golden retriever. I enjoy weight lifting, running and anything outdoors including heading up to our cabin in Outing, Minnesota. 

What do you think are the most important issues facing rural health?

Our biggest issues are the changing demographics of Minnesota and access to mental health services.

In a rural area, maintaining independence becomes increasingly difficult as we age—from accessing transportation to finding primary and specialty care. Preparing our communities, providers and families will be a challenge and an opportunity for us in the coming years. 

Access to mental health services is already challenging for rural Minnesotans and the ability to recruit mental health professionals is becoming a near crisis.

What do you think would make the most difference for rural health? 

We need to engage our cities, counties, non-governmental organizations and providers in preparing for the graying of Minnesota. If we want to maintain an emphasis on independence, our communities need to learn how to change and adapt to new needs and service demands. 

We also need to invest in recruiting health and medical professionals and work to provide the educational and training opportunities that will attract and retain them.

The Rural Health Advisory Committee advises the commissioner of the Minnesota Department of Health and other state agencies on rural issues; provides a systematic and cohesive approach toward rural health issues; and encourages cooperation among rural communities and providers.

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View online all previous issues of the Office of Rural Health and Primary Care publications.

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SAVE JUNE 25-26 for the
2012 RURAL HEALTH CONFERENCE!


Minnesota Office of Rural Health and Primary Care
P. O. Box 64882
St. Paul, Minnesota 55164-0882
Phone 651-201-3838
Toll free in Minnesota 800-366-5424
Fax: 651-201-3830
TDD: 651-201-5797
www.health.state.mn.us/divs/orhpc

 

MISSION
To promote access to quality health care for rural and underserved urban Minnesotans. From our unique position within state government, we work as partners with communities, providers, policymakers and other organizations. Together, we develop innovative approaches and tailor our tools and resources to the diverse populations we serve.