Abstract
To determine whether and to what extent the state policy environment for the dental hygiene workforce affects the availability of dental services at Federally Qualified Health Centers (FQHCs). We examined data drawn from the Uniform Data System on 1,135 unique FQHC grantees receiving community health center funding from the U.S. Health Center program between 2004 and 2012. The Dental Hygiene Professional Practice Index was used to quantify variations in state policy environment. We then examined the influence of state policy environment on the availability of dental care through generalized linear mixed-effects models. Approximately 80% of FQHCs reported delivering dental services. We consistently observed that FQHCs with favorable levels of state support had the highest proportion of FQHCs that delivered dental services, even more so than FQHCs with extremely high support. FQHCs located in the most restrictive states had 0.28 the odds of delivering dental services as did those located in the most supportive states. The state policy environment for the dental hygiene workforce is likely associated with the availability of dental services at FQHCs. The greatest proportion of FQHCs delivering dental services was found in states with policy provisions supporting professional independence in public health settings. Nevertheless, additional research is needed to understand the specific mechanism by which these policies affect FQHCs.
Highlights
The oral health workforce is the foundation of the US oral health care delivery system
Unadjusted regression models demonstrated that the odds of Level 1 Federally Qualified Health Centers (FQHCs) delivering dental services was approximately half that of Level 5 FQHCs
The findings suggest that the state policy environment for the professional practice of the dental hygiene workforce to some extent influence the availability of dental services at FQHCs
Summary
The oral health workforce is the foundation of the US oral health care delivery system. All policies that define and regulate this workforce influence oral health system capacity and access to dental care. National accreditation standards for dental hygiene education are overseen by the Commission on Dental Accreditation (CODA). While dental hygiene education is determined at the national level, policies regulating professional practice are determined at the state-level through statutes and regulation by professional licensing boards [1]. These state policies create the context for dental hygienists’ professional practice within a state, and thereby are responsible for between-state variations in policy and regulation of VC 2016 The Authors. Journal of Public Health Dentistry published by Wiley Periodicals, Inc. on behalf of American Association of Public Health Dentistry
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