were areas that needed training emphasis when the therapists returned for their preceptorships in Alaska. 4.7.2.4 Scope of Practice The scope of practice is explicitly delimited in the Standards and Procedures of the Certification Board of the Community Health Aide Program. All of the therapists and all of the dentists who supervised therapists indicated that therapists were very conscientious of the importance of staying within the prescribed scope of practice. One supervisory dentist said, “This was such a new program, and under such scrutiny, that everyone was very conservative.” Work experiences varied across DHAT practice sites, due to the underlying needs of patients, available resources, and the program’s philosophy. Dispensing of medication by therapists had the most significant variation across sites. This was in part a function of how the supervisory dentist interpreted the Standards. In one locale the therapist relied on the dispensing authority of an onsite nurse practitioner or other medical provider. In another location, the supervisory dentist authorized the therapist to dispense, without supervisory consultation, nonnarcotic prescriptions (e.g., ibuprofen) on the basis of the authority to provide pain relief, but administering other medications (e.g., acetaminophen with codeine) required direct consultation and approval by the supervisory dentist. 4.7.2.5 Supervisory Practices Supervisory practices also varied across sites. Frequent, usually daily, contact characterized supervisory practices when therapists were first deployed. Typically, the therapist would begin the day with a phone call or e-mail to the supervisory dentist to review the upcoming schedule of patients. In some locales this continues to be the practice. In others, as the therapist and dentist became more comfortable with the therapist’s judgment and experience, the therapist would consult with the supervisor on an as-needed basis. Means of communication varied across sites. In one setting where electronic dental records were available system-wide in all of the practice sites (including small villages), the therapist could consult with the supervisor, sharing both dental records and radiographs. In others, the therapist used the intraoral camera probe to send video images via the telemedicine system that links the remote clinic with the regional clinic. A third way was to send a digital xray via e-mail. All of the therapists said that supervisory dentists were always available for consultation, regardless of the time or day of week.
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