SECTION 5 DISCUSSION The overall purpose of this project was to evaluate the implementation of the DHAT workforce model by providing a comprehensive assessment of the use of a small number of therapists in Alaska. Although additional persons have been trained as therapists in a training program established in Alaska, our study was restricted to members of the initial three classes who were trained in New Zealand. Each of the five therapists for whom we conducted site visits worked for different tribal organizations and under somewhat different circumstances, which afforded the opportunity to examine how these circumstances may be influencing their practice. Specific parameters of focus included
patient satisfaction, oral health–related quality of life, and perceived access to care;
oral health status;
clinical technical performance and performance measures;
record-based process measures and evaluation of clinical facilities; and
implementation of community-based preventive plans and programs.
Level of Patient Satisfaction and Access to Care Level of patient satisfaction derived from surveys was generally high and did not vary
across sites or by age. Therapists were rated as explaining things clearly, listening carefully, and treating patients with courtesy and respect. As a system characteristic, therapists and other dental providers were rated as making patients feel comfortable and generally not keeping their patients waiting for more than 15 minutes. Qualitative interviews indicated that most respondents expressed pride that an Alaska Native had been trained to provide these dental services, with the therapists serving as positive role models for the children of the village, particularly in the two village sites where the therapists reside permanently (Sites B and E). Many of the patients did not make the distinction between therapists and dentists, although in one site that had previously had a full-time dentist there were reports of a few people who were unwilling to be seen by the therapist. Key informant interviews are important to take into account as the DHAT model moves from initial implementation toward wider scale implementation to improve access to care. It is clear that the dentist supervisors set the philosophy on how the first therapists were deployed. For example, one dental director placed his therapists in remote villages with high disease rates