AGD cautions against misuse of DHAT report

Oct 27, 2010

The Academy of General Dentistry (AGD) has issued a press release cautioning against misinterpreting the results of the "Evaluation of the Dental Health Aide Therapist (DHAT) Workforce Model in Alaska" report released October 26.

The AGD stated in a press release that it has seen misleading reports from a number of organizations in response to the evaluation, which was conducted by RTI International and funded by the W.K. Kellogg Foundation, the Rasmuson Foundation, and the Bethel Community Services Foundation.

The report found that five DHATs who had acquired two years of experience working closely with dentists after completion of DHAT education had improved the oral health of a few hundred rural native residents of Alaska, the AGD noted.

However, the authors caution readers against drawing broad and inaccurate conclusions from its findings, the AGD said.

"The bottom line is that special vested interests are using this admittedly premature report to justify their unwarranted advocacy of still unproven concepts," said AGD President Fares Elias, D.D.S., in the press release. "While the AGD applauds the five DHATs for providing some care to an area of atypically dire need, the evaluation did not find the answers to questions of quality of care or utilization of care."

First, the AGD noted, the evaluation cautions against a conclusion that it includes definitive findings on quality of care or patient oral health outcomes:

"Some of these evaluations are considered by many to measure the 'quality of care' that has been provided, although that interpretation equates quality of care with technical excellence while ignoring the more important consideration of patient outcomes. Also, no norms for comparison of technical performance using these evaluation measures are available," the report states.

As a result, the authors state, "it would be premature to attempt to evaluate the DHAT experience on the basis of oral health outcomes at this time."

Second, the AGD noted, the report is not intended as a comparative study of the quality of services provided by DHATs versus those provided by dentists. With regard to the clinical technical performance evaluations, the authors make the following observations:

Several opportunities for bias in these evaluations should be noted. For the evaluations of cavity preparations and oral hygiene instruction, therapists were aware they were being evaluated. For evaluations of restorations performed during the oral health status survey, which represent the large majority of all restorations evaluated, restoration placement could have occurred up to 2 years earlier. Length of exposure can affect many of the criteria employed in restoration evaluations. The numbers of evaluations performed is small in all instances, and some sites are not represented in some evaluations. Finally, all such technical performance evaluations are subjective.

The report also affirms that the availability of dentists is important to the provision of oral healthcare. As the authors note, "All of the therapists said that supervisory dentists were always available for consultation, regardless of the time or day of week."