title: Barriers faced by expanded practice dental hygienists in Oregon.
abstract: OBJECTIVE
  Oregon allows dental hygienists to provide services without the supervision of a dentist if they hold an expanded practice permit (EPP). This study surveyed practicing and non-practicing EPP holders with the purpose of assessing perceived barriers to practicing independently and better educating students to begin independent practice upon graduation.
  
  
  METHODS
  A survey was developed, approved by the institutional review board and pilot tested with current Expanded Practice Dental Hygienists (EPDHs). A list of EPDHs was obtained from the Oregon State Dental Board, and 181 surveys were mailed in November 2011.
  
  
  RESULTS
  The response rate was 39% (n=71). Data from this study indicate a large number of new EPP holders, with 62% (n=41) holding their permit for 3 years or less, but only 41% (n=29) of respondents are actually providing care in a setting requiring an EPP. Responding practicing EPDHs reported barriers including: challenges with insurance reimbursement, lack of knowledge/acceptance, equipment cost/maintenance, difficulty obtaining a collaborative agreement/cooperating facility, advertising and inability to make a living wage. Responding non-practicing EPDHs reported barriers including: currently working in another setting, lack of business knowledge, time, start-up cost, inability to make a living wage, lack of opportunity, reimbursement difficulties and lack of experience.
  
  
  CONCLUSIONS
  Perceived barriers to practicing independently differ between those practicing utilizing their EPP and those not practicing. Ways to eliminate barriers for both practicing and non-practicing EPDHs should be explored. There is potential to reduce the barriers to independent practice through curricular changes, public health partnerships among EPDHs, and new health care systems that specifically address barriers found through this study.
authors.forename: Amy E
authors.initials: AE
authors.lastname: Coplen
authors.forename: Kathryn P
authors.initials: KP
authors.lastname: Bell
mesh_terms: D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D003479:Curriculum; D003752:Dental Health Services / Q000191:economics / Q000458:organization & administration*; D003756:Dental Hygienists / Q000193:education*; D019538:Health Care Surveys; D006297:Health Services Accessibility / Q000191:economics / Q000458:organization & administration; D006801:Humans; D008875:Middle Aged; D009922:Oregon
keywords: access to oral health care; dental Hygiene extended practice permits; dental hygiene; direct access; expanded practice; independent practice; limited access