Study identifies keys to oral healthcare integration

Awareness is increasingly spreading for the need to integrate oral healthcare into primary care treatments and evaluations. Researchers interviewed more than 90 healthcare practitioners in Canada to find out what the barriers are to this integration and how they can be overcome.

The researchers identified four keys to this integration, focusing on the needs to adapt any program to local factors to be successful. Their study was published in PLOS One on on October 12.

"Our study results suggest that advancing oral health integration into primary care necessitates adjusted designs and role-specific approaches, which take into account each profession's needs in practice, analyzing both context and group interrelations," wrote the study authors, led by Hermina Harnagea from the University of Montreal School of Public Health in Quebec.

Perceptive comments

The researchers wanted to explore the perceptions of primary healthcare teams on the integration of oral health into primary care and discover any barriers. To find out, they interviewed a total of 91 general physicians, social workers, occupational therapists, dentists, dental hygienists, and others in Quebec involved in providing healthcare.

From the interviews, four overarching themes emerged as keys to any integration of oral healthcare into primary healthcare:

1. What are the drivers of integration?
2. Is the importance of integration recognized?
3. What is professionals' role in integrated care?
4. What are the barriers and enablers of integration?

In addition, two prominent subthemes developed under the drivers of integration theme, the authors reported. The first is that oral healthcare services are missing in publicly funded health services. The majority of the interviewed participants said that, at organizational and clinical levels, integrated oral health services were either completely absent or largely insufficient.

The other subtheme is that oral health needs are a driver of integration. As an example, the study authors cited parents' lack of awareness and education on oral health and oral health-related problems.

Considering the question of the importance of integration, they noted that nondental providers, especially those tasked with patients' oral health evaluations, agreed that oral health fits in the concept of holistic primary care, and, in fact, these providers considered oral healthcare "instrumental" for preventing diseases.

The third theme of professionals' role highlighted the lack of training in oral healthcare for these providers. While the providers agreed on the importance of oral healthcare, they generally believed that they were not versed in oral healthcare enough to play an important role in their patients' oral healthcare and highlighted the need for adding dental workforce to their team.

The barriers to integration were mostly related to organizational issues, such as a lack of policies or mechanisms to facilitate the delivery of oral health services, the interviewed practitioners said. They also identified a shortage of qualified providers and a high cost for services as barriers.

For facilitators of integrating oral healthcare into primary care, the practitioners reported budget allocation, fundraising strategies, and innovative care models.

Facilitation

The authors listed several limitations with their study, including the following:

• The study did not include patients' perspectives.
• The findings may not be transferable to other locations.

However, they noted that the facilitation of oral healthcare into primary healthcare required a commitment from stakeholders, including funders and government agencies.

"Implementation of governance policies, the prioritization of educational and management measures, as well as interprofessional collaboration toward innovative care models, could facilitate this integration," the study authors concluded.