From theoretical concepts to policies and applied programmes: the landscape of integration of oral health in primary care

Abstract

BackgroundDespite its importance, the integration of oral health into primary care is still an emerging practice in the field of health care services. This scoping review aims to map the literature and provide a summary on the conceptual frameworks, policies and programs related to this concept.MethodsUsing the Levac et al. six-stage framework, we performed a systematic search of electronic databases, organizational websites and grey literature from 1978 to April 2016. All relevant original publications with a focus on the integration of oral health into primary care were retrieved. Content analyses were performed to synthesize the results.ResultsFrom a total of 1619 citations, 67 publications were included in the review. Two conceptual frameworks were identified. Policies regarding oral heath integration into primary care were mostly oriented toward common risk factors approach and care coordination processes. In general, oral health integrated care programs were designed in the public health sector and based on partnerships with various private and public health organizations, governmental bodies and academic institutions. These programmes used various strategies to empower oral health integrated care, including building interdisciplinary networks, training non-dental care providers, oral health champion modelling, enabling care linkages and care coordinated process, as well as the use of e-health technologies. The majority of studies on the programs outcomes were descriptive in nature without reporting long-term outcomes.ConclusionsThis scoping review provided a comprehensive overview on the concept of integration of oral health in primary care. The findings identified major gaps in reported programs outcomes mainly because of the lack of related research. However, the results could be considered as a first step in the development of health care policies that support collaborative practices and patient-centred care in the field of primary care sector.

Two-eyed seeing of the integration of oral health in primary health care in Indigenous populations: a scoping review

“…Figure 2 illustrates the twoeyed seeing view of approaches and outcomes of programs on integrating oral health services within primary health services. Evidence on approaches and outcomes of integration of oral health into primary care in the general population is consistent with our results [34,35,82]. The identified approaches of the integrated primary oral health care interventions extended from the micro to macro level of integration in the form of colocation, interprofessional coordination, interprofessional training and education, integration of oral health into public health programs, financial support, shared health records, cultural safety, and shared vision and mission [78,79].…”

“…According to recent scoping reviews conducted by a group of researchers in Canada, several programs on the integration of oral health into primary care have been developed worldwide during the last decade [34,35]. These programs have been successful in implementing integrated primary oral health care in terms of reducing patient non-attendance, improving providers' and patients' satisfaction, dental visits, screening and prevention of oral diseases, referrals, and access to dental care [34,35].…”

How primary health care teams perceive the integration of oral health care into their practice: A qualitative study

“…At the macro level and in the systemic domain, lack of human resources, integrated services costs, and low political priority accorded to oral health were reported mostly by managers. These findings were similar to results of our recent scoping review [ 10 ] on the integration of oral health into primary care.…”

“…Primary oral health care has been defined by Isman [ 5 ] as “ the integration of services that promote and preserve oral health , prevent oral disease , injury and dysfunction and provide a regular source of care for acute and chronic oral diseases and disabilities .” Although various demonstrations and pilot programs have shown promising results for the integration of oral health into primary care, the rate of implementation of this approach remains low [ 6 – 8 ]. Our comprehensive scoping review on this topic showed that one of the main barriers for primary oral health care is the lack of collaborative work and related suboptimal competencies of health care providers [ 9 , 10 ]. Accordingly, in many countries strategic health care plans have been implemented to promote interprofessional collaboration, increase knowledge, improve skills, and shape positive attitudes towards primary oral health care.…”

A strife of interests: A qualitative study on the challenges facing oral health workforce policy and planning

“…We argue that health system deficiencies, especially within the payment and practice mechanisms of dentistry, could be tackled by the greater integration of oral health with general health. In a primary care setting clinical integration needs to emerge at a more micro level, [25,63,64] which focuses on improving the interdependence among dental, medical, nursing and allied health teams [50,65]. This could take approaches ranging from (i) dental teams conducting some routine medical functions such as diabetes screening, blood pressure checks, nutrition and health promotion counselling (ii) general practitioners/nurses involved in screening for oral diseases (iii) allied health professionals (e.g.…”