Medical–Dental Integration in a Rural Community Health Center: A Qualitative Program Evaluation

Abstract

Background A community health center (CHC) implemented a medical–dental integration (MDI) program where children were seen at a pediatric medical clinic or women, infants, and children program location by medical and dental providers in the same visit. Our study aims were to elicit the perspectives and experiences of providers and administrators involved in the MDI program to assess the acceptability, feasibility, and success of a CHC integration strategy in Eastern Washington. Methods This is a qualitative study where we conducted semistructured interviews over the phone over a period of 2 months with 12 medical and dental providers and clinical administrators who were involved with the MDI program. Questions addressed perspectives on workflow, patient identification and engagement, leadership support, and barriers and facilitators of the initiative. Qualitative data were analyzed, and emergent themes were identified. Results The emergent themes included (a) the MDI program is feasible and acceptable albeit with key considerations regarding the setting, including charting and service integration, progressive leadership and effective communication, and appropriate providers; (b) implementation included structural, systemic, and individual behavior barriers, (c) the program is seen as a benefit to the clinic and patients and a success to date as a way to increase access to quality care. Conclusions Findings from this study helped identify facilitators, such as cultural relevancy and progressive office systems, as well as barriers, such as reimbursement, associated with integrating medical and dental care in a rural CHC setting, is acceptable by providers, and can inform future studies and implementation strategies for others wishing to integrate these services.

Oral health community engagement programs for rural communities: A scoping review

“…Although the overall findings of this scoping review revealed oral healthcare improvements in various rural communities, the findings also suggested that developing countries face a substantial burden of oral diseases [ 16 – 18 , 22 – 24 , 26 , 28 , 29 , 35 , 36 ]. Furthermore, the inclusion of studies evaluating oral health strategies in rural communities of developed countries provided evidence of persistent discrepancies in oral healthcare accessibility and a shortage of oral healthcare professionals, confirming that this burden is of global significance [ 15 , 25 , 27 , 30 – 34 ].…”

“…The subsequent category delineates the school-based dental interventions implemented in the primary school setting [ 17 , 18 , 28 – 30 ]. The third category emphasizes the importance of integrated dental-based interventions [ 25 , 28 , 32 , 35 ]. The fourth category characterises the auxiliary care community-based interventions [ 16 , 35 , 36 ].…”

“…The third category emphasizes the importance of integrated dental-based interventions [ 25 , 28 , 32 , 35 ]. The fourth category characterises the auxiliary care community-based interventions [ 16 , 35 , 36 ]. The summary of categories of oral health community engagement interventions and their programs are outlined and depicted in Table 3 .…”

Strategies to integrate oral health into primary care: a systematic review

“…The initial search resulted in the identification of 8731 unique articles, of which 213 were assessed for eligibility. On completion of the full text review, 49 studies describing various interventions were included in this review 25–73. List of studies excluded during the full text review, along with the reasons, is presented in online supplemental table S4.…”

Oral Health in America

“…71 Additional models of care delivery, even in rural settings, are showing promise. 72 To achieve the promise of oral health integration and better align oral and medical health care delivery, interprofessional partnerships between dental and medical practitioners are needed. In addition, the long-standing system-level barriers that perpetuate the separation of dental and medical professions, education, care, and payment systems need to be addressed.…”