Partnering for Integrated Care: A Learning Collaborative for Primary Care and Oral Health Teams

Abstract

PURPOSEThe Teaming and Integrating for Smiles and Health (TISH) Learning Collaborative was developed to help health care organizations accelerate progress in integrating delivery of oral and primary care. By providing expert support and a structure for testing change, the project aimed to improve the early detection of hypertension in the dental setting and of gingivitis in the primary care setting, and to increase the rate of bidirectional referrals between oral and primary care partners. We report its outcomes. METHODS A total of 17 primary and oral health care teams were recruited to participate in biweekly virtual calls over 3 months. Participants tested changes to their models of care through Plan-Do-Study-Act cycles between calls. Sites tracked the percentages of patients screened and referred, completed the TeamSTEPPS (Team Strategies and Tools to Enhance Performance and Patient Safety) and Interprofessional Assessment questionnaires, and provided qualitative feedback and updates in storyboard presentations. RESULTSOn average, with implementation of the TISH Learning Collaborative, sites displayed a nonrandom improvement in the percentages of patients screened for hypertension, referred for hypertension, referred to primary care, and referred for gingivitis. Gingivitis screening and referral to oral health care were not markedly improved. Qualitative responses indicated that teams made progress in screening and referral workflows, improved communication between medical and dental partners, and furthered understanding of the connection between primary care and oral care among staff and patients. CONCLUSIONSThe TISH project is evidence that a virtual Learning Collaborative is an accessible and productive avenue to improve interprofessional education, further primary care and oral partnerships, and achieve practical progress in integrated care.

Perceptions of mental health screening and referral to treatment in National Dental‐Practice Based Research Network practices: A qualitative study

“…The strong relationship with patients underscores the desire to contribute to the overall health of their patients beyond oral care, including utilizing active methods for identifying and responding to mental health concerns. This aligns with prior research findings that dentists exhibit the willingness to engage in screening endeavors for healthcare concerns, provided they are equipped with appropriate training, support, and resources, ensuring effective implementation within a suitable timeframe [20–23, 39, 40, 45–48].…”

“…To address these challenges, various facilitators have been identified, including continuing education (CE) and training, prior knowledge, training during professional schooling, supportive follow‐up practices, and approaches like screening, brief intervention, and referral to treatment [20–22, 42, 43, 45]. The effectiveness of these facilitators in mitigating the challenges has led to increased calls for integrated care, where different aspects of healthcare are interconnected and coordinated [46–48].…”

Current scientific evidence for why periodontitis should be included in diabetes management

“…A search for “oral health” at the American Medical Association (AMA)’s homepage ( https://www.ama-assn.org/ ) turned up 2 hits, one of which links to a paper by physician Hugh Silk, a long-time, avid advocate for integration of primary care and oral health ( 139 , 171 – 176 ).…”

Obstacles and Opportunities on the Path to Improving Health Professions Education and Practice: Lessons From HRSA’s Academic Units for Primary Care Training and Enhancement

“…12 Primary care clinicians, when properly trained, are well situated to both screen and refer for some oral health problems. 13,14 They also could provide preventive oral care, such as fluoride varnish to children, which is particularly important in cases where barriers to accessing dental care exist. 15 Similar to programs preparing primary care clinicians to address oral health and the challenges they face, oral health training programs frequently omit teaching on topics seen as outside their scope.…”

“…Communities of practice, united by shared interests and a commitment to learning and change, 18 feature heavily in the work of the Academic Units. Several articles in this supplement provide examples of communities of practice, or learning communities, applied to diverse primary care-related areas including promoting cross-disciplinary partnering between dentistry and primary care, 13 increasing research and scholarship in rural primary care programs, 19 accelerating the integration of oral health into primary care training program curricula, 14 increasing the number of primary care professionals providing oral health services, 20 addressing social determinants of health in health professions education, 21 and increasing community engagement in undergraduate medical education. 22 Collectively, these researchers explore varied facets of how these communities are formed and function, and the goals they can achieve in changing educational and clinical practices.…”