Table 1 Integration of oral health into primary care: Summary of integrated oral health care programmes
Authors, Country/ Year | Program type/Target population | Program main strategy | Oral health care provider | Main outcomes |
|---|---|---|---|---|
Bain & Goldthorpe, Canada/1972 | University-initiated outreach /Aboriginal community | • Assigned full-time dentists to community’s hospital, providing dental services in nursing stations and satellites | Dentists & dental residents | • Creation of supportive environment • Demonstration of feasibility, replicability |
Rozier et al., USA/2003 | Statewide community clinics preventive program/Low income children 0–3 years old | • Reimbursement of non-dental care providers for preventive dental services | Paediatricians, family physicians, nurses and other health care professionals in community clinics | • ↑ trained medical professionals (88% participation rate) • Wide geographical oral health coverage • ↑ 2.8 times the number of practices with submitted claims over one-year period • ↑ follow-up visits |
Wysen et al., USA/ 2004 | Public-health based program /Low-income children ≤5 years old | • Empowering case management model • Co-location of dental and medical clinics • Providers cross-training • Community education and outreach | Case managers, community agency staff, physicians, public health nurses, dentists and dental hygienists | • Successful training of community care providers • ↑ numbers of screening, dental visits and oral health services • 109% ↑ in fluoride varnish applications over 10-month period |
Heuer, S., USA/2007 | School-linked clinics /Low income children | • Contractual partnership with a local community dental health center and employment of dental hygienists at school • Training of school nurse practitioners for screening of oral diseases | Nurse practitioners and dental hygienists | • ↑ Parents’ satisfaction • ↓ of no-show rates for dental care |
Stevens et al., USA/2007 | Oral health-oriented prenatal practice /Pregnant low income adolescents | • Incorporation of evidence-based oral health guidelines in prenatal care • Inclusion of dental consultations in prenatal sessions | Nurse midwives and nurse practitioners, paediatric dental consultant, obstetrician, physician, social worker and nutritional specialist | • ↑ Patients’ satisfaction |
Dugdill, L. & Pine, CM., UK/ 2011 Pine CM & Dugdill L, UK/2011 | Global multi-objective public-health programs in collaboration with National Dental Associations, the member associations of Federal Dental International (FDI) and Unilever Oral Care/Wide-range population groups | • Public-private partnership • Training of day care workers to deliver oral health promotion in day care centers (Philippines) • Education of future parents (Poland) • Training of dental educators (Indonesia) • Training for dentists (Nigeria) | Non-dental care providers Dentists | • Raised awareness of oral health in 1 million people from 36 countries • ↑ capacity building to deliver oral health in 36 countries • Improvement of oral health status in children over a ten-year period |
Brownlee, B., USA/2012 Nycz, G., USA/ 2014 Maxey, H., USA/2015 Taflinger et al., USA/2016 Acharya, A., USA/2016 Gesko, DS., USA/2016 | Patient-centered dental homes targeting various models of care: physician led model, administration-driven model, culture of integration, interprofessional collaboration, dental outreach coordinator/Low income children, pregnant women and diabetic patients | • Co-location of dental and medical care • Oral health champion modelling to provide oral health care in the primary care setting • Implementation of protocol for referral protocols • Cross-training of dentists and medical providers | Primary health care providers & clinical assistants Dental care team (dentist, dental hygienist, dental assistant, dental therapist) | • ↓ oral health risk factors for some of the models including • ↑ number of patients receiving dental care in all delivery models • Implementation of systematic and reproducible risk assessment tool for periodontal disease and oral cancer • Some programs based on physician-led models were not sustainable |
Ramos-Gomez, FJ., USA/2014 | University initiated program in partnership with community-based organizations | • Training of all staff involved • 3-month rotation for dental paediatric residents | Non-dental providers and dental residents | • 672 patients and 1500 visits over a 3 year period • More than 42% of the children had 2 or more visits • 138 patients were maintained caries-free and the programme prevented lesions from progressing in 51 patients |
Leavitt Partners, USA/2015 | Dental services integrated in accountable care organizations/ Public & private-insured population groups | • Co-location of medical and dental care • Case management • Higher reimbursement rates for care coordination via medical providers • Reimbursement of non-dental and dental care providers for preventive dental services • Contracting with dental associations to provide dental care in private and public settings • Empowering dental leadership | Dentists, care coordinators, non-dental care providers, outreach and referral team | • ↓ 55% of operating room utilization for children’s dental care under sedation • ↓ 50% of dental pain complaints • ↓ 9.1% in emergency visits over one-year period • ↑ 3.3% outpatient visits over one- year period |
Wooley, S., Australia/ 2016 | Community-controlled primary health care service /Aboriginal population | • Care coordination to enable two-way referrals and information exchange between staff and community | Dentist and dental consultant, nurses | • Fissure sealants and fluoride varnish to 100% of the children over a five- year period • ↓ emergency attendance rates over a five- year period • DMFT = 0 in 53.1% of 12 years old children and dmft = 0 in 16.9% of 0–4 year old children over a five-year period |