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Table 1 Integration of oral health into primary care: Summary of integrated oral health care programmes

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

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