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Table 2 Integration of oral health into primary care: Summary of oral health outcomes

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

Author, Year/Country Study objective/Study design Setting/Target health care users Data collection Indicators Main outcomes
Haughney et al.,
1998/UK
To develop and evaluate a model of integrated medical and dental care/Cohort study Co-located medical and dental practices under National Health System regulation/General population • Postal questionnaire
• Health records archive
• Number of registered joint patients
• Information discrepancies
• Joint work practices
• Number of secondary referrals
• 90% increase in the number of registered joint patients over a 3-year period
• ↓ discrepancies
• 42% ↑ in 0–5 year olds’ number of joint visits
• 24% ↑ in > 75 year olds’ number of joint visits
• ↓ need for secondary referrals (n = 41) over a 3-year period
Pronych et al.,
2010/USA
To examine the efficacy of systems approach and training nursing staff on the oral health of nursing home residents/Pilot study Long-term care facilities (LTC)/Geriatric population • Clinical examination
• Interviews with the oral health coordinators
• Simplified debris index (DI-S) of residents at baseline, 2, 6 and 12 month follow-up
• Success and barriers of the model
• Feedback on the oral health coordinator’s role
• Statistically significant improvement in the oral hygiene of LTC residents
Dyson et al.,
2012/ Australia
To examine the cost-effectiveness of a rural and remote networked hub-and-spokes model / Retrospective economic analysis Fixed dental services embedded in Aboriginal Health Services/Aboriginal communities • Services activities data • Cost-to-value ratio • Cost-to-value ratio average: 1.61
• Not statistically significant difference between sites, according to the Accessibility/Remoteness Index of Australia
Gerritsen et al., 2013/
Netherlands
To compare the cost and effects of integrated care versus incidental care/Observational study Long-term care facilities/Geriatric population • Clinical examination
• Administrative data
• Oral health status
• Cost of dental care
• Integrated care ↓ dental treatment needs
• Integrated care ↑ cost and time spent on dental care
Hom et al., 2013/USA To evaluate the adherence to early and periodic screening, diagnosis and treatment guidelines for medical practices/
Observational study
Medical practices/Medicaid registered children • Medicaid administrative data base • Number of states adhering to the best oral health practices
• Number of states requiring dental referral by age 1
• 88% of states adhered to the content and timing of best oral health practices
• 33% of the states adhered to the best oral health practice by requiring referral by age 1
Kranz et al., 2014/USA To examine the association between the type of the service provider (primary care provider/PCP, dentist) and subsequent dental-caries related treatment (CRT) and CRT payment/Retrospective study North Carolina Medicaid / Children aged 3–5 years • Medicaid enrollment and claim files from 2000 to 2006 • CRT
• CRT payment
• Statistically significant difference among children visiting PCPs, dentist or both in regard to CRT and CRT payments
• The dentist provider type was associated with ↑ CRT and ↑ CRT payments per year
Langelier et al., 2015/USA
Langelier, M., 2015/USA
To identify effective approaches to integrating primary care and oral health services delivery /Case studies Federally qualified health care centers across United States /Vulnerable population groups • Interviews and focus group discussion • Number of dental clinics
• Number of dental personnel
• Number of dental visits
• Attendance
• Referral mechanisms
• Number of primary care providers trained
• ↑ number of dental clinics
• ↑ number in dental residents
• After 3 months, some clinics were fully booked, with 3–4 week waits for appointments
• Electronic health record interoperability
Grisanti et al., 2015/USA To examine the performance of Federally Qualified Health Centers over 5-year period (2007–2012)/
Observational study
Community health center’s dental department /Medicaid, uninsured and privately insured patients • Administrative records • Oral health age-specific indicators: number of dental visits, number of received oral health services/year, number of received preventive interventions/year, percentage of preventive measures, number/percentage of preventive visits • 87% ↑ in the total number of patients who received at least one dental visit over 5-year period
• About 50% ↑ in the total number of patients who received preventive interventions
• 27% ↑ comprehensive exam
• 97% ↑ in number of patients having preventive interventions
• No increase in Medicaid patients having a dental procedure
• 56% ↑ in restorative procedures for 65 +
• 140% ↑ in preventive services
DiMarco et al., 2016/USA To test the feasibility of integrating primary preventive interventions into the practice of nurses, registered dieticians and students Sites of the Supplemental Nutrition Program for women, children and infants/Low income preschool children • Dental screening and administrative records
• Parent/Guardian oral health survey
• Number of preventive fluoride varnishes and education sessions
• Oral force diversity, capacity and flexibility
• Interprofessional collaboration
• Fluoride varnish applied to 40% of children in order to reduce the number of cavities by 25%
• Enhanced education of 40% of women and mothers at both sites
• Establishing a dental home for 75% of children
• Expanded the scope of practice of RD, RN, NP
• Enhanced cross training opportunities