How primary health care teams perceive the integration of oral health care into their practice: A qualitative study.

Hermina Harnagea,Elham Emami,Lise Lamothe,Yves Couturier,Denis Bourgeois

doi:10.1371/journal.pone.0205465

Hermina Harnagea, Elham Emami + Show 3 more

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https://doi.org/10.1371/journal.pone.0205465

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Abstract

Recently, new models for the integration of oral health into primary care have been proposed. However, these models may be adopted by a variety of health care systems, and will reach successful outcomes only if they can be adapted to suit the local context. To this end, the objective of this study was to explore the perceptions of Quebec primary health care teams on the integration of oral health into primary care. A qualitative approach and interpretive description methodology were used to conduct the study within a case-study design. Purposeful sampling with maximum variation and snowball technique were used for recruitment of study participants. Seventy-four in-depth, semi-structured interviews and five focus groups were conducted with primary health care teams including health care providers and managers working in a rural and an urban health care center. The interview guide and study conceptual framework were based on the Rainbow model. Data collection and data analyses were conducted concurrently and continued until saturation was achieved. To analyze the data, four phases of qualitative analysis were followed. The thematic analysis included interview debriefing, transcript coding, data display, and interpretation. Data analysis was conducted both manually and with the use of Atlas-ti software. A total of four themes emerged from the interviews and focus group discussions. These themes covered all domains of the study theoretical model and included: 1) drivers of integration; 2) importance of integration; 3) professionals’ role in integrated care; and 4) barriers and enablers of integration. In general, most of the barriers expressed by study participants were related to the organizational and system domains of integration. Primary health care teams who provide care in rural and urban areas in Quebec expressed their concerns on the absence of integrated oral health services. Implementation of governance policies, the prioritization of educational and management measures as well as inter-professional collaboration toward innovative care models could facilitate this integration.

Highlights

Various health organizations have proposed the integration of oral health into primary care as an effective approach to improve access to oral health care [1,2,3,4].Primary oral health care has been defined by Isman [5] as “the integration of services that promote and preserve oral health, prevent oral disease, injury and dysfunction and provide a regular source of care for acute and chronic oral diseases and disabilities.” various demonstrations and pilot programs have shown promising results for the integration of oral health into primary care, the rate of implementation of this approach remains low [6,7,8]
How primary health care teams perceive the integration of oral health care into their practice care; and barriers and enablers of integration
This study explored the perceptions of primary health care teams on the integration of oral health into primary care

Summary

Introduction

Various health organizations have proposed the integration of oral health into primary care as an effective approach to improve access to oral health care [1,2,3,4].Primary oral health care has been defined by Isman [5] as “the integration of services that promote and preserve oral health, prevent oral disease, injury and dysfunction and provide a regular source of care for acute and chronic oral diseases and disabilities.” various demonstrations and pilot programs have shown promising results for the integration of oral health into primary care, the rate of implementation of this approach remains low [6,7,8]. Primary oral health care has been defined by Isman [5] as “the integration of services that promote and preserve oral health, prevent oral disease, injury and dysfunction and provide a regular source of care for acute and chronic oral diseases and disabilities.”. In many countries strategic health care plans have been implemented to promote interprofessional collaboration, increase knowledge, improve skills, and shape positive attitudes towards primary oral health care. The US Health Resources and Services Administration has encouraged primary health care providers to develop competencies in the areas of primary oral health care including: risk assessment, oral health evaluation, preventive intervention, counseling and education and interprofessionnal collaborative practices [11]. As defined by D’Amour and Oandasan [12], interprofessional work: “The process by which professionals reflect on and develop ways of practicing that provide an integrated and cohesive answer to the needs of the client, family, and populations.”

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