IADR Abstract Archives
Barriers and Facilitators of Primary Oral Health Care: A Field-Based Case Study
Objectives: To develop a theoretically based perspective and empirically examine the barriers and facilitators of the integration of oral health into primary care.
Methods: Grounded in the conceptual framework of integrated care, a field-based case study was conducted. Using the methodological framework of Arksey and O’Malley, a scoping review was carried out. Various databases of professional biomedical literature as well as relevant organizations were systematically searched to map the literature on the concept of integration of oral health into primary care. In parallel, 29 in-depth, semi-structured, face-to-face interviews with Quebec primary care providers and health care managers from a rural health centre were realized. Informants were purposively selected for maximum variation. Interviews were continued until saturation was achieved. Qualitative data analysis included interview debriefing, transcript coding, data display, and interpretation. Triangulation among data sources and content cross-analysis were performed to ensure the study credibility.
Results: Barriers and facilitators were related to six interconnected domains at micro, meso, and macro levels. The domains included clinical, professional, organizational, functional, normative, and systematic integration. Barrier-related themes emerging from qualitative data included discipline-oriented training, lack of interprofessional education, conflict of perspectives, practice behaviour, and health care prioritization. Additional barrier themes such as traditional dentistry, lack of clinical, organizational, and political leadership, and lack of community-sensitive care were identified by cross-analysis. The main facilitators of integration were implemented policies and interprofessional collaborative practices.
Conclusions: The implementation of comprehensive, integrated primary care is dependent on the existence of facilitators at different levels of health care system organization. Multi-level and diverse interventions are needed to support the development and the continuity of this approach.
Methods: Grounded in the conceptual framework of integrated care, a field-based case study was conducted. Using the methodological framework of Arksey and O’Malley, a scoping review was carried out. Various databases of professional biomedical literature as well as relevant organizations were systematically searched to map the literature on the concept of integration of oral health into primary care. In parallel, 29 in-depth, semi-structured, face-to-face interviews with Quebec primary care providers and health care managers from a rural health centre were realized. Informants were purposively selected for maximum variation. Interviews were continued until saturation was achieved. Qualitative data analysis included interview debriefing, transcript coding, data display, and interpretation. Triangulation among data sources and content cross-analysis were performed to ensure the study credibility.
Results: Barriers and facilitators were related to six interconnected domains at micro, meso, and macro levels. The domains included clinical, professional, organizational, functional, normative, and systematic integration. Barrier-related themes emerging from qualitative data included discipline-oriented training, lack of interprofessional education, conflict of perspectives, practice behaviour, and health care prioritization. Additional barrier themes such as traditional dentistry, lack of clinical, organizational, and political leadership, and lack of community-sensitive care were identified by cross-analysis. The main facilitators of integration were implemented policies and interprofessional collaborative practices.
Conclusions: The implementation of comprehensive, integrated primary care is dependent on the existence of facilitators at different levels of health care system organization. Multi-level and diverse interventions are needed to support the development and the continuity of this approach.