Non-Cochrane · intervention · PM37407034
Strategies to integrate oral health into primary care: a systematic review.
Christian Bradley, George Ajesh, Veginadu Prabhakar, et al. · BMJ open · 2023 · PubMed · doi:10.1136/bmjopen-2022-070622
Full textEvery question was extracted from the full text, figures and supplements by two independent LLM extractors, disagreements adjudicated. Rows cite where in the review the value comes from.
Questions
8
current version
GRADE rated
0
No studies
0
Included studies
75
linked below
No studies 0 · 0%Ungraded 8 · 100%Very low 0 · 0%Low 0 · 0%Moderate 0 · 0%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | No population-level exclusions: all ages, all ability types and all locations. Only English-language, peer-reviewed research studies included. | 49 studies; populations included children, pregnant women, older adults in residential/aged care, people with disabilities and general primary care patients; predominantly high-income countries (USA n=20, Australia n=10, Canada n=5, Belgium n=3). WHO region: Americas n=27, Western Pacific n=11, Europe n=9, South-East Asia n=3, Eastern Mediterranean n=0. Setting: primary care n=28, plus community, schools and aged-care facilities |
| Intervention | Any strategy or intervention to integrate oral health into primary care (policies, guidelines, frameworks, funding mechanisms and insurance schemes, interprofessional training/education, interprofessional practice, common performance indicators, and local/international networks) | Integration strategies (n=49): oral healthcare provided by non-dental primary care professionals in primary care (n=24, mainly via training/education and/or policy change); training/education of facility/nursing/midwifery staff; policy/financing changes including insurance coverage/reimbursement (n=5 policy-related); colocation of dental and medical services; interprofessional and community-health-worker collaboration; teledentistry; integrated oral health assessment tool; school-based activities |
| Comparison | Not specified (no comparator restriction; controlled and uncontrolled study designs eligible) | Varied; many included studies uncontrolled. Controlled designs: quasi-experimental/non-randomised trial n=8 and RCT n=2; uncontrolled/other: qualitative n=12, retrospective n=8, pre-post n=5, mixed-method n=5, pilot n=4, cross-sectional n=3 |
| Outcomes | Any indicator of strategy effectiveness: (A) uptake of guidelines/policies; (B) fidelity of implementation of guidelines/policies/programmes; (C) provider/clinician-related (scope of practice, improved knowledge, service-delivery efficiencies); (D) patient-related (oral health outcomes, oral health-related quality of life, oral-health knowledge/behaviours/attitudes, cost savings, increased access to care); cost-effectiveness | Access to oral healthcare (n=19); knowledge/attitudes/perceptions of staff and patients (n=16); oral disease outcomes (n=9, of which dental caries n=7); barriers and facilitators to implementation (qualitative); staff/patient experience and satisfaction. Economic/cost-effectiveness outcomes were a planned outcome but a major evidence gap (lack of studies) |
| Study designs | Any study design evaluating integration strategies (no design restriction) | Qualitative n=12, retrospective n=8, quasi-experimental/non-randomised controlled trial n=8, pre-post intervention n=5, mixed-method n=5, pilot n=4, cross-sectional n=3, RCT n=2 |
| Timing | Not specified | Not specified (varied follow-up; e.g., a 1-year follow-up was noted as too short for caries outcomes) |
Search date: No date limits, until the third week of June 2022. Databases: MEDLINE (principal), CINAHL, Embase, Scopus, ProQuest, Cochrane and Google Scholar; reference lists of eligible studies; experts in the field and existing professional networks consulted
Questions and results
Strategies to integrate oral health into primary care (e.g., training/education of non-dental primary care professionals, policy/financing and health-insurance changes, colocation of dental and medical services, interprofessional and community-health-worker collaboration, teledentistry, integrated oral health assessment tools, school-based activities) vs No integration / usual care (or pre-integration baseline; many included studies uncontrolled)
Population: People of all ages and abilities served through primary care and related settings (children, pregnant women, older adults in aged-care/residential and nursing homes, people with disabilities, and general primary care patients)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Access to oral healthcare (referral pathways, documentation processes, operating efficiencies, staffing, visits for oral health issues, uptake of fluoride varnish/other preventive treatment, and visits to an oral health professional) Most strategies to integrate oral health into primary care were associated with improved access to oral healthcare (19 studies, narrative synthesis; ungraded). Source: Abstract; Results (Figure 3 'Summary of outcomes and key findings'); Discussion · same question in other reviews | Access to oral healthcare was the primary outcome most studied (n=19). Most studies reported results favouring the integration strategy, including improvements in referral pathways, documentation processes, operating… | 19 studies | Ungraded |
Knowledge, attitudes and perceptions of staff and patients regarding oral health Integration strategies were generally associated with positive oral health knowledge, attitudes and perceptions among staff and patients (16 studies, narrative synthesis; ungraded). Source: Results (Figure 3 'Summary of outcomes and key findings'); Discussion · same question in other reviews | Knowledge/attitudes/perceptions of staff and patients was the second most studied outcome (n=16). Patient and staff perceptions on various aspects of the integration strategy were usually reported as positive.… | 16 studies | Ungraded |
Barriers and facilitators to implementation of the integration strategy (qualitative) Key barriers to implementing integration strategies were time/staff/resource constraints and lack of organisational support, while facilitators were professionals' knowledge and attitudes and supportive governance/leadership (qualitative; ungraded). Source: Results ('The most commonly studied qualitative outcomes were barriers and facilitators'); Discussion · same question in other reviews | The most commonly studied qualitative outcomes were barriers and facilitators related to the strategy implementation process. Reported barriers were time and staff constraints, resource limitations and lack of… | 15 studies | Ungraded |
Dental caries estimates Population: People receiving or providing primary care; all ages, ability types, and locations Seven studies measured change in dental caries estimates. Source: Results · same question in other reviews | 6 of 7 studies reported improved dental caries outcomes; 1 (Vichayanrat 2012) reported no change | 7 studies | Ungraded |
Oral disease outcomes, including dental caries estimates Most studies reported improved oral disease outcomes with integration strategies (8 of 9 studies improved, 1 no change; 9 studies, narrative synthesis; ungraded). Source: Results (Figure 3 'Summary of outcomes and key findings'); Discussion ('only nine studies ... reported oral disease outcomes') · same question in other reviews | Nine studies reported oral disease outcomes, seven of which measured change in dental caries estimates. Eight of the nine studies reported improved oral disease outcomes; one (Vichayanrat 2012) reported no change in… | 9 studies | Ungraded |
Comparison
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Quality of life | 1 study reported an unfavourable outcome | 1 study | Ungraded |
Oral health practices | 2 of 2 studies reported favourable outcomes | 2 studies | Ungraded |
Confidence | 3 of 3 studies reported favourable outcomes | 3 studies | Ungraded |
AMSTAR 2 appraisal
Two independent extractors rated each item. Their ratings are shown side by side because they have not been reconciled yet. The overall rating follows Shea et al. 2017: one critical flaw gives Low, more than one gives Critically Low.
| Item | Extractor A | Extractor B | Agree |
|---|---|---|---|
| 1Research question includes PICO components | Yes | Partial Yes | no |
| 2Protocol established before the reviewcritical | Partial Yes | Partial Yes | yes |
| 3Choice of study designs explained | No | No | yes |
| 4Comprehensive literature searchcritical | Partial Yes | Partial Yes | yes |
| 5Study selection in duplicate | Yes | Yes | yes |
| 6Data extraction in duplicate | No | No | yes |
| 7List of excluded studies with reasonscritical | Yes | Yes | yes |
| 8Included studies described in detail | Partial Yes | Partial Yes | yes |
| 9Risk of bias assessed satisfactorilycritical | NRSI: Yes · RCT: Yes | RCT: Yes · NRSI: Yes | no |
| 10Funding of included studies reported | No | No | yes |
| 11Appropriate meta-analysis methodscritical | NRSI: N/A · RCT: N/A | NRSI: N/A · RCT: N/A | yes |
| 12Impact of risk of bias on the pooled results | N/A | N/A | yes |
| 13Risk of bias accounted for in interpretationcritical | Yes | Yes | yes |
| 14Heterogeneity explained | Yes | Yes | yes |
| 15Publication bias investigatedcritical | N/A | N/A | yes |
| 16Conflicts of interest reported | Yes | No | no |
| Overall | Moderate | Moderate | yes |
Included primary studies 75
Open as a trial list| Study | Also included by | Outcomes it informs here | Trial PICO | Results |
|---|---|---|---|---|
| Biordi 2015 Improving access and provision of preventive oral health care for very young, poor, and low-income children through a new… PMID:25689183 | 1 other review | Oral disease outcomes, including dental caries estimates | not extracted yet | not extracted yet |
| Duijster 2017 'Fit for school' - a school-based water, sanitation and hygiene programme to improve child health: Results from a longitudinal study in… PMID:28381246 | 1 other review | Oral disease outcomes, including dental caries estimates | not extracted yet | not extracted yet |
| Lawrence 2004 matched by author and year (probable) | 1 other review | Dental caries estimates | not extracted yet | not extracted yet |
| Vichayanrat 2012 The evaluation of a multi-level oral health intervention to improve oral health practices among caregivers of preschool children. PMID:23082602 | 1 other review | Oral disease outcomes, including dental caries estimates | not extracted yet | not extracted yet |
| Villena 2019 Reducing carious lesions during the first 4 years of life DOI:10.1016/j.adaj.2019.04.003 | 1 other review | Oral disease outcomes, including dental caries estimates | not extracted yet | not extracted yet |
| Villena 2019 Reducing carious lesions during the first 4 years of life: An interprofessional approach. PMID:31470971 | 1 other review | not stated | not extracted yet | not extracted yet |
| Aagaard 2020 Improving oral health in nursing home residents: A process evaluation of a shared oral care intervention DOI:10.1111/jocn.15373 | this review only | not stated | not extracted yet | not extracted yet |
| Aagaard 2020 Improving oral health in nursing home residents: A process evaluation of a shared oral care intervention. PMID:32533875 | this review only | not stated | not extracted yet | not extracted yet |
| Adams 2017 Integrating a Nurse-Midwife-Led Oral Health Intervention Into CenteringPregnancy Prenatal Care: Results of a Pilot Study. PMID:28686808 | this review only | Oral disease outcomes, including dental caries estimates | not extracted yet | not extracted yet |
| Ajwani 2019 Process evaluation of the midwifery initiated oral health‐dental service program: Perceptions of dental professionals DOI:10.1002/hpja.224 | this review only | not stated | not extracted yet | not extracted yet |
| Ajwani 2019 Process evaluation of the midwifery initiated oral health-dental service program: Perceptions of dental professionals. PMID:30512207 | this review only | not stated | not extracted yet | not extracted yet |
| Arif 2021 Perception and Utilization of Oral Screenings and Fluoride Application in Medical Offices Following the Michigan Caries Prevention Program… PMID:33627453 | this review only | Dental caries estimates | not extracted yet | not extracted yet |
| Aronoff-Spencer 2020 A comprehensive assessment for community-based, person-centered care for older adults. PMID:32503440 | this review only | not stated | not extracted yet | not extracted yet |
| Basso 2019 A construção da rede de atenção à saúde bucal no Distrito Federal, Brasil DOI:10.1590/1413-81232018246.08552019 | this review only | not stated | not extracted yet | not extracted yet |
| Basso 2019 The construction of the oral health care network in the Federal District, Brazil. PMID:31269174 | this review only | not stated | not extracted yet | not extracted yet |
| Batra 2018 Integration of oral health in primary health care through motivational interviewing for mothers of young children: A pilot study DOI:10.4103/jisppd.jisppd_19_17 | this review only | Dental caries estimates | not extracted yet | not extracted yet |
| Batra 2018 Integration of oral health in primary health care through motivational interviewing for mothers of young children: A pilot study. PMID:29607846 | this review only | not stated | not extracted yet | not extracted yet |
| Brännemo 2021 Impact of an extended postnatal home visiting programme on oral health among children in a disadvantaged area of Stockholm, Sweden DOI:10.1111/apa.15457 | this review only | Oral disease outcomes, including dental caries estimates | not extracted yet | not extracted yet |
| Brännemo 2021 Impact of an extended postnatal home visiting programme on oral health among children in a disadvantaged area of Stockholm, Sweden. PMID:32623798 | this review only | not stated | not extracted yet | not extracted yet |
| Burgette 2018 Access to preventive services after the integration of oral health care into early childhood education and medical care. PMID:30243426 | this review only | not stated | not extracted yet | not extracted yet |
| Crall 2016 An Innovative Project Breaks Down Barriers to Oral Health Care for Vulnerable Young Children in Los Angeles County. PMID:27416646 | this review only | not stated | not extracted yet | not extracted yet |
| Dahlen 2019 Process evaluation of the midwifery initiated oral health-dental service program: Perceptions of midwives in Greater Western Sydney,… DOI:10.1016/j.wombi.2018.06.021 | this review only | not stated | not extracted yet | not extracted yet |
| Dahlen 2019 Process evaluation of the midwifery initiated oral health-dental service program: Perceptions of midwives in Greater Western Sydney,… PMID:30025676 | this review only | not stated | not extracted yet | not extracted yet |
| de Mey 2016 Oral Hygiene in Patients With Severe Mental Illness: A Pilot Study on the Collaboration Between Oral Hygienists and Mental Health Nurses DOI:10.1111/ppc.12117 | this review only | Oral disease outcomes, including dental caries estimates | not extracted yet | not extracted yet |
| de Mey 2016 Oral Hygiene in Patients With Severe Mental Illness: A Pilot Study on the Collaboration Between Oral Hygienists and Mental Health Nurses. PMID:25902957 | this review only | not stated | not extracted yet | not extracted yet |
| De Visschere 2015 The integration of oral health care into day‐to‐day care in nursing homes: a qualitative study DOI:10.1111/ger.12062 | this review only | Dental caries estimates | not extracted yet | not extracted yet |
| De Visschere 2015 The integration of oral health care into day-to-day care in nursing homes: a qualitative study. PMID:23786637 | this review only | not stated | not extracted yet | not extracted yet |
| Dooley 2016 Oral Health Prevention and Toddler Well-Child Care: Routine Integration in a Safety Net System. PMID:26647374 | this review only | not stated | not extracted yet | not extracted yet |
| Fallon 2006 Implementation of oral health recommendations into two residential aged care facilities in a regional Australian city DOI:10.1111/j.1479-6988.2006.00040.x | this review only | Dental caries estimates | not extracted yet | not extracted yet |
| Fallon 2006 Implementation of oral health recommendations into two residential aged care facilities in a regional Australian city. PMID:21631764 | this review only | not stated | not extracted yet | not extracted yet |
| George 2016 The evaluation of an oral health education program for midwives in Australia DOI:10.1016/j.wombi.2015.10.004 | this review only | not stated | not extracted yet | not extracted yet |
| George 2016 The evaluation of an oral health education program for midwives in Australia. PMID:26552339 | this review only | not stated | not extracted yet | not extracted yet |
| George 2018 Evaluation of a midwifery initiated oral health-dental service program to improve oral health and birth outcomes for pregnant women: A… DOI:10.1016/j.ijnurstu.2018.03.006 | this review only | not stated | not extracted yet | not extracted yet |
| George 2018 Evaluation of a midwifery initiated oral health-dental service program to improve oral health and birth outcomes for pregnant women: A… PMID:29605753 | this review only | not stated | not extracted yet | not extracted yet |
| George 2019 Process evaluation of the midwifery initiated oral health‐dental service program: perceptions of pregnant women DOI:10.1111/adj.12660 | this review only | not stated | not extracted yet | not extracted yet |
| George 2019 Process evaluation of the midwifery initiated oral health-dental service program: perceptions of pregnant women. PMID:30375645 | this review only | not stated | not extracted yet | not extracted yet |
| Heilbrunn-Lang 2015 Midwives' perspectives of their ability to promote the oral health of pregnant women in Victoria, Australia. PMID:25943399 | this review only | not stated | not extracted yet | not extracted yet |
| Ho 2021 'Don't forget the mouth!': a process evaluation of a public oral health project in community-dwelling frail older people. PMID:34663274 | this review only | Dental caries estimates | not extracted yet | not extracted yet |
| Janssens 2018 Effect of an oral healthcare programme on care staff knowledge and attitude regarding oral health: a non-randomised intervention trial DOI:10.1007/s00784-017-2110-6 | this review only | not stated | not extracted yet | not extracted yet |
| Janssens 2018 Effect of an oral healthcare programme on care staff knowledge and attitude regarding oral health: a non-randomised intervention trial. PMID:28367601 | this review only | not stated | not extracted yet | not extracted yet |
| Kanan 2020 <scp>MORE</scp> Care: an evaluation of an interprofessional oral health quality improvement initiative DOI:10.1111/jphd.12407 | this review only | not stated | not extracted yet | not extracted yet |
| Kanan 2020 MORE Care: an evaluation of an interprofessional oral health quality improvement initiative. PMID:33103760 | this review only | not stated | not extracted yet | not extracted yet |
| Kohli 2017 Dental care practices and oral health training for professional caregivers in long-term care facilities: An interdisciplinary approach to… DOI:10.1016/j.gerinurse.2016.11.008 | this review only | Dental caries estimates | not extracted yet | not extracted yet |
| Kohli 2017 Dental care practices and oral health training for professional caregivers in long-term care facilities: An interdisciplinary approach to… PMID:28063685 | this review only | not stated | not extracted yet | not extracted yet |
| Kranz 2015 Effects of Physician-Based Preventive Oral Health Services on Dental Caries. PMID:26122805 | this review only | Oral disease outcomes, including dental caries estimates | not extracted yet | not extracted yet |
| Lambert 2018 Dental Attendance in Undocumented Immigrants before and after the Implementation of a Personal Assistance Program: A Cross-Sectional… PMID:30558160 | this review only | not stated | not extracted yet | not extracted yet |
| Mason 1994 Integration of primary care dental and medical services: a pilot investigation DOI:10.1038/sj.bdj.4808588 | this review only | not stated | not extracted yet | not extracted yet |
| Mason 1994 Integration of primary care dental and medical services: a pilot investigation. PMID:7946665 | this review only | not stated | not extracted yet | not extracted yet |
| Mathu-Muju 2017 The perceptions of first nation participants in a community oral health initiative. PMID:28859556 | this review only | not stated | not extracted yet | not extracted yet |
| McKeown 2014 matched by author and year (probable) | this review only | not stated | not extracted yet | not extracted yet |
| McNally 2015 Implementing Oral Care Practices and Policy Into Long-Term Care: The Brushing up on Mouth Care Project DOI:10.1016/j.jamda.2014.08.018 | this review only | Dental caries estimates | not extracted yet | not extracted yet |
| McNally 2015 Implementing oral care practices and policy into long-term care: the Brushing up on Mouth Care project. PMID:25306289 | this review only | not stated | not extracted yet | not extracted yet |
| Mofidi 2009 Community-based dental partnerships: improving access to dental care for persons living with HIV/AIDS. PMID:19910473 | this review only | not stated | not extracted yet | not extracted yet |
| Nelson 2018 Elevating Oral Health Interprofessional Practice Among Pediatricians Through a Statewide Quality Improvement Learning Collaborative DOI:10.1097/phh.0000000000000622 | this review only | Dental caries estimates | not extracted yet | not extracted yet |
| Nelson 2018 Elevating Oral Health Interprofessional Practice Among Pediatricians Through a Statewide Quality Improvement Learning Collaborative. PMID:28832432 | this review only | not stated | not extracted yet | not extracted yet |
| Niiranen 2008 Oral Health Care Reform in Finland - aiming to reduce inequity in care provision. PMID:18226197 | this review only | not stated | not extracted yet | not extracted yet |
| O'Neil 2002 matched by author and year (probable) | this review only | not stated | not extracted yet | not extracted yet |
| Pawloski 2022 Medical–Dental Integration in a Rural Community Health Center: A Qualitative Program Evaluation DOI:10.1177/15248399211002832 | this review only | Dental caries estimates | not extracted yet | not extracted yet |
| Pawloski 2022 Medical-Dental Integration in a Rural Community Health Center: A Qualitative Program Evaluation. PMID:33853397 | this review only | not stated | not extracted yet | not extracted yet |
| Sengupta 2017 Oral Health Integration Into a Pediatric Practice and Coordination of Referrals to a Colocated Dental Home at a Federally Qualified Health… PMID:28817337 | this review only | not stated | not extracted yet | not extracted yet |
| Silk 2010 The Central Massachusetts Oral Health Initiative (CMOHI): a successful public-private community health collaboration DOI:10.1111/j.1752-7325.2010.00188.x | this review only | not stated | not extracted yet | not extracted yet |
| Silk 2010 The Central Massachusetts Oral Health Initiative (CMOHI): a successful public-private community health collaboration. PMID:20663048 | this review only | not stated | not extracted yet | not extracted yet |
| Simon 2018 Integration of an Oral Health Team into a Student-Faculty Collaborative Clinic: Successes and Challenges DOI:10.1353/hpu.2018.0041 | this review only | not stated | not extracted yet | not extracted yet |
| Simon 2018 Integration of an Oral Health Team into a Student-Faculty Collaborative Clinic: Successes and Challenges. PMID:29805123 | this review only | not stated | not extracted yet | not extracted yet |
| Skapetis 2012 Can a four-hour interactive workshop on the management of dental emergencies be effective in improving self reported levels of clinician… DOI:10.1016/j.aenj.2011.12.003 | this review only | not stated | not extracted yet | not extracted yet |
| Skapetis 2012 Can a four-hour interactive workshop on the management of dental emergencies be effective in improving self reported levels of clinician… PMID:22813619 | this review only | not stated | not extracted yet | not extracted yet |
| Song 2020 The effect of an accountable care organization on dental care for children with disabilities DOI:10.1111/jphd.12375 | this review only | not stated | not extracted yet | not extracted yet |
| Song 2020 The effect of an accountable care organization on dental care for children with disabilities. PMID:32519336 | this review only | not stated | not extracted yet | not extracted yet |
| Trudnak Fowler 2018 Evaluation of a Comprehensive Oral Health Services Program in School-Based Health Centers DOI:10.1007/s10995-018-2478-1 | this review only | Dental caries estimates | not extracted yet | not extracted yet |
| Trudnak Fowler 2018 Evaluation of a Comprehensive Oral Health Services Program in School-Based Health Centers. PMID:29453520 | this review only | not stated | not extracted yet | not extracted yet |
| Tynan 2018 An integrated oral health program for rural residential aged care facilities: a mixed methods comparative study. PMID:29970073 | this review only | Dental caries estimates | not extracted yet | not extracted yet |
| Vece 2016 Impacting Vulnerable Populations Through Integrating Oral Health Care Into Nurse-managed Health Centers DOI:10.1016/j.nurpra.2016.07.028 | this review only | Dental caries estimates | not extracted yet | not extracted yet |
| Wood 2020 Interprofessional Health Care Delivery: Perceptions of oral health care integration in a Federally Qualified Health Center. PMID:33376122 | this review only | not stated | not extracted yet | not extracted yet |
| Wright 2017 Residential age care and domiciliary oral health services: <i>Reach‐<scp>OHT</scp></i>—The development of a metropolitan oral health… DOI:10.1111/ger.12282 | this review only | Oral disease outcomes, including dental caries estimates | not extracted yet | not extracted yet |
| Wright 2017 Residential age care and domiciliary oral health services: Reach-OHT-The development of a metropolitan oral health programme in Sydney,… PMID:28722250 | this review only | not stated | not extracted yet | not extracted yet |
Overlap with other reviews
Reviews that include the same primary studies are not independent evidence. Shared counts match studies by PMID, DOI or NCT, and otherwise by author and year (a probable match).