Table 2.

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

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