L’intégration des services buccodentaires et des services publics de soins primaires

Despite its importance, integrating oral health into primary care remains an emerging practice in the health care services. The general objective of this PhD project was to understand the concept of integration of oral health care with primary care, to contextualize it in Quebec public health organizations, and to identify its barriers and facilitators.  To this end, we conducted a synthetic case study, using a qualitative research approach with an interpretive description methodology. The study comprises two parts: i) a scoping study (Levac et al. 2010) and ii) a holistic multiple case study, guided by the conceptual framework of Valentijn et al. (2013) and including an environmental scan. The data were collected through the organizations' websites, operational documents, and observation notes taken during site visits, as well as via seventy-four semi-structured interviews and five focus groups with primary health care teams working in a rural and an urban health care organization. Data collection and thematic analysis were conducted simultaneously. The analysis was conducted manually and with Atlas-ti software.  Our results showed that the majority of policies related to the integration of oral health into primary care are derived from the common risk factor approach. In general, integrated oral health care programs rely on partnerships with government agencies and academic institutions. These programs adopt a variety of strategies: interdisciplinary networking, training of non-dental primary care providers, championing oral health, and the use of new technologies. So far, most studies of these programs have been descriptive in nature and few studies show long-term results. Lack of political leadership and health policies; implementation challenges; limited stakeholder training; lack of continuity of care; and the oral care needs of patients are the barriers to integration. On the other hand, support policies and resource allocation, interdisciplinary training, collaborative practices, the presence of local strategic leaders, and co-location could facilitate this integration.  Normative aspects, care trajectories, and integration initiatives shaped the delivery of primary oral care services in the two cases. The public dental health program coexisted with different integration strategies, mostly informal liaison and coordination mechanisms. The themes identified in the study aligned with the domains of the research project’s conceptual framework and included: the driver and the importance of integration; the role of professionals in integrated care; and the factors that promote or hinder this integration. Our analysis showed that most of the barriers were related to the organizational and systemic domains of integration, and few strategic institutional resources were allocated to oral health.  In Quebec, the integration of oral health into primary care is carried by the dental public health sector, and the sustainability of integration initiatives in other primary care sectors remains unclear. Better resource management, interprofessional collaboration, and partnership with academic institutions could contribute to this integration. Rigorous, evidence-based research is needed to evaluate the results of integrating the various strategies for improving oral health, performance, and costs incurred by oral health programs.

Keyphrases: Oral health, Primary care, Integration