College of Dental Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.
Institut für Allgemeinmedizin, Heinrich-Heine-Universität, Düsseldorf, Germany.
Gerodontology. 2021 Jun;38(2):154-165. doi: 10.1111/ger.12507. Epub 2020 Dec 4.
to synthesise a framework of barriers and facilitators in the normative integration of oral health care (OHC) into general health care for frail older adults at macro (system), meso (organisation and interprofessional integration) and micro (clinical practice) levels.
Identification of these barriers and facilitators is expected to promote better and more appropriate care.
For this qualitative study, comprising 41 participants, representatives of 10 different groups of (professional) care providers, and OHC receivers (home-dwelling, and nursing home patients) in East Netherlands were interviewed. Transcripts of the in-depth, topic-guided interviews were thematically analysed. In a subsequent workshop with 52 stakeholders, results and interpretations were discussed and refined.
Two main themes were identified: (1) a compartmentalised care culture in which OHC and general health care are seen as two separate realms, and (2) prioritisation, awareness and attitude regarding OHC integration. Subthemes such as low political attention (macro level); unclear responsibilities, hierarchical relations and the lack of vision of organisations (meso level); and poor awareness and low prioritisation by care providers and patients (micro level) were identified as potential barriers. Subthemes such as leadership (meso level), and the supportive personality of individual caregivers and ownership of patients (micro level) were identified as facilitators.
Barriers and facilitators in normative OHC integration in The Netherlands are interrelated and apparent at macro-, meso- and micro levels. They are mainly related to (a) a compartmentalised care culture, and (b) related low prioritisation, and poor awareness of and attitude towards (integration of) oral health (care).
综合分析宏观（系统）、中观（组织和跨专业整合）和微观（临床实践）层面上，将口腔保健（OHC）纳入虚弱老年人常规综合保健过程中的障碍和促进因素。
识别这些障碍和促进因素有望促进更好和更适当的护理。
本定性研究包括来自荷兰东部的 10 个不同（专业）护理提供者群体的代表，以及 OHC 接受者（居家和养老院患者）共 41 人参与了访谈。对深度、主题引导式访谈的记录进行了主题分析。在随后的 52 名利益相关者研讨会上，讨论并完善了研究结果和解释。
确定了两个主要主题：（1）OHC 和常规保健被视为两个独立领域的分割式护理文化，以及（2）OHC 整合的优先级、意识和态度。低政治关注度（宏观层面）；职责不明确、等级关系和组织缺乏远见（中观层面）；护理提供者和患者的意识和优先级低（微观层面）等子主题被确定为潜在障碍。领导力（中观层面）以及个别护理人员的支持性人格和患者的自主权（微观层面）等子主题被确定为促进因素。
荷兰规范的 OHC 整合中的障碍和促进因素相互关联，且在宏观、中观和微观层面上都存在。这些障碍和促进因素主要与（a）分割式护理文化以及（b）相关的低优先级、对（OHC）的意识和态度有关。
