College of Dental Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.
Institut für Allgemeinmedizin, Heinrich-Heine-Universität Düsseldorf, Medizinische Fakultät, Germany.
Gerodontology. 2021 Sep;38(3):289-299. doi: 10.1111/ger.12525. Epub 2021 Jan 2.
to synthesise a framework of barriers and facilitators in the functional 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) 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 themes were identified: (1) compartmentalised care systems and (2) poor interprofessional and communication infrastructure. Barriers related to (1) included lack of integrative policies and compartmentalised healthcare education (macro level); poor embedding of OHC in care procedures, instruments and guidelines (meso level); and poor interprofessional skills (micro level). Barriers related to (2) included poor financial incentives for collaborative practices (macro level) and badly connected ICT systems (meso level). Identified facilitators included integration of an OHC professional into care teams, and interdisciplinary consultations (meso level); and integration of OHC in individual care plans (micro level).
In The Netherlands, OHC for older people is at best poorly integrated into general care practices. Barriers and facilitators are interconnected across macro-, meso- and micro levels and between normative and functional domains and are mainly related to compartmentalisation at all levels and to poor interprofessional and communication infrastructure.
综合分析口腔保健（OHC）纳入脆弱老年人大众健康照护的功能整合的宏观（系统）、中观（组织和跨专业整合）和微观（临床实践）层面的障碍和促进因素。
识别这些障碍和促进因素有望促进更好和更适当的护理。
本定性研究纳入了 41 名参与者，他们代表了 10 个不同的（专业）护理提供者群体，以及 OHC 接受者（居家和养老院患者），对其进行了深入的主题引导访谈。对访谈的文字记录进行了主题分析。随后，在一个有 52 名利益相关者参加的研讨会上，对结果和解释进行了讨论和完善。
确定了两个主题：（1）条块分割的护理系统和（2）较差的跨专业和沟通基础设施。与（1）相关的障碍包括缺乏综合政策和分割的医疗保健教育（宏观层面）；OHC 在护理程序、工具和指南中的嵌入不足（中观层面）；以及跨专业技能较差（微观层面）。与（2）相关的障碍包括合作实践的财务激励不足（宏观层面）和 ICT 系统连接不良（中观层面）。确定的促进因素包括将 OHC 专业人员纳入护理团队和跨学科咨询（中观层面）；以及将 OHC 纳入个人护理计划（微观层面）。
在荷兰，老年人的 OHC 最多只是勉强纳入了一般护理实践。障碍和促进因素在宏观、中观和微观层面以及规范和功能领域之间相互关联，主要与所有层面的条块分割以及较差的跨专业和沟通基础设施有关。
