How primary health care teams perceive the integration of oral health care into their practice: A qualitative study

Recently, new models for the integration of oral health into primary care have been proposed. However, these models may be adopted by a variety of health care systems, and will reach successful outcomes only if they can be adapted to suit the local context. To this end, the objective of this study was to explore the perceptions of Quebec primary health care teams on the integration of oral health into primary care. A qualitative approach and interpretive description methodology were used to conduct the study within a case-study design. Purposeful sampling with maximum variation and snowball technique were used for recruitment of study participants. Seventy-four in-depth, semi-structured interviews and five focus groups were conducted with primary health care teams including health care providers and managers working in a rural and an urban health care center. The interview guide and study conceptual framework were based on the Rainbow model. Data collection and data analyses were conducted concurrently and continued until saturation was achieved. To analyze the data, four phases of qualitative analysis were followed. The thematic analysis included interview debriefing, transcript coding, data display, and interpretation. Data analysis was conducted both manually and with the use of Atlas-ti software. A total of four themes emerged from the interviews and focus group discussions. These themes covered all domains of the study theoretical model and included: 1) drivers of integration; 2) importance of integration; 3) professionals’ role in integrated care; and 4) barriers and enablers of integration. In general, most of the barriers expressed by study participants were related to the organizational and system domains of integration. Primary health care teams who provide care in rural and urban areas in Quebec expressed their concerns on the absence of integrated oral health services. Implementation of governance policies, the prioritization of educational and management measures as well as inter-professional collaboration toward innovative care models could facilitate this integration.

近年来，学界已提出多款将口腔健康融入初级医疗照护的整合模型。然而，各类医疗系统或可采纳此类模型，但唯有适配本土情境，方能达成理想成效。为此，本研究旨在探究魁北克省初级医疗团队对于将口腔健康融入初级医疗照护的认知态度。本研究采用质性研究方法与诠释性描述方法论，基于个案研究设计开展。研究对象招募采用最大变异目的性抽样结合滚雪球抽样法。研究团队共对魁北克省乡村与城市医疗中心的初级医疗团队开展74场半结构化深度访谈及5场焦点小组讨论，受访对象涵盖医疗服务提供者与管理人员。本研究的访谈提纲与概念框架均基于彩虹模型（Rainbow model）。数据采集与数据分析同步开展，直至达到信息饱和为止。数据分析共分为四个质性研究阶段：主题分析环节涵盖访谈复盘、转录文本编码、数据呈现与解读。数据分析采用人工编码与Atlas-ti软件辅助结合的方式开展。访谈与焦点小组讨论最终提炼出四大主题，全面覆盖本研究理论模型的所有维度，分别为：1）整合动因；2）整合的重要性；3）专业人员在整合照护中的角色；4）整合过程中的阻碍与促进因素。总体而言，受访对象提及的绝大多数阻碍均与整合照护的组织与系统维度相关。魁北克省城乡地区的初级医疗团队均表示，对当前缺乏整合式口腔健康服务一事深感担忧。落实治理政策、优先推进教育与管理举措，以及开展跨专业协作以构建创新型照护模式，均可推动口腔健康与初级医疗的整合进程。