One of the greatest challenges faced by our society is an ever-increasing number of homebound elderly patients suffering from multi-morbidity.
Oral health problems for homebound patients have been neglected in health care services due to knowledge gaps, disintegrated and fragmented healthcare services, blurred responsibility between different levels of care.
It is urgent to include oral health in the integrated care perspective for these patients to avoid unnecessary health deterioration and increased care dependency and utilisation of health care services.
About the project
In CORAL, we will apply methods and framework that have not been applied previously within the oral health- and home care service research. We will provide knowledge beyond the state of the art regarding the validity, applicability and methodological approaches within the field and across services and boundaries.
We aim to expand our understanding of the underlying mechanisms of collaborative practices, facilitators, barriers and opportunities by applying innovative approaches to improve oral health services for homebound patients.
Stakeholders from different disciplines and scientific collaborators will together design solutions for connecting home health care and oral health care.
In CORAL, we will build on a multilevel approach on integrated care framework for complex intervention as the main theoretical and methodological approaches for organising our project. The overarching goal is to provide a scientific-based generic integrated care model for connecting home health care and oral health services.Throughout three work packages the objective is to:
- Design a scientific-based intervention for connecting oral health and home care services
- Test the model for connecting public dental service with home health care services
- Provide guidelines for best practice and innovative digital decision support that enable patient-centred health care across service levels.
We will evaluate (1) the service utilization as a measure of accessibility, (2) the number of acute referrals and (3) health-related quality of life. Health economic evaluation will include a cost-utility. Cost will be estimated from the societal perspective, including both medical and non-medical costs.
Disconnected services and uncoordinated inter-professional collaboration are two fundamental barriers for establishing integrated oral care for elderly receiving home health care. Today, collaborative communication channels between home care and public dental services include telephones, letters, emails, and meetings. This type of communication is time-consuming, vulnerable and associated with reduced efficiency.
Oral diseases are the most common of the chronic diseases for elderly people and represent an important public health problem due to prevalence and subsequent impact on individuals and society. Oral health problems lead to severe pain, have negative effects on nutrition and quality of life. Due to oral diseases, an increased bacterial systemic exposure and increased levels of inflammatory factors, may lead to adverse health outcomes such as uncontrolled diabetes, cardiovascular disease, respiratory disease and premature death. In addition to the somatic consequences of oral disease, psychosocial aspects such as a reduced ability to speak and interact socially often influence the quality of life of these patients.
Previous research on integrate care has addressed collaboration between hospital (governmental level) and municipalities. In oral health services, we are faced with another structural obstacle because public dental servoces is organized at the county level. Collaboration between the healthcare providers are hampered by layers of organizational complexity and administrative levels, as well as by a lack of collaboration and guidelines. We lack in-depth knowledge as well as scientific-based interventions about how to improve the oral health service on individual and organizational level.
Norwegian Research Council project.
Oral Health Centre of Expertise in Eastern Norway (OHCEE), NTNU Gjøvik, SINTEF, Pensjonistforbundet, Inland University College of Applied Sciences, Charité – Universitätsmedizin Berlin, University Medical Centre Groningen.
Participants UiO: Faculty of Medicine, Institute of Health and Society, and Faculty of Dentistry, Institute of Clinical Dentistry.
Project Start and Finish