Patients’ perspectives on integrated oral healthcare in a northern Quebec Indigenous primary health care organisation: a qualitative study

Abstract

ObjectivePatient-centred care is considered to be an important element in the evaluation of integrated healthcare and has been effective in addressing oral health disparities. This study explored the patients’ perspectives of patient-centred integrated care in oral health services integrated into a primary healthcare organisation serving a northern Quebec Cree population.DesignThis study used a multiple case study design within a qualitative approach and developmental evaluation methodology. Two theoretical models, Picker’s Principles of Patient-Centred Care and Valentijn’s Rainbow Model of Integrated Care, guided data collection and data analysis. The thematic analysis included transcription, debriefing, codification, data display and interpretation.SettingThis study was conducted in purposefully selected four Cree communities of Northern Quebec.ParticipantsAdult patients in need of oral healthcare and who attended the local dental clinic were identified and recruited by maximum variation sampling and snowball techniques.Outcome measuresPatients’ perspectives of patient-centred integrated oral healthcare.ResultsData analysis generated six major themes: enhanced accessibility, creating supportive environment, building trust through shared decision making, appreciation of public health programmes, raising oral health awareness and growing cultural humility among healthcare providers. Patients identified the integration of dental care into primary healthcare with respect to co-location, provision of free oral healthcare services, care coordination and continuity of care, referral services, developing supportive environment, shared decision making, oral health promotion and culturally competent care.ConclusionThese results confirmed that patient-centred care is an important element of integrated care. Patients valued the use of this concept in all domains and levels of integration. They recommended to further strengthen the clinical integration by involving parents in oral health promotion as well as optimising care coordination and empowering a supportive environment in organisational integration.

Person-centred integrated care with a health promotion/public health approach: a rapid review

“…Eight papers are included in this rapid review with a variety of methodological approaches utilised; two qualitative studies (Lilleheile et al , 2020; Shrivastava et al , 2019) and six mixed method studies (Grace et al , 2019; Lo et al , 2018; Palmer et al , 2019; Plunger et al ., 2019; Quigley et al , 2019; Stoop et al , 2020).…”

Associations Between Dental Care Approachability and Dental Attendance Among Women Pregnant With an Indigenous Child: A Cross-Sectional Study

“…Barriers to successfully navigate mainstream dental services include language and cultural barriers. Empirical research has demonstrated that awareness of dental service availability may be limited for some Indigenous people [21], and also midwives [39]. Making dental service systems more navigable is crucial, given the negative impacts that poor dental care utilisation on oral health outcomes.…”

“…The low utilisation of dental care among Indigenous Australians may arise from a range of barriers Indigenous Australians face in regard to accessing timely, culturally appropriate and affordable dental care. Speci cally, factors affecting dental care uptake of Indigenous Australians include cultural appropriateness of service [20,21], remoteness of residency [22], cost [23] and experience of discrimination in previous receipt of health services [24].…”

Anthropological perspectives on Miyupimaatisiiun and the integration of oral health in primary care in the Cree communities of Northern Quebec

“…This is a Canadian Institutes of Health Research funded participatory research project that involved an interdisciplinary team of researchers and professionals from Canada [14]. This comprehensive project commenced with a planning phase that included a planning meeting at one of the communities followed by a real-time video-conference workshop held at Montreal and Mistissini in 2016 involving an interdisciplinary team of Cree community members, administrators, and health and oral health care providers from Cree communities, public health representatives, as well as researchers [11,12]. Ethics approval for this study was obtained from the Institutional Review Board of the Université de Montréal and McGill University and in addition permission was obtained from the Research Committee of the Cree Board of Health and Social Services of James Bay.…”

“…In establishing its PHC services the CBHSSJB has included the integration of oral health care [10][11][12]. This anthropological analysis study was conducted to have a deep understanding of the cultural aspects of the integration of oral health into PHC in this Indigenous health care organization.…”