Status Update on Translation of Integrated Primary Dental-Medical Care Delivery for Management of Diabetic Patients

Abstract

Escalating prevalence of both diabetes and periodontal disease, two diseases associated with bi-directional exacerbation, has been reported. Periodontal disease represents a modifiable risk factor that may reduce diabetes onset or progression, and integrated models of cross-disciplinary care are needed to establish and manage glycemic control in affected patients. An ad-hoc environmental scan of current literature and media sought to characterize factors impacting status of integrated care models based on review of the existing evidence base in literature and media surrounding: (1) current cross-disciplinary practice patterns, (2) epidemiological updates, (3) status on risk assessment and screening for dysglycemia in the dental setting, (4) status on implementation of quality metrics for oral health, (5) care model pilots, and (6) public health perspectives. The survey revealed: escalating prevalence of diabetes and periodontitis globally; greater emphasis on oral health assessment for diabetic patients in recent medical clinical practice guidelines; high knowledgeability surrounding oralsystemic impacts on diabetes and growing receptivity to medical-dental integration among medical and dental providers; increasing numbers of programs/studies reporting on positive impact of emerging integrated dental-medical care models on diabetic patient healthcare access and health outcomes; a growing evidence base for clinically significant rates of undiagnosed dysglycemia among dental patients reported by point-of-care pilot studies; no current recommendation for population-based screening for dysglycemia in dental settings pending a stronger evidence base; improved definition of true periodontitis prevalence in (pre)/diabetics; emerging recognition of the need for oral health quality indicators and tracking; evidence of persistence in dental access disparity; updated status on barriers to integration. The potential benefit of creating clinically-applicable integrated care models to support holistic management of an escalating diabetic population by targeting modifiable risk factors including periodontitis is being recognized by the health industry. Cross-disciplinary efforts supported by high quality research are needed to mitigate previously-and newly-defined barriers of care integration and expedite development and implementation of integrated care models in various practice settings. Implementation of quality monitoring in the dental setting will support definition of the impact and efficacy of interventional clinical care models on patient outcomes.

Screening for dysglycaemia in dental primary care practice settings: systematic review of the evidence

“…The removal of barriers inherent in currently‐established diabetes care delivery paradigms defined across dental and medical domains will require a new evidence base for demonstrating value, patient centricity and cost‐effectiveness of alternative paradigms in care delivery, including integrated medical and dental care delivery models that effectively bridge these domains. Apropos to such models is the capacity to identify subpopulations at risk for dysglycaemia in the dental setting and triage them to medical care.…”

The patient‐centered dental home: A standardized definition for quality assessment, improvement, and integration

“…The PCDH can serve as the foundational framework for these ongoing measure development efforts, as it is clear that a measurement framework is critically important to enable systematic quality assessment and improvement . Having an established PCDH framework is therefore important for the identification and development of quality metrics at both the system and practice level to evaluate oral health care delivery and quality and to foster cross‐system communication in ways that can assist medical‐dental integration …”

“…8 Having an established PCDH framework is therefore important for the identification and development of quality metrics at both the system and practice level to evaluate oral health care delivery and quality and to foster cross-system communication in ways that can assist medical-dental integration. 9 The need for a PCDH model for medical-dental integration is enhanced by the growing recognition of the importance of coordinated health care delivery, where the PCMH is often identified as a model for transforming and improving care delivery. The integration of dentistry into accountable care organization development and other value-based purchasing arrangements could be enhanced by the development of a PCMH-based PCDH.…”

Oral Health Matters- Tooth Problem and its Treatment-seeking Behaviour Among Older Adults in India

“…There is evidence that shows limited and poor dental health care access to the elderly population has put at the risk for other systemic chronic and infectious diseases (3,19). Geriatric health problems, especially oral and dental-related health care issues are very common and highly persisting amongst disadvantaged and vulnerable groups (26)(27)(28)(29)(30). Poor strata of the community face unprecedented problems in accessing oral health care services and those who reside in rural areas are more vulnerable.…”