Barriers and facilitators: Integrating oral health into the medical home

Objective: From the First Tooth, Phase One provided funding to diverse organizations throughout Maine to embed within the medical home the delivery of oral health assessments, fluoride varnish and parent counseling for children aged 0-3. The sites represented diverse practices in urban and rural areas: pediatric residency, independent pediatric practice, hospital-based practices, family medicine, FQHC, and WIC. The purpose of this paper is to report the barriers and facilitators to adoption of these services in order to facilitate successful replication.

Methods: A learning session was convened in year 2 to solicit candid insights to the challenges and successes of the partnering organizations. The session results were recorded and then independently coded for themes by three individuals. From these results, a coding rubric was established and used in a second coding of the data. This process was completed individually by each analyst in order to foster inter-rater reliability. Once completed, the analysts established a fixed set of codes which were used to finally classify the data.

Results: Over 24 months, 6 diverse medical care organizations provided oral health services to 3029 children. The most common barriers identified were related to training, workflow, documentation, and practice characteristics. The most common facilitators were leadership/champion, ongoing support, building on existing infrastructure and well defined staff roles.

Conclusion: Challenges exist regarding the provision of oral health services in pediatric practices, however, the lessons learned from implementing services in diverse pediatric settings can facilitate and smooth the adoption in other practices.