The proportion of elderly people retaining their own teeth is increasing, and epidemiological studies suggest that the incidence of caries and periodontal diseases will rise among the elderly, including the frail elderly (Uhlen-Strand et al., 2023). Maintaining good oral health is of great importance for the general health and quality of life of the elderly, as reduced oral health can lead to inadequate nutrition, pain, and the risk of infections and systemic diseases such as pneumonia and cardiovascular disease (Henni et al., 2022).
The public dental health service is organized as a county municipal responsibility, and according to the Dental Health Services Act (1984), it should organize preventive measures for the entire population, as well as provide regular and outreach services to specific groups, including "the elderly, long-term sick, and disabled in home nursing care" (Dental Health Services Act 1984). The health and care staff in the municipalities are responsible for daily dental and oral care and maintaining oral hygiene for users who need help with this. The same regulation states that it is the county municipal dental health service that is responsible for training the health and care staff in dental and oral care, as well as any examinations and treatments of these patients. This task distribution requires a high degree of interaction to ensure that the rights associated with dental health for this patient group are maintained properly. The county municipal dental health service has tried to secure this by entering into cooperation agreements with all municipalities. However, experiences show that the cooperation works differently and is often difficult to achieve. Surveys and studies further suggest that the maintenance of dental and oral health for this group is inadequate in many municipalities, and these problems have been linked to interaction challenges (Forren et al., 2018; Henni et al., 2023; Hovden et al., 2017; Uhlen-Strand et al., 2023).
In this project, Center for Care Research follows and evaluates a pilot project that aims to find remedies for these challenges. The pilot project is initiated and owned by the Norwegian Directorate of Health, which in collaboration with the dental health service in the county of Nordland, is implementing the project involving the employment of a municipal dental hygienist in the municipalities of Meløy, Narvik, and Vestvågøy for the period 2023-2025. The purpose of the pilot project is to improve the interaction between the municipal health and care service and the county municipal dental health service, and through this, strengthen and improve the follow-up of dental and oral health for people with rights under the Dental Health Services Act §1-3c, namely the elderly, long-term sick, and disabled in institutions and home nursing care.
The overarching goal of this follow-up evaluation is to investigate, analyze, and communicate relevant findings, experiences, and proposed solutions from the pilot project during the implementation period within four main areas:
- Service recipients' oral hygiene, oral status, and nutritional status, their awareness of rights to free dental health services, as well as their perceived oral health condition and quality of life associated with this;
- Employees' knowledge, competence, attitudes, and work practices regarding oral health, service recipients' rights to daily oral and dental care, and information about rights to free treatment;
- Interaction and collaboration between municipalities, dental health service, and private dental clinics, both in terms of documented structures and routines, and leaders' and service providers' experience of the nature of the interaction/collaboration; and
- Economic and administrative effects of the municipal dental hygienist initiative.
Fundamentally, this project in rooted in an action research tradition and will further utilize a case design including both method and data triangulation, where various quantitative and qualitative data (surveys, interviews, written documents, and workshops) are viewed in conjunction with each other – to provide a comprehensive and credible description of both the current situation and development in each of the participating municipalities.
Litterature:
Forren, K. L., Hovden, E., Ansteinsson, V., Kalland, B., and Søberg, H. A. (2018). Prosjektrapport 2018. Kommunal tannpleier - samhandling mellom hjemmebasert omsorg og tannhelsetjenesten. Samarbeidsprosjekt mellom Hamar kommune og Tannhelsetjenesten Hedmark. Hamar kommune/Tannhelsetjenestens kompetansesenter øst/Hedmark fylkeskommune. Hamar
Henni, S. H., Arnsteinsson, V., Mamykina, L., Hovden, E. A. S., Hove, L. H., and Hellesø, R. (2023). Factors influencing home health care providers´ performance of oral health care for older people: A qualitative study. International Journal of Older People Nursing, 18(e12561). doi:10.1111/opn.12561
Hovden, E. S., Krona, E. R., and Disch, P. G. (2017). Tannhelsetilbudet til brukere av hjemmebaserte omsorgstjenester med rettigheter etter tannhelsetjenesteloven i region Sør. En beskrivelse av dagens praksis med fokus på samhandling mellom den fylkeskommunale tannhelsetjenesten og den kommunale helse- og omsorgstjenesten (3). Senter for omsorgsforskning, sør. S. f. omsorgsforskning, Oslo
Uhlen-Strand, M.-M., Hovden, E. A. S., Schwendicke, F., Arnsteinsson, V. E., Mdala, I., and Skudutyte-Rysstad, R. (2023). Dental Care for Older Adults in Home Health Care Services - Practices, Perceived Knowledge and Challenges among Norwegian Dentists and Dental Hygienists. BMC Oral Health, 23(222). doi:https://doi.org/10.1186/s12903-023-02951-x
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