O2121: Understanding Family and Patient Experiences with Integrated Dental Hygienists in Pediatric and Prenatal Primary Care Clinics

Background: Early access to preventative oral health care can improve maternal and child oral health outcomes, however, populations with low socioeconomic status, and those from racial/ethnic minority groups, often encounter obstacles. Integration of a dental hygienist into primary care teams is one strategy to improve access for these populations. This strategy has positively impacted healthcare teams and patient health; however, patient and family perspectives remain underrepresented. Therefore, this project aimed to engage families and patients to understand their experiences with this integrated model.

Methods: Semi-structured, 30-minute interviews were conducted at two clinics integrating hygienists into pediatric and prenatal primary care. Participants included parents/caregivers of pediatric patients and prenatal patients who had received integrated visits. Recruitment occurred in-person, post-appointment. The interview guide elicited questions on experiences with the integrated model, prior oral health experiences, and utilized the “Six Conditions of System Change” from the Racial Equity Toolkit as a framework to understand conditions that hold oral health inequalities in place from families’ and patients’ perspectives. Interviews were conducted in English or Spanish. A $20 gift card and childcare were provided. Audio recordings were transcribed, and a codebook was developed from initial responses for thematic analysis.

Results: Twenty-seven interviews were conducted (Table 1). Participants expressed overwhelmingly positive experiences and high satisfaction with integrated dental care. They appreciated the convenience, education provided, and opportunity to address oral health questions, and care coordination to a dental provider (Table 2). For many, it was their first experience with accessing any type of oral health care. Before receiving care with the integrated model, participants had varied dental care experiences, but most had not received preventive oral health care. Prenatal patients noted that prior to pregnancy many only sought care for emergencies due to access issues and could only obtain preventive care during pregnancy. Several participants had immigrated from countries outside the United States and noted a lack of provider options and only seeking emergency oral health care in their country of origin. The major factor affecting oral health care access identified by interviewees was insurance. Those with state insurance faced barriers, including longer travel for services, fewer care options, and perceived negative treatment compared to private insurance holders. Race/ethnicity were not cited as a major facilitator or barrier to oral health care, but support with translation and knowledge of available services was noted to be a facilitator to oral health care. Interviewees discussed how the system can enhance community engagement (Table 2).

Conclusion: Families of pediatric patients and prenatal patients expressed very positive experiences with integrated dental hygienists in primary care settings. Consistent community engagement is imperative to provide more patient- and family-centered care.