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HELSEVEL-H-Gode og effektive helse-, omsorgs- og velferdstjenester

Connecting ORAL health and home care services for homebound patients in Norway (CORAL)

Alternative title: Samhandling for bedre tannhelsetjeneste til hjemmeboende pasienter (CORAL)

Awarded: NOK 13.4 mill.

Oral diseases are the most common of chronic diseases in elderly persons and represent an important public health issue due to their prevalence and subsequent impact on individuals and society. Oral health problems lead to serious infections, severe pain and nutritional deficiencies. Elderly patients in homecare need coordinated health services, where dental service should be an integral part. In CORAL, the primary objectives are 1) to develop new knowledge for the organization of public dental services for elderly homebound patients; and 2) to test and design a scientific model for connecting public dental services with homecare services based on the UK Medical Research Council's (MRC) framework for complex interventions. Currently, we have insufficient knowledge about the oral health status of patients in homecare service and its impact on their quality of life. Moreover, little is known about the challenges health care professionals face in their daily work and how they manage to meet the patients’ oral health needs. We know that disconnected services and uncoordinated inter-professional collaboration are two fundamental barriers for establishing integrated health care for elderly persons receiving homecare. However, the research on inter-professional and inter-service collaboration has, until now, mainly addressed the coordination between hospital and municipality and has not focused on services organized at different levels of administration. This results in major gaps in the knowledge about the interaction between county public dental services and municipal home care services. CORAL will address this research gap by conducting novel, high quality research at the micro, meso and macro levels. By using the principle of "co-creation", CORAL will involve service providers and end-users in all phases of the project and together with users, CORAL will develop generic guidelines that will be tested and ready for large-scale implementation in health care services.

Oral health in elderly is a growing, under-researched, neglected and non-prioritized area associated with development of severe diseases, increased hospitalization and costs for the patients and the society. Caring for patients in their home is becoming the preferred policy when aiming for healthy ageing, both nationally and internationally. However, homebound patients suffer from a bifurcation of the dental service from the primary health services. Despite of patients’ statutory rights to receive free public dental service (PDS) and their increased need of preventive measures and complex dental treatment, only 30% of homecare patients visited the PDS during the last 12 months. With CORAL, we will design and implement a scientific model for connecting the public dental service and (PDS) the homecare service (HCS). Collaboration, both inter-professional and inter-service is known to be a crucial factor that can improve coherence and quality of health services. Research on integrated care has mainly addressed collaboration between hospital and primary health care or collaboration within the same level of care. Inter-service and inter-professional collaboration between oral health service and home care have not experienced the same focus CORAL consists of four work packages (WPs): WP1: will provide knowledge about oral- health and health care service delivery for elderly in HCS. Based on WP1, WP2 will trough an interdisciplinary methodological approach will provide a design for inter-professional and inter-service collaboration model for connection the oral health service with the home care service. In WP3 CORAL focuses on evaluation; evaluation of the implementation process and effectiveness on cost and service utilization. WP4 is a transverse package that will deliver dissemination and communication at micro-, meso- and macro level to contribute to the impact and exploitation of CORAL.


HELSEVEL-H-Gode og effektive helse-, omsorgs- og velferdstjenester