Oral Health Guidelines in Primary Care Policies

Timothy Martinez DMD

December 7, 2022

Whether you are a primary care physician, an oral health specialist, or both, there are several important considerations when considering incorporating oral health guidelines into your practice. These factors include the healthcare system’s social, political, and institutional structures and changes in healthcare expenditures for primary care. In addition, it cannot be easy to communicate and build referral networks among primary care physicians and oral health specialists.

Communication and referral networks are difficult

Providing patient-centered care involves communication between primary care providers and specialists. A poorly conducted consultation and referral process increases the risk of complications and poor health outcomes. There are few guidelines to guide the integration of oral health into primary care. However, the Roundtable on Health Literacy of the National Academies recently commissioned a paper that identifies some of the challenges in this area.

A multistep referral process was identified as one of the most important components of a successful integrated healthcare system. This includes a direct physician-to-physician interface, referral guidelines, and provider educational curricula. There is also a need for more effective mechanisms to address communication and referral challenges. The primary care staff coordinating referrals reported substantial difficulty communicating with specialists. They reported using e-consults and telephone contact with specialists and frequently rejected referral requests because of rigid informational requirements.

Barriers to referrals in primary care clinics

Putting a spin on the fabled multi-specialty referrals and coordinating care across a medical neighborhood is no easy feat. The benefits of a tiered referral scheme are well rehearsed, but the challenges of getting it done vary. For example, many health centers lack the internal coordination required to build the relationship to reap the benefits of a tiered referral system. Similarly, many centers have not yet mastered the art of follow-up.

A recent Center for Medicare and Medicaid Innovation study examined the most significant facets of primary care delivery, from the patient to the provider. The resulting report, which includes the results of a nationwide survey, was a trove of information on patient engagement, quality and cost data, and the best practices for health system managers.

Changes in health care expenditures for primary care

Compared with other countries, the United States spends more on health care administration, which includes hospital administrative costs. Hospital administrative costs are 25% of total healthcare expenditures in the United States, compared with 12% in the Netherlands and 12% in England.

The American College of Physicians supports efforts to reduce healthcare administration costs, such as by increasing funding for primary care services. It also supports efforts to reduce price variation, particularly for services not associated with the cost of providing them.

Primary care is a critical component of population health. It helps avoid costly future care and is essential for the early detection and treatment of disease. Recent state-level analyses show that greater investment in primary care reduces hospitalizations, ambulatory care, and mortality.

Impact of social, political, and institutional structures on health systems

Whether the United States should adopt an all-payer model of health care financing is a debate that continues to rage. Although some policymakers argue for this model, there are other concerns. One is that the cost of transitioning to such a model could be too high. Another concern is that it would lead to price controls and restrict physician participation. All stakeholders must collaborate to develop policies promoting the best health outcomes while controlling costs.

The American College of Physicians (ACP) supports several policy changes to slow spending growth and promote efficiency. In particular, it supports implementing policies to reduce excessive list prices and enhance the generosity of premium tax credits. The ACP also supports the development of a single-payer model, which would be financed through progressive income taxes, system-wide savings, and other means.

Bridging primary care and oral health care for low health literacy populations

Bringing oral health and primary care together in an integrated manner can improve the quality of care and access to services. However, a significant challenge is bridging the gap between these two areas.

There are several approaches to bridging the gap. For example, electronic tools can help providers share information and provide patient referrals. Another approach is to implement health literacy initiatives. Those with high levels of health literacy are empowered to advocate for their health.

Another approach is to integrate oral health and primary care services through technology. Specifically, a core set of oral health clinical competencies is being developed by the Health Resources and Services Administration for primary care providers in safety net settings. These competencies include communication, education, risk assessment, and appropriate referral systems.