Perceptions and practices of general practitioners on providing oral health care to people with diabetes - a qualitative study

Abstract

Background: Poorly controlled diabetes leads to multiple complications including oral health problems. General practitioners (GPs) are at the forefront of management of chronic diseases in primary health care. Diabetes guidelines encourage a proactive role for GPs in oral health complications management in people with diabetes, yet little is known about this area of care. This study aimed to explore current practices, perceptions and barriers of GPs towards oral health care for people with diabetes. Methods: We employed a qualitative research method utilising telephone interviews. Purposive and snowball sampling were used to recruit 12 GPs from Greater Sydney region. A thematic analysis involving an inductive approach was used to identify and analyse contextual patterns and themes. Results: A majority of participants were males (n = 10), working in group practices (n = 11) with a mean ± SD age of 55 ± 11.4 years and 25 ± 13.6 years work experience. Three major themes emerged: oral health care practices in general practice settings; barriers and enablers to oral health care; and role of diabetes care providers in promoting oral health. Most GPs acknowledged the importance of oral health care for people with diabetes, identifying their compromised immune capacity and greater risks of infections as risk factors. GPs reported 20-30% of their patients having oral health problems, however their current oral health care practices relating to education, risk assessment and referrals were reported as very limited. GPs identified several barriers including time constraints, absence of referral pathways, and limited knowledge and training in promoting oral health care. They also reported patient barriers including oral health care costs and lower oral health awareness. GPs perceived that resources such as education/training, a standardised assessment tool and patient education materials could support them in promoting oral health care. GPs also perceived that other diabetes care providers such as diabetes educators could play an important role in promoting oral health. Conclusions: Despite current recommendations, GPs' current oral health care practices among people with diabetes are limited. Further strategies including capacity building GPs by developing appropriate oral health training programs and simple risk assessment tools along with accessible referral pathways are needed to address the current barriers.

Eating disorders and oral health: a scoping review on the role of dietitians

“…The most consistent barrier to OHP as identified in this review was the limited availability of professional development materials, both generally and specifically for OHP in ED clinical settings. This is synonymous with other studies involving non-dental health professionals who have also been reported to experience a lack of resources for both the client and health professional [ 59 – 62 , 64 , 66 ]. Support in the form of training for health professionals in OHP has resulted in improved knowledge and confidence, and clinicians were more likely to incorporate OHP in their practice [ 64 , 70 ].…”

“…By means of addressing this gap in dietetics, both position statements call for the inclusion of 'didactic' education models that demonstrate the role of the dietitian in OHP in tertiary education [37,38]. This is however not unique to dietitians, but a finding that was shared amongst other non-dental health professionals as a salient barrier to OHP [59][60][61][62].…”

Interprofessional diabetes and oral health management: what do primary healthcare professionals think?

“…Much of the current literature nonetheless focuses on assessment of diabetes screening in dental settings or the evolution of the dental profession 3,9,11 . Some have also explored the views of healthcare professionals on integration of diabetes and periodontitis management including some recent work conducted at the Centre for Oral Health Outcomes, Research Translation and Evaluation at Western Sydney University in New South Wales [12][13][14][15][16][17] . However, limited research on interprofessional diabetes and oral health care has been conducted in Victoria or focused on public community health service (CHS) setting.…”

A Qualitative Study Exploring the Experiences and Perspectives of Australian Aboriginal Women on Oral Health during Pregnancy

“…Qualitative research approaches have informed interdisciplinary oral health models of care involving the broader health workforce in other populations [26][27][28]. In general, these qualitative studies commenced by identifying existing needs and perspectives of key stakeholders and then explored components of an acceptable, feasible and practical oral health model of care.…”