Interprofessional collaboration on oral health for frail home-dwelling older people: a focus group study on needs and barriers experienced by general practitioners and community pharmacists.

Abstract

Despite the increased risk of deteriorating oral health among older individuals, dental attendance often declines over time in frail home-dwelling older people (FHOP), resulting in a significant burden of untreated oral disease. Literature highlights the importance of interprofessional collaboration to address oral health problems in ageing societies, emphasising the potential roles of general practitioners (GPs) and pharmacists. However, there is currently limited evidence regarding (a) their engagement in oral health and (b) the perceived needs and barriers in contributing collectively to the oral health of FHOP. Therefore, this study aims to explore the needs and barriers perceived by GPs and pharmacists regarding interprofessional collaboration on oral health for FHOP. Between February and December 2023, seven focus groups were conducted in two primary care zones in Flanders (Belgium) - five with GPs and two with pharmacists, involving a total of 51 participants. All conversations were recorded, transcribed, and analysed in NVivo using a reflexive thematic approach. The identified barriers and needs for interprofessional collaboration were: limited engagement of GPs and pharmacists in oral health (theme 1), primarily due to a lack of knowledge and responsibility, time constraints, low outcome expectations, low prioritisation by FHOP, and the perception of oral health as a sensitive topic. Recognition of their potential roles was identified as a facilitator. Additionally, there is a need for improved interprofessional relationships (theme 2) and enhanced information exchange on oral health (theme 3), with the absence of a communication platform identified as a significant barrier. Limited accessibility of oral health professionals (OHPs) (theme 4) was also identified as an important barrier, which also contributed to frustrations of GPs towards OHPs. This study provides novel insights into barriers to oral health engagement among GPs and pharmacists (micro level) and calls for improved communication and relationships between OHPs and GPs/pharmacists (meso level). Furthermore, it addresses macro-level obstacles to interprofessional collaboration, including a perceived shortage of OHPs, absence of a shared communication platform, and limited resources for preventive care.