Needs and barriers for interprofessional collaboration in oral health care for frail home-dwelling older people: experiences of primary care professionals in Belgium.
Authors: Hoste Natalie , Baele Ellen , De Vleeschauwer Aster , Pype Peter , Janssens Barbara , Mertens Fien , Poppe Louise 
Published: January 2024

Background: Although older people are at risk for worsening oral health, dental attendance decreases in Belgium for home-dwelling frail people after the age of 65, resulting in a high burden of untreated oral disease. Furthermore, primary care professionals do not seem to pay enough attention to oral health.

Objective: Oral health is an integral and essential part of overall health and well-being. Oral diseases do not only share common risk factors with overall health problems (e.g. aspiration pneumonia, cardiovascular disease, diabetes), but can also cause mental health issues (e.g. feelings of shame, lower self-esteem and social isolation).

Literature shows that interprofessional collaboration and the integration of oral health care into other aspects of care are important factors in improving oral health for frail home-dwelling older people.

The aim of the study is to gain insights into the perceived barriers and needs of primary care professionals to collectively contribute to the oral health of frail home-dwelling older people.

Methods: Focus groups were organized between December 2022 and May 2023. Participating professionals were oral healthcare professionals (dentists and dental hygienists) and primary care professionals or caregivers (general practitioners, pharmacists, speech therapists, physiotherapists, occupational therapists, dietitians, home nurses, home care workers, social workers and cleaning aids).

Homogeneity by professional group was aimed for. In each professional group, two focus groups were conducted in two regions in Flanders.

A stakeholder group of organizations dedicated to the care and support of elderly people was assembled. They supported the recruitment of participants and served as a sounding board to discuss the results, thereby increasing the internal validity.

With respect to frail home-dwelling older people, the following topics were discussed:

1.The importance of oral health care within their profession

2.Current practices regarding interprofessional collaboration on oral health

3.Perceived needs and barriers for interprofessional collaboration on oral health

4.How oral care should ideally be organized

Results were classified according to the Rainbow Model of Integrated Care. 

This study is part of the larger Gerodent PLUS project at Ghent University.

Results: Preliminary results show a variety of needs and barriers at different levels. For example, at the macro level, reimbursement criteria can impact dental attendance. At the meso level, unclear responsibilities regarding oral health care complicate interprofessional collaboration (normative integration) and referral practices are inadequate (functional integration). At the micro level, increasing awareness of the importance of oral health is needed.

Next steps: These findings aim to provide broad insights into the experienced needs and barriers, since many different primary care professionals or caregivers who work with home-dwelling frail older people were included. These insights will be used to develop interventions to improve the oral health of frail home-dwelling older people (e.g. the development of an interprofessional training and a referral tool). Furthermore, policy recommendations will be formulated to improve integration of oral care into other aspects of healthcare.