Interprofessional communication between general dental practitioners and general medical practitioners: a qualitative study

Introduction

Interprofessional communication is of great clinical importance for integrated, comprehensive, and patient-centred health care, especially for managing complex health care challenges.^1–3 Despite the fact that each health profession has specialised skills and knowledge when it comes to providing care for the patient, numerous barriers still exist between interprofessional health care teams that may interfere with a collaborative team-based health care system.^4,5

In the existing health care systems, medical and dental systems are greatly siloed, which makes it difficult for both dental practitioners and physicians to work together to provide integrated care.⁶ General dental practitioners (GDPs) play an important role in assessing medical conditions and could potentially be a great first line of contact if they are well trained to identify and monitor patient’s medical conditions. The role of GDPs in interprofessional collaborative practice continues to be in demand with increasing links between oral health and medical conditions. Moreover, studies have also claimed that dental practitioners could be an important source for screening medical diseases and detecting chronic diseases during the early phases.^7,8

On the other hand, it is equally important that general medical practitioners (GPs) are well-educated to diagnose oral health problems and make appropriate referral to dental practitioners for treatment.⁹ In Aotearoa New Zealand (NZ), Health Pathways and the Ministry of Health’s Hospital Dental Services Service Specification provide guidelines to GPs on when and how to refer patients to public hospital dental services, outlining eligibility criteria and patient priority.^10,11 A wealth of data and evidence have highlighted the advantages of involvement of GPs in diagnosing and managing oral diseases, which include providing comprehensive quality of care and making more appropriate dental referrals.^12–14 Management of patients with complex needs becomes more effective when interprofessional teams such as dental, medical, and allied health care professionals work together to view the disease from different standpoints. Despite repeated calls for enhanced interprofessional communication in the health care system, little is known about the communication and interface between GDPs and GPs.^15,16 Improved connection and referral between GDPs and GPs are the first steps toward bringing two separate systems with minimal communication to a completely integrated system.⁶ In NZ, GPs typically operate as independent practitioners with funding derived from both public and private sources. They play a crucial role as gatekeepers for referrals to secondary care services. Similarly, in Australia, GPs function independently within a dual funding system, also serving as gatekeepers for specialist referrals. In the United Kingdom, GPs are independent contractors within the National Health Service, supported by public funding, and they too act as gatekeepers for accessing secondary care services.¹⁷ Comparing these models provides insights into the roles of GPs, their funding structures, and their pivotal role in managing patient care pathways.

This study aimed to investigate the perspective and contents of the interprofessional communication between GDPs and GPs, and to explore the barriers and strategies that could bridge the gap between these health care professionals.

Methods

This study utilised qualitative methodology to acquire in-depth perspectives and experiences of GDPs and GPs regarding their interprofessional communication. The snowball sampling technique was used to select general GDPs and GPs from Auckland and Dunedin, NZ. This method involved identifying potential participants who could provide in-depth information based on their clinical experiences and interactions with the health care system.

Results

In total, six GPs and ten GDPs agreed to take part in this study. Demographics and educational background of the GPs and GDPs are shown in Table 1. The interviewees who participated in this study had a range of experience levels. Most GP participants worked in the private sector while GDP participants were involved in different sectors.

The findings of this study are presented under three themes which illustrate the participants’ perspective on interprofessional communication in NZ, medical conditions perceived necessary for communication, and suggestions to improve interprofessional relationships.

Discussion

Multiple perspectives with descriptive insights emerged from the findings. The 10 GDPs and 6 GPs interviewed in NZ reported a lack of efficient interprofessional communication. Time constraints, lack of knowledge of each other’s specialties, and absence of integrated health record systems were described as the main contributing factors to communication barriers.

There was a consensus among GDPs and GPs that the most common reasons these two specialties would contact each other were regarding medically complex and polypharmacy patients. This included patients with chronic diseases such as hypertension, diabetes mellitus, kidney failure, unstable epilepsy, pregnancy and cancer diseases. Patients on blood thinners, bisphosphonate medications, and a long list of medications were also of great concern. Common reasons for referral from GPs to GDPs included oral pathologies, TMJ, and obstructive sleep apnea. Some of the participants, especially GPs, also indicated that the dental and medical systems in NZ were greatly siloed, in which some GPs often perceived that oral care was not part of general care, making it more challenging to bring these two health care professionals together to provide whole patient-centred care. Overall, these findings were in accordance with previous research on the interface between GPs and GDPs.^6,15,20 Additional supporting evidence comes from studies conducted in other countries that have investigated the interprofessional collaboration between dental practitioners, medical practitioners, and pharmacists which accentuated the disappointing nature of collaboration between health care professionals.²¹

Considering that the NZ population is predicted to expand, with a higher tooth retention rate and a higher prevalence of chronic systemic illness in the older age group,^22,23 it is commonplace for GDPs and GPs to encounter patients with complex medical conditions in their daily practice.^24,25 This study revealed the situations of GDPs in NZ when they would communicate with the primary care provider in order to provide holistic care. The results are in agreement with findings of other studies that reported cardiovascular diseases as the most prevalent and controversial issue faced in the dental setting.²⁴ The consultative professional relationship allows a better insight into a patient’s medical history, specific investigations that may be needed before treatment, or any prophylactic measures to be taken into consideration.²⁵ Besides, it was also supported by an article that dentists could be the first provider to detect signs of a medical problem,²⁴ in correspondence with our participants’ response.

Furthermore, GPs participating in this study specifically highlighted that they would refer endocarditis patients, geriatric patients, and mental illness patients to dentists for further management of oral care.²⁶ Poor oral health is also known as the main contributing factor to poor eating habits in the elderly, which can eventually lead to a detrimental nutritional status and health with a reduced quality of life.²⁷ Most GPs in this study admitted they had received limited or no formal teaching in the management of dental problems at undergraduate level. A qualitative study conducted in NZ on referral of patients to oral medicine specialists by GDPs and GPs revealed that dental knowledge among GPs is insufficient.²⁸

In NZ, the training provided in medical and dental schools typically focuses on their respective professions with some cross-disciplinary education between the two. Medical schools primarily educate future doctors on diagnosing and treating medical conditions, including some basic understanding of oral health as it relates to systemic health. Similarly, dental schools train future dentists extensively in oral health diagnosis, treatment, and management. However, there is generally a gap in comprehensive training that integrates medical and dental knowledge across both professions. This may impact the ability of health care providers to collaborate effectively in managing patients with complex medical and dental needs. Despite the recognised importance of interdisciplinary collaboration, formal training that bridges the gap between medical and dental education remains somewhat limited. Efforts to enhance interprofessional education and collaboration between medical and dental schools could potentially improve patient care outcomes by fostering a more integrated approach to health care delivery. Integrating aspects of each profession’s education could better prepare health care providers to work together seamlessly, benefiting patient care across medical and dental domains. Improved oral health training for non-dental teams in fundamental dental skills would lay the foundation for better communication and referral pathways between GPs and GDPs. Dental participants perceived the necessity to equip GPs with dental knowledge to improve patient outcomes and to enhance collaboration with the dental team.²⁰ A study in Germany criticised that there was lack of attention given to clinical dental problems in the medical school curriculum as opposed to the considerable inclusion of medical conditions and related systemic disease in dental school curricula.¹⁵ A NZ study involving dentists and doctors proposed the need for seminars, information packs, and interprofessional observation in dental clinics among medical students to increase their knowledge level in oral health.²⁸ Moreover, a previous study stressed the importance of interprofessional education in both undergraduate and postgraduate training of all health care departments to prepare students for the need of multidisciplinary intervention.⁴

Strategies suggested by dental participants in this study included creating opportunities to meet and organising regular face-to-face meetings to help build positive relationships between dentists and doctors to enhance communication. A qualitative study in Australia reported that the dental participants agreed on the advantages of the use of technology such as intraoral cameras and video or tele-conferencing for the convenience of future collaboration.²⁰

Most of the medical participants in this study expressed the convenience of integrated electronic health records (EHRs) in medicine, but there is no involvement of dental professionals in these. Hence, a vast majority of both participants suggested the development of a common system to gain access to patients’ medical records. One report from Information Systems Research stated that a standardisation of electronic patient records across multidisciplinary professionals is important to provide holistic patient care. In addition, a previous study discussed that this standardisation allows access to important medical information, increases the speed of treatment, avoids misdiagnosis, and enables accessible communication among doctors and dentists.⁶

The findings from this study highlighted the complex multifaceted interface between GDPs and GPs in NZ. The present study had a few limitations. A key limitation of this study was that participants were recruited from only two cities in NZ (Auckland and Dunedin). Hence, the findings may not claim representativeness and cannot be generalised to all health care professionals. A cross-sectional sample was also utilised in this study in which participants were asked to recall from past experiences. Therefore, the conclusions drawn from this study and interpretation of the data may be influenced by subjective perceptions and interviewers’ theoretical reasoning, which could be a potential limitation. Moreover, most of the GP participants involved in this study worked in the private sector which could lead to a gap in the data resulting in discrepancies. GPs in New Zealand are predominantly private independent contractors who contract with their local primary health organisations to receive capitation payments and other public funding. Only a small number are directly employed and funded by both public and private sectors. In this study, all GPs were in the private sector, except for one who worked mainly in the private sector but also part-time in the public sector. A further limitation is that no GP researcher was involved in the design and analysis of the study in which the authors are all dentists when the study focuses on two professional groups. Additional future studies on the collaboration of health care professionals and referral guidelines would create a more standardised health system that includes bidirectional access and effective communication across oral health and general health.

Conclusion

Both GDPs and GPs in this study reported a lack of efficient interprofessional communication, mainly due to time constraints, knowledge deficits, and absence of integrated health record systems. Strategies aiming to integrate interprofessional education during undergraduate and postgraduate training could be useful. In view of this, it is crucial for health care organisations to assess and address interprofessional issues to work towards multidisciplinary and integrated patient-centred care.

Supplementary material

Supplementary material is available online.