Development of oral health interventions for inter-professional management of diabetes

PhD ThesisBackground Periodontitis impairs glycaemic control in people with diabetes and diabetes is a major risk factor for periodontitis. Cochrane reviews have reported HbA1c reductions of up to 4 mmol/mol following treatment of periodontitis, yet many clinicians and patients with diabetes are unaware of this. Aims/objectives To develop oral health interventions for delivery in primary medical care and to explore interprofessional communication in the context of management of diabetes and periodontitis. Methods The behaviours of medical and dental practitioners in relation to published diabetes and periodontitis best practice recommendations were surveyed using theoretically designed online questionnaires to assess predictors and determinants. The questionnaires were designed using a novel combination of social cognitive theory and normalisation process theory. The survey findings were discussed in iterations of workshops with patients, and medical and dental professionals to develop and pilot interventions in primary medical care for feasibility and acceptability. Results The self-reported survey findings showed that medical and dental professionals had limited knowledge of best practice recommendations; however, the importance of improved communication to enhance patient care was valued. Clinicians from both professions expressed a preference for indirect referrals, though a case study revealed negative consequences following this approach. Through workshop development, oral health interventions to inform patients about the bidirectional relationship between diabetes and periodontitis and advise those without a dentist to attend for periodontitis assessment and treatment were designed and subsequently experienced as feasible and acceptable by nurses. Conclusions Best practice recommendations to improve the uptake of evidence-based care in the context of diabetes and periodontitis are not widely known and inter-professional communication is problematic. Nurses have an important role in the delivery of oral health interventions and future research should evaluate these interventions formally