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Uptake of best practice recommendations in the management of patients with diabetes and periodontitis: a cross-sectional survey of healthcare professionals in primary care
  1. Susan M Bissett1,
  2. Tim Rapley2,
  3. Philip M Preshaw3,
  4. Justin Presseau4
  1. 1 School of Dental Sciences, University of Newcastle upon Tyne, Newcastle upon Tyne, UK
  2. 2 Social Work, Education and Community Wellbeing, Northumbria University Department of Social Work and Communities, Newcastle upon Tyne, UK
  3. 3 National University Centre for Oral Health, National University of Singapore, Singapore
  4. 4 School of Epidemiology and Public Health, and the School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
  1. Correspondence to Dr Susan M Bissett; s.m.bissett{at}


Objectives To investigate the practices of healthcare professionals in relation to best practice recommendations for the multidisciplinary management of people with diabetes and periodontitis, focusing on two clinical behaviours: informing patients about the links between diabetes and periodontitis, and suggesting patients with poorly controlled diabetes go for a dental check-up.

Design Cross-sectional design utilising online questionnaires to assess self-reported performance and constructs from Social Cognitive Theory (SCT) and Normalisation Process Theory.

Setting Primary care medical practices (n=37) in North East, North Cumbria and South West of England Clinical Research Networks.

Participants 96 general practitioners (GPs), 48 nurses and 21 healthcare assistants (HCAs).

Results Participants reported little to no informing patients about the links between diabetes and periodontitis or suggesting that they go for a dental check-up. Regarding future intent, both GPs (7.60±3.38) and nurses (7.94±3.69) scored significantly higher than HCAs (4.29±5.07) for SCT proximal goals (intention) in relation to informing patients about the links (p<0.01); and nurses (8.56±3.12) scored significantly higher than HCAs (5.14±5.04) for suggesting patients go for a dental check-up (p<0.001). All professional groups agreed on the potential value of both behaviours, and nurses scored significantly higher than GPs for legitimation (conforms to perception of job role) in relation to informing (nurses 4.16±0.71; GPs 3.77±0.76) and suggesting (nurses 4.13±0.66; GPs 3.75±0.83) (both p<0.01). The covariate background information (OR=2.81; p=0.03) was statistically significant for informing patients about the links.

Conclusions Despite evidence-informed best practice recommendations, healthcare professionals currently report low levels of informing patients with diabetes about the links between diabetes and periodontitis and suggesting patients go for a dental check-up. However, healthcare professionals, particularly nurses, value these behaviours and consider them appropriate to their role. While knowledge of the evidence is important, future guidelines should consider different strategies to enable implementation of the delivery of healthcare interventions.

  • diabetes
  • periodontitis
  • clinical behaviours
  • best practice

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See:

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  • Contributors SMB, TR, PMP and JP contributed to the conception and design of the study. SMB collected the data, which was supervised by TR, PMP and JP. JP, TR and PMP were the major contributors in analysis and interpretation of the data and in writing the manuscript. SMB, TR, PMP and JP were involved in drafting the work, revising it critically for important intellectual content and the final approval of the version published. SMB, TR, PMP and JP agree to be accountable for all aspects of the work. Members of Newcastle School of Dental Sciences Patient and Public Involvment group contributed to the study design and development.

  • Funding This research was funded by a UK National Institute for Health Research Doctoral Research Fellowship (DRF-2014-07-023) awarded to SMB.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval North West-Greater Manchester West NHS Research Ethics Committee (16/NW/0030).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information. A PDF of the online survey has been made available as a supplementary file. Permission is required from the authors for re-use.

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