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Listening to paediatric primary care nurses: a qualitative study of the potential for interprofessional oral health practice in six federally qualified health centres in Massachusetts and Maryland
  1. Judith Bernstein1,2,
  2. Christina Gebel1,2,
  3. Clemencia Vargas1,3,
  4. Paul Geltman1,
  5. Ashley Walter1,2,
  6. Raul Garcia1,
  7. Norman Tinanoff1,3
  1. 1Center for Research to Evaluate and Eliminate Dental Disparities, Boston University Henry M. Goldman School of Dental Medicine, Boston, Massachusetts, USA
  2. 2Department of Community Health Sciences, Boston University School of Public Health, Boston University, Boston, Massachusetts, USA
  3. 3Department of Orthodontics and Pediatric Dentistry, University of Maryland School of Dentistry, Baltimore, Maryland, USA
  1. Correspondence to Dr Judith Bernstein; jbernste{at}bu.edu

Abstract

Objectives To explore the opportunities for interprofessional collaboration (IPC) to improve paediatric oral health in federally qualified health centres (FQHCs), to identify challenges to IPC-led integration of oral health prevention into the well-child visit and to suggest strategies to overcome barriers.

Sample Nurse managers (NMs), nurse practitioners (NPs), paediatric clinical staff and administrators in six FQHCs in two states were interviewed using a semistructured format.

Design Grounded theory research. Topics included feasibility of integration, perceived barriers and strategies for incorporating oral health into paediatric primary care.

Measurements Qualitative data were coded and analysed using NVivo 10 to generate themes iteratively.

Results Nurses in diverse roles recognised the importance of oral health prevention but were unaware of professional guidelines for incorporating oral health into paediatric encounters. They valued collaborative care, specifically internal communication, joint initiatives and training and partnering with dental schools or community dental practices. Barriers to IPC included inadequate training, few opportunities for cross-communication and absence of charting templates in electronic health records.

Conclusions NMs, NPs and paediatric nursing staff all value IPC to improve patients' oral health, yet are constrained by lack of oral health training and supportive charting and referral systems. With supports, they are willing to take on responsibility for introducing oral health preventive measures into the well-child visit, but will require IPC approaches to training and systems changes. IPC teams in the health centre setting can work together, if policy and administrative supports are in place, to provide oral health assessments, education, fluoride varnish application and dental referrals, decrease the prevalence of early childhood caries and increase access to a dental home for low-income children.

  • Pediatric oral health
  • Interprofessional relations
  • Collaborative practice

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

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Footnotes

  • Contributors JB, CG, CV, PG, AW, RG and NT all participated in study design and implementation, interpretation of study findings and writing of this report.

  • Funding This study was supported in part by a cooperative agreement with the National Institute of Dental and Craniofacial Research, National Institutes of Health (U54-DE019275).

  • Competing interests None declared.

  • Ethics approval Boston University's Institutional Review Board was the lead university on this project.

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

  • Data sharing statement Small cells and a need to protect confidentiality of participating nurses and their clinics preclude release of identifiable tapes or transcripts, and Nvivo codes include identification of clinic and participant. The authors are happy to respond to queries from researchers interested in this topic.