IDF21-0641 Diabetes Mellitus and periodontal health: identifying factors that influence implementation of best practice guidance

Abstract

Background: Evidence suggests the existence of a two-way relationship between periodontal (gum) disease and diabetes mellitus. There are several guidance documents available internationally for both medical and dental practitioners, which outline the management of diabetic patients with regards to their oral health. These documents advise medical practitioners that they should discuss that sub-optimal glycaemic control can worsen periodontal health and treatment outcomes, whilst poor periodontal health can lead to poorer glycaemic control. Guidance also states that medical practitioners should refer newly diagnosed diabetic patients to their dentist for a periodontal assessment and advise regular dental visits. Previous research in England has demonstrated that despite available guidance documents, medical professionals do not routinely inform their patients about the link between these conditions. There was also found to be a lack of inter-disciplinary communication between medical and dental professions. There was a need to corroborate this evidence, by investigating current practice within a Scotland wide cohort and on a larger scale. Our study explored current practice, knowledge and beliefs with regards to health practitioners’ communication with patients regarding diabetes and periodontal disease as well as exploring the barriers and facilitators to implementation of the advice. Methods: A cross-sectional observational study was undertaken. Virtual focus groups with medical professionals were carried out to ascertain whether and how the link between diabetes and periodontal disease was being discussed with patients and to identify facilitators and barriers to these discussions. An online questionnaire was then developed, based upon data collected from the focus groups. This was underpinned by the Theoretical Domains Framework, a behaviour change tool that can be used to understand implementation behaviours. The questionnaire was distributed via local networks to Endocrinology consultants, registrars, GPs, diabetes specialist nurses, practice nurses and healthcare assistants involved in the care of diabetic patients across Scotland. Qualitative data was analysed using qualitative content analysis. Quantitative data was analysed using IBM SPSS Statistics v24, and subjected to frequencies calculations, correlations, analysis of variance and regression. Results/Discussion: Results from the focus groups revealed a lack of knowledge and anecdotal evidence that the desired behaviours were not being carried out by medical professionals. There were 131 responses in total to the questionnaire. Seventy-five percent of the responses were from GPs and nurses, and 88% of the respondents worked in primary care. Results highlighted that medical practitioners rarely discussed the bidirectional relationship of diabetes and periodontal disease with patients. In addition, results demonstrated the lack of inter-disciplinary communication between the medical and dental professions. Lack of knowledge, lack of guidance, belief that this is not within the remit of the profession, time/administration pressures and patient influences were amongst some of the main barriers identified from the quantitative and qualitative data. Conclusion: Identification of barriers and facilitators can allow for the development of interventions to support medical practitioners in adhering to best practice guidance. The next stages of this project will be to design, implement and evaluate these interventions with the hope of improving care outcomes for patients with diabetes.