Improving Oral Health Care for Frail, Community-Dwelling Older People: Exploring Barriers and Facilitators for Interprofessional Collaboration

TL;DR

This study explores challenges and solutions for improving oral health care for frail older people through better teamwork among health professionals.

Contribution

Identifies barriers and facilitators for interprofessional collaboration in oral health care for frail older people at multiple levels.

Findings

Barriers include limited awareness, unclear responsibilities, and poor digital integration.

Facilitators include interprofessional education, clear referral pathways, and improved ICT systems.

Macro-level solutions require national guidance and financial incentives for sustainable integration.

Abstract

Oral health is an important aspect of overall well-being, especially for frail older people, who are increasingly ageing in place. As this population with associated complex health care needs grows, integrated and collaborative oral health care becomes more urgent. Despite its importance, oral health is often overlooked in both practice and policy. This study aims to identify barriers and facilitators at the micro, meso, and macro levels to improve interprofessional collaboration for oral health care of frail, community-dwelling older people.

This qualitative study was conducted in the Netherlands and comprised two data collection methods: six semistructured interviews and five discipline-specific focus group discussions, involving a total of 38 health care professionals. Each focus group consisted of professionals from a single discipline, including oral health care professionals, general practitioners, home care professionals, pharmacists, and public health professionals. Participants represented health care professionals both within nationally recognized integrated geriatric care networks and those not yet participating in such networks. Data were analysed inductively using thematic analysis in Atlas.ti.

At the micro level, barriers included limited awareness, knowledge, and prioritization of oral health, unclear responsibilities, time constraints, and inconsistent referral pathways. At the meso level, participants reported insufficient standardized protocols, lack of interprofessional education, and poor digital integration of medical record systems. At the macro level, key issues were inadequate funding and reimbursement, fragmented policies, and limited support for home-based oral care. Facilitators at the micro and meso level included raising awareness and interprofessional education, practical tools and clear referral pathways, improved ICT systems, and appointing regional coordinators to strengthen multidisciplinary collaboration. At the macro level, national guidance and structural financial incentives were viewed as crucial for sustainable integration.

In conclusion, this study, identified critical barriers and facilitators for effective interprofessional collaboration and better oral health care for community-dwelling frail older people at the micro, meso, and macro levels. Improvement requires increasing awareness and education among professionals, better integration of oral health care in multidisciplinary care networks, shared electronic medical record systems, and adequate reimbursement. These findings should inform guidelines and be validated through implementation studies.