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Aim: To evaluate the feasibility of the Swiss complex interprofessional intervention, NEODOL© (NEOnato DOLore), for improving the management of procedural pain in neonates in the Finnish context. Background: Interprofessional collaboration is important for all professionals involved in the care of neonates and for neonates' parents, to understand the appropriate use of non‐pharmacological and/or pharmacological methods for each pain situation and how to assess pain in real‐life situations. Appropriate methods of pain relief for neonates should be preferred as they protect the development of the neonate's brain. Design: A descriptive qualitative design. Method: Data were collected through semi‐structured focus group discussions following the Medical Research Council's framework for evaluation of complex interventions, in this case NEODOL© which aims to improve the procedural pain management of neonates. A purposive sample (n = 13) included eleven professionals representing various professions within Finnish Neonatal Intensive Care Units and two parents of infants who have received care in a Neonatal Intensive Care Unit. Data were analysed using inductive content analysis, and the results were reported in accordance with the COREQ guidelines. Results: Professionals' and parents' evaluations suggest that NEODOL© is feasible, because it is consistent and addresses a current need. They assessed its overall content to be relevant and accessible, and its components to be internally coherent. However, they emphasise the need for further evaluation and refinement of the intervention to achieve the desired outcomes and cost‐effectiveness. Conclusions: While NEODOL© is considered feasible, it requires further evaluation and refinement in the local context of each hospital before implementation. [ABSTRACT FROM AUTHOR]

Aims: Digital health transformation may enhance or impede person‐centred care and interprofessional practice, and thus the provision of high‐quality rehabilitation and nutrition services. We aimed to understand how different elements and factors within existing digital nutrition and health systems in subacute rehabilitation units influence person‐centred and/or interprofessional nutrition and mealtime care practices through the lens of complexity science. Methods: Our ethnographic study was completed through an interpretivist paradigm. Data were collected from observation and interviews with patients, support persons and staff. Overall, 58 h of ethnographic field work led to observing 125 participants and interviewing 77 participants, totalling 165 unique participants. We used reflexive thematic analysis to analyse the data with consideration of complexity science. Results: We developed four themes: (1) the interplay of local context and technology use in nutrition care systems; (2) digitalisation affects staff participation in nutrition and mealtime care; (3) embracing technology to support nutrition and food service flexibility; and (4) the (in)visibility of digitally enabled nutrition care systems. Conclusions: While digital systems enhance the visibility and flexibility of nutrition care systems in some instances, they may also reduce the ability to customise nutrition and mealtime care and lead to siloing of nutrition‐related activities. Our findings highlight that the introduction of digital systems alone may be insufficient to enable interprofessional practice and person‐centred care within nutrition and mealtime care and thus should be accompanied by local processes and workflows to maximise digital potential. [ABSTRACT FROM AUTHOR]

Most individuals with avoidant/restrictive food intake disorder (ARFID) never receive treatment, and treatment needs far exceed the current capacity of mental health services. Occupational therapy (OT) focuses on enhancing function in daily activities, including eating and feeding. Given OT's rich history in mental health and pediatric feeding disorder treatment, we spotlight the potential role of OT in ARFID treatment, current knowledge, and opportunities for future research. Through a preliminary exploratory inquiry involving a review of current literature and clinical practice, we investigated OT's current involvement, knowledge, and interprofessional collaborative practice gaps in ARFID treatment. While many occupational therapy practitioners (OTPs) engage in ARFID treatment, interventions lack rigorous evaluation, and there is limited evidence defining OT's distinct role in interprofessional ARFID treatment. OTPs are uniquely positioned to provide interventions for individuals with ARFID across the lifespan, though research is needed to evaluate the efficacy of OT interventions. Future research suggestions include standardizing OT approaches to ARFID treatment and conducting single‐case experiments and randomized controlled trials to compare OT approaches with alternative methods. Recommendations to address practice gaps include enhancing ARFID education for OT students and practitioners and fostering a greater understanding of OT's role on the interprofessional team. Public Significance: Individuals with ARFID face barriers to eating that impact their health and function. On a multidisciplinary team, OTPs can treat diverse client populations by identifying and addressing barriers to daily participation, such as physical impairments, trauma history, and environmental barriers. More research is needed to evaluate the efficacy of OT practices in ARFID treatment. [ABSTRACT FROM AUTHOR]

Background: Persons with aphasia (PWA) experience a number of communicative and social‐emotional challenges. Reported experiences of PWA include but are not limited to, being misunderstood, isolated, frustrated, and infantilised. Aims: The aim of this pilot study, involving a Life Participation Approach to Aphasia (LPAA), conducted over the course of 2 years, was to understand community perceptions of aphasia while PWA engaged in an interprofessional treatment program involving speech and drama therapy. Methods & Procedures: The interprofessional treatment program involved PWA participating in a therapeutic theatre program using the CoActive Therapeutic Theater (CoATT) while also receiving speech‐language therapy. Each year, the PWA performed a different, original therapeutic theatre production for a public audience, at the culmination of their interprofessional treatment program. In this paper, we share data obtained from perspectives of audience members who witnessed the theatre production and aphasia education during the first year of the study and friends and family of PWA who participated in the therapeutic theatre process during the second year of the study. Outcomes & Results: Responses from audience members who participated in aphasia education and witnessed the therapeutic theatre performance by the PWA during the first year, indicated an increased knowledge of aphasia. Friends and family members of PWA who witnessed their loved ones engaging in the CoATT process through interprofessional treatment, in the second year, reported that their loved ones benefited from the CoATT process, which was distinct from other therapeutic processes to their knowledge and that they were impacted by watching their loved one perform. Conclusions & Implications: These initial findings create footing towards understanding impact of therapeutic theatre in combination with speech‐language therapy in the lives of PWA. They help us to obtain an initial appreciation of how therapeutic theatre and aphasia education help connect PWA and their community. WHAT THIS PAPER ADDS: What is already known on this subject: Caregivers and communities at large play a significant role in and substantially impact the recovery of their loved ones (Dalemans et al., 2010; Grawburget et al., 2013; Kniepmann & Cupler, 2014) with aphasia. However, existing research suggests that persons with aphasia (PWA) are often misunderstood, isolated and infantilised by their communities. What this paper adds to existing knowledge: The findings of our study reveal that friends, families and extended communities of PWA gain a positive and deep understanding of challenges experienced by PWA through therapeutic theatre supported by speech language therapy, based in a new CoActive Therapeutic Theatre (CoATT) model. This PWA community also agrees that therapeutic theatre in combination with speech‐language therapy provides confidence and camaraderie between PWAs and strengthen connection between all constituencies. These results support the need for interprofessional intervention within the framework of a Life Participation Approach to Aphasia (LPAA). What are the potential or actual clinical implications of this work?: Treatment paradigms that bring PWAs in contact with their communities using an LPAA approach can increase confidence and social engagement for PWAs potentially leading to better outcomes for their individual speech‐language therapy as well as create means of educating communities about PWA, and their stories. [ABSTRACT FROM AUTHOR]

Objective: As the participation of dental professionals in multidisciplinary care is often limited, instructions on oral health management provided by dental professionals to other professionals are important to achieve transdisciplinary oral health management; however, the effectiveness of such instructions remains unclear. In this longitudinal study, we aimed to determine the impact of oral health management provided by dental professionals and nurses instructed on oral health management by dental professionals on the oral health of inpatients eligible for a Nurition Support Team (NST). Methods: The study participants were 117 patients (66 men and 51 women, mean age: 71.9 ± 12.5 years) who received oral health management during the NST intervention period. The participants received oral health management from nurses (Ns group) or dental professionals (D group). The nurses who conducted the oral health management received instructions from dental professionals. Oral health was assessed at the beginning and end of the NST intervention using the Oral Health Assessment Tool (OHAT). Result: The Ns and D groups showed significant improvements in the total OHAT scores at the end of the NST intervention. Both groups showed significant improvements in the OHAT subitems of lip, tongue, gums and tissues, saliva, oral cleanliness and dental pain, while only the D group showed a significant improvement in the denture subitem. Conclusion: Effective oral health management provided by dental professionals or by nurses trained by them improved the oral health status of inpatients eligible for NST at an acute‐care hospital. [ABSTRACT FROM AUTHOR]

Introduction: Knee osteoarthritis (OA) negatively impacts the health outcomes and equity, social and employment participation, and socio‐economic wellbeing of those affected. Little community‐based support is offered to people with knee OA in Aotearoa New Zealand. Identifying Māori and non‐Māori with knee OA in community pharmacy and providing co‐ordinated, evidence‐ and community‐based care may be a scalable, sustainable, equitable, effective and cost‐effective approach to improve health and wellbeing. Aim: Assess whether the Knee Care for Arthritis through Pharmacy Service (KneeCAPS) intervention improves knee‐related physical function and pain (co‐primary outcomes). Secondary aims assess impacts on health‐related quality of life, employment participation, medication use, secondary health care utilisation, and relative effectiveness for Māori. Methods and analysis: A pragmatic randomised controlled trial will compare the KneeCAPS intervention to the Pharmaceutical Society of New Zealand Arthritis Fact Sheet and usual care (active control) at 12 months for Māori and non‐Māori who have knee OA. Participants will be recruited in community pharmacies. Knee‐related physical function will be measured using the function subscale of the Short Form of the Western Ontario and McMaster Universities Osteoarthritis Index. Knee‐related pain will be measured using an 11‐point numeric pain rating scale. Primary outcome analyses will be conducted on an intention‐to‐treat basis using linear mixed models. Parallel within‐trial health economic analysis and process evaluation will also be conducted. Ethics and trial dissemination: Ethical approval was obtained from the Central Health and Ethics Committee (2022‐EXP‐11725). The trial is registered with ANZCTR (ACTRN12622000469718). Findings will be submitted for publication and shared with participants. [ABSTRACT FROM AUTHOR]

Background: Patients with schizophrenia present with both cognitive impairment as well as language difficulties. There are similarities in the language output of patients with schizophrenia and patients with aphasia, thus a differential diagnosis of patients who present with a question of dual diagnoses can be a clinical challenge. This case report highlights the importance of an interdisciplinary approach to a patient with schizophrenia who benefitted from intervention from both psychiatry and speech–language pathology services due to the patient's unique verbal output. Aims: The primary aim of this case report is to highlight the critical importance of interdisciplinary collaboration in this patient population. The secondary aim is to disseminate an interesting and unique clinical phenomenon whereby the patient demonstrated an awareness of two distinct speech patterns and the unique ability to 'code switch' between them, something not commonly appreciated in this clinical population. Methods & Procedures: This case report describes a patient seen as part of routine clinical care. Information shared was solely observational and involved dissemination of information regarding case history, assessment and treatment plan. No interventions were implemented as a part of this study. Outcomes & Results: Interprofessional communication was critical in order to diagnose a patient with schizophrenia with an atypical speech pattern. The patient's language output did not manifest as a true aphasia but rather as two distinct language patterns that the patient could use at will. This ability to 'code switch' between languages is a unique clinical profile that is atypical of patients with schizophrenia. WHAT THIS PAPER ADDS: What is already known on this subject: Contemporary literature discusses the similarities between the language patterns of patients with aphasia and those with schizophrenia. There has been debate about how to classify and identify the mechanism of schizophrenic language. It is unclear whether the tangential press of speech in schizophrenia is a consequence of a formal thought disorder, or whether it constitutes an actual disorder or expressive language. Additionally, the mechanism for this speech pattern is not well defined in the literature as there is no consensus on whether it is a breakdown in linguistic processing or simply a patient's disordered thoughts being put into words. A less robust literature exists that suggests that there is a cognitive mechanism responsible for these speech patterns, as tangential speech has been linked to poor goal maintenance in other types of cognitive tasks. What this paper adds to existing knowledge: This study adds an important discussion about the critical importance of interprofessional collaboration when differentially diagnosing this complex patient population. It highlights the importance of the clinical exchange of information between the two disciplines of psychiatry and speech–language pathology about a patient population where clinical information is intertwined in the way described above. Regardless of the cause of the disordered output, what is lacking in the literature is evidence of how to address the complexities of the output of these patients and how to best manage the care of the patient. This study adds a practical clinical approach to collaborating on the assessment and management of this complex patient population. Importantly, it adds a description of a clinical manifestation of the language output of a patient with schizophrenia that we do not believe to have been previously published in the literature. What are the potential or actual clinical implications of this work?: Implications of this study include a much‐needed shift in the field in two regards. First, to include this patient population in the groups of patients that can benefit from interprofessional collaboration for differential diagnosis and consideration for speech and language therapy. Second, it offers a practical clinical approach to inter‐professional management in this patient population, something the literature is currently lacking. Additionally, publication of this unique clinical manifestation provides foundational knowledge for other clinicians appreciating similar clinical patterns of language output. To our knowledge, this is the first published case in which a patient could volitionally inhibit certain speech characteristics and thus this case study may assist in future differential diagnosis of patients with schizophrenia. [ABSTRACT FROM AUTHOR]

Objectives: This project aimed to enhance the identification of patients at‐risk for prediabetes or diabetes within a dental school patient population by introduction of a modified screening tool and related training of dental residents and students. Methods: The American Diabetes Association Risk Tool (ADART) was modified by addition of three diabetes‐linked oral health questions. Of the 1477 dental patients screened, 551 (37.3%) indicated an at‐risk status using the modified tool. A subset of 138 patients received follow‐up chairside HbA1c blood testing conducted by dental residents and students. Data was analysed to determine a) the influence of the modifications on the tool's discrimination strength and b) change in the tool's predictive value. Results: The addition of the 3 oral health questions to the 7‐item ADART resulted in a 9.4% increase in identification of patients at‐risk for pre‐diabetes/diabetes. The predictive value of the tool remained stable. Residents and students successfully incorporated the new screening activities within their assigned clinics. Conclusions: This project demonstrates that screening for risk for prediabetes/diabetes is both prudent and practical in the dental setting. Dental personnel, including trainees, can successfully incorporate enhanced screening methods within their traditional activities. Further, screening tools used in the dental setting might be enhanced by inclusion of certain oral health variables associated with diabetes. These findings add to emerging knowledge on the importance of screening for prediabetes/diabetes in dental settings and have particular relevance and application to institutional practice. [ABSTRACT FROM AUTHOR]

Purpose: This study evaluates third‐year dental medicine students' perceived competencies related to interprofessional collaborative practice (IPCP) after completing two exposure level experiences with students from other professions across a large academic health center. Methods: Two cohorts of D3 dental medicine students (2018–2019 and 2019–2020) completed the Interprofessional Collaborative Competencies Attainment Survey (ICCAS) after participating in in‐person 2.5‐h Interprofessional (IP) Forums in the Fall and Spring semesters. Self‐reported competencies were compared between pre‐and post‐IP Forum ratings and between Fall and Spring. Results: Prior to the IP Forums, dental medicine students (n = 185) reported perceived skill in the interprofessional competencies to be from Good to Very Good using the ICCAS. After participation in the Fall IP Forum, students' ICCAS scores increased in all ICCAS subscales with large effect sizes. Students reported a perceived decline in these skills in the four months between Fall and Spring IP Forums and restoration of IP skill levels after participating in a second IP Forum (Spring). Conclusions: Participation in IP Forums has a positive impact on students' IPCP skill perception. Our data suggest that perceived skill level requires repeated IP learning experiences. If dental medicine students are expected to embrace collaborative practice to enhance patient outcomes, then dental school educators must provide opportunities for students to engage in collaborative practice experiences at all levels of their training. [ABSTRACT FROM AUTHOR]

Objectives: Clinical supervision is essential for ensuring effective service delivery. International imperatives to demonstrate professional competence has increased attention on the role of supervision in enhancing client outcomes. Although supervisor competency tools are recognised as important components in effective supervision, there remains a shortage of tools that are evidenced‐based, applicable across workforces and freely accessible. Design: An expert multidisciplinary group developed the Generic Supervision Assessment Tool (GSAT) to assess supervisor competencies across a range of professions. Initially the GSAT consisted of 32 items responded to by either a supervisor (GSAT‐SR) or supervisee (GSAT‐SE). The current study, using surveys, employed a cross‐sectional design to test the reliability and construct validity of the GSAT. Methods: The study consisted of two phases and included 12 professional groups across Australasia. In 2018, exploratory factor analysis (EFA) was undertaken with survey data from 479 supervisors and 447 supervisees. In 2019 survey data from 182 supervisors and 186 supervisees were used to conduct confirmatory factor analysis (CFA). The results were used to refine and validate the GSAT. Results: The final GSAT‐SR has four factors with 26 competency items. The final GSAT‐SE has two factors with 21 competency items. The EFA and CFA confirmed that the GSAT‐SR and the GSAT‐SE are psychometrically valid tools that supervisors and supervisees can utilise to assess competencies. Conclusion: As a non‐discipline specific supervision tool, the GSAT is a validated, freely available tool for benchmarking the competencies of clinical supervisors across professions, potentially optimising supervisory evaluation processes and strengthening supervision effectiveness. Practitioner points: Supervisor competency tools are recognised as important components of safe and effective supervision provision yet there is a dearth of valid, reliable and effective measures.The Generic Supervision Assessment Tool (GSAT‐SR and GSAT‐SE) are unique psychometrically valid, and reliable measures of supervisor competence.The GSAT‐SR and the GSAT‐SE can enhance translation of evidence‐based supervision competency skills into regular practice.Validated with a broad cross section of professionals in diverse practice settings the GSAT provides a comprehensive conceptualization of supervisor competence. [ABSTRACT FROM AUTHOR]

Background: Educators and health professionals support the learning and participation of diverse children in school environments. Tiered approaches to service delivery may assist these efforts through consideration of universal supports that are useful to all children, targeted supports for some children and individualized supports for the smallest number of children. This study explored how an interprofessional team worked with educators to develop and implement tiered services in two school communities where many families experience economic and social disadvantages. Methods: Using a participatory action research approach and qualitative case study methods, the research and stakeholder teams jointly designed and conducted this study in two schools during the 2017–2018 school year. Data collected included weekly logs written by the interprofessional team members and 16 interviews conducted with team members, parents, educators and administrators. Results: The team provided a variety of services to individual students, groups, whole classes and the school community. Collaboration and communication were needed to define roles and expectations and to plan and share student information. Reported benefits included timely service, capacity building and student goal achievement. The main barriers were related to service fragmentation, time and workload. Conclusions: Recommendations included clearer direction about expectations and improved coordination within the systems that offer services. Further research should include exploration of comparative cases with varying contexts, the inclusion of child perspectives and direct observation. [ABSTRACT FROM AUTHOR]

Inter‐professional collaboration remains a significant concern within healthcare and social care. However, there has been scant attention paid to practices at the interface of clinicians and carers, namely foster carers and residential carers. The present study considers child and adolescent self‐harm management and prevention practices as a site of empirical interest due to reports that multi‐agency teams are not effectively operating. Drawing upon a grounded theory approach, data were generated via semi‐structured interviews and focus groups with residential carers (n = 15) and foster carers (n = 15) in Wales. Themes were developed through axial coding. The results present two central themes to explain the nature and perceived causes of inter‐professional discord. First, there are clear contestations in expertise, with carers challenging clinicians' propositional knowledge in favour of their own experiential expertise. However, participants simultaneously endorse medical dominance, which contributes to their sense of disempowerment and marginalisation. Second, is the preclusion of carers' professional identity, primarily due to inadequate professionalisation procedures. Meanwhile, the privileging of their parenting role is perceived to support the perpetuation of courtesy stigma. Carers are then compelled to undertake the effortful labour of legitimisation. Together these thematic insights provide direction on mechanisms to improve inter‐professional interactions, notably around training and accreditation. [ABSTRACT FROM AUTHOR]

Background: In the context of interprofessional practice, a patient‐centred approach is recommended, which generally means power‐sharing, shared decision making and involving patients as part of the health‐care team. These aspects, which are essential to "patient‐centred" practice, do not appear to be sufficient to illustrate the full richness of this practice. Objective: This article aimed to understand how interprofessional patient‐centred (IPPC) practice in oncology teams contributes to creating a more positive experience for patients. Objectives were to (a) describe the IPPC practice of oncology teams using the IPPC Practice Framework; (b) determine the usefulness of this framework; and (c) offer alternative proposals for expanding our understanding of IPPC practice. Design: A secondary analysis was performed with data from a multicase study designed to explore the effects of interdisciplinary work among oncology teams. Data were provided from six focus groups with professionals (n = 22) and patients diagnosed with cancer (n = 16). An iterative content analysis was performed. Results: Applying the theoretical framework to data analysis enabled us to distinguish between the IPPC practice of the different teams and structure the data collected in order to show the processes and place them in context. However, it proved to be difficult to describe the central component of the theoretical framework, patient‐centred processes. This situation raises new hypotheses for representing practice in a real‐life context. An alternative perspective for illustrating IPPC practice is therefore proposed. Conclusion: This study emphasizes the importance of exploring the utility of theoretical frameworks and refining them in order to broaden our understanding of IPPC practice. [ABSTRACT FROM AUTHOR]

Access to quality dental care for many adults and children remains a serious concern. Many communities throughout the U.S. are at great disadvantage for preventive care and treatment due to payment concerns, location and types of providers, and poor communication between dental providers and primary care professionals. Voids in shared technology and information also persist. Integrating primary care with oral health can boost both preventive care and interventions focused on increasing efficacy and efficiency between dental and primary care professionals in addressing the onset and duration of disease. Academic and community partnerships can help increase access to care and bring together the dental and medical communities for better integration and care coordination. Academic and community partnerships promote the sharing of information, facilitate provision of basic diagnostic services, and bring the bidirectional flow of knowledge, training, and skills to one another in a systematic and sustained manner. [ABSTRACT FROM AUTHOR]

Interprofessional education (IPE) and interprofessional practice (IPP) are game‐changers. They will completely alter the way that health professionals are educated and the way that health care is delivered. The transition from our current silo‐based approach to team‐based education and practice is under way, and there is nothing that can be done to stop them from happening. This article will provide a historical context to the development of IPE in health professions education, identify ways in which the dental professions have addressed these developments, and provide recommendations for opportunities for the dental professions to engage in IPE and IPP, especially for the benefit of the people we serve as patients and current students and learners who will be practicing in a collaborative environment with other health professionals in the future. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate characteristics of pregnant women served through the University of North Carolina's (UNC) prenatal oral health program (pOHP) dental clinic and community healthcare pathways to inform efforts in promoting prenatal oral health policies.Methods: The pOHP provides medical and dental students and practitioners with interprofessional experiences caring for pregnant women. A retrospective chart audit captured 314 pregnant women who made appointments over 33 months. Descriptive statistics and bivariate comparisons were computed to assess factors associated with dental appointment attendance and treatment completion.Results: There were 564 pregnant women, with mean age of 29 years and gestation of 25 weeks, referred to the pOHP dental clinic from UNC OB-GYN and 20 community sites. Only 56% (N = 314) scheduled an appointment. Of the 314 appointed women, 55% (N = 172) attended at least one appointment. The majority (87%) presented with acute and/or complex treatment needs. Medicaid status was positively associated with appointment attendance (P = 0.001). Less than half (42%) of the women completed treatment prior to delivery. Mean maternal age, gestational age, and weeks to estimated date of delivery (EDD) were not significantly associated with completed treatment.Conclusions: This study provides descriptive evidence of an academic, interprofessional program's ability to provide safety-net dental care to pregnant women in the state of North Carolina. Results underscore the need for dental services among pregnant women, signaling for promotion of prenatal oral health clinical standards and informing policy on the state and national levels to maximize dental coverage. [ABSTRACT FROM AUTHOR]

Nowhere is the discrepancy between good and poor oral health status more pronounced in the U.S. than in the Appalachian region, where there is a high incidence of dental problems related to non-flouridated water, limited access to care, and tooth loss. To address these disparities, in 2016 University at Buffalo dental and nurse practitioner faculty members led a group of dental and nursing students on a two-day service-learning experience in rural Tennessee. The aim of this study was to assess the dental and nursing students' reflections on this interprofessional service-learning experience in Appalachia. After the program, all 36 students who took part in it were invited to complete a survey with open-ended questions about the experience and their attitudes about interprofessional practice. Of the students, 34 (94.4%) returned the surveys, and 23 completed all the questions. Thematic analysis was used to code and analyze the student comments, which were then organized into themes. Five themes emerged: facilitating care through teamwork, gaining mutual respect, gaining confidence, understanding dental role in overall health, and relieving suffering. The overarching pattern was the link among all the themes: that everyone has a part to play in ensuring that patients get the best care. The themes and overarching pattern corresponded to the Interprofessional Education Collaboration (IPEC) competencies and the overall goal of delivering patient-centered care to a population that is underserved. These findings suggest that exposure to patients who lack dental care and have severe oral health problems can impact developing nursing and dental professionals in ways that can increase their appreciation of interprofessional practice and their future willingness to provide care in underserved settings. [ABSTRACT FROM AUTHOR]

The aims of this study were to evaluate the feasibility of an interprofessional education and collaborative practice model (IECPM) developed by the School of Dentistry (SOD) and College of Pharmacy (COP) for the University of Minnesota dental clinics and to report results of the needs assessment using specific primary care metrics and medication histories gathered through use of the model in 2015-16. Planning focused on establishing a workflow to implement the IECPM by the SOD and COP. The interprofessional team that provided patient care for the study consisted of 50 dental students, ten dental therapy students, one pharmacy student, one pharmacy resident, one faculty pharmacist, one dental assistant, one faculty dental hygienist, and two dentists. The team selected 190 patients in the SOD clinic for the study based on the inclusion criteria: patients with two or more chronic medical conditions who were taking medications. The 190 patients received a comprehensive dental exam, review of social and medical history, and medication therapy management assessment by the interprofessional team. Specific core primary care metrics (blood pressure, pulse, tobacco use, and diabetes status) and identification of drug therapy problems (DTPs) were monitored and/or screened for during the dental visit. The results showed that the IECPM helped identify that this cohort of patients presented with chronic conditions: 64% had hypertension, 34% had diabetes, and 10.5% reported smoking cigarettes. Several DTPs were identified, of which "needs additional drug therapy" was the most common. This cohort was taking multiple medications (2-34 per patient) to address a variety of medical conditions. The study concluded that the IECPM with the SOD and COP helped address a primary care need that often goes unmet in dental clinics. [ABSTRACT FROM AUTHOR]

This executive summary for Section 6 of the "Advancing Dental Education in the 21st Century" project provides an overview of five background articles that address the role of research and scholarship in dental education in the year 2040. Beginning with a historical account of research and discovery science in dentistry's evolution as a profession, the article then reviews the role of early thought leaders and organized dentistry in establishing research as a cornerstone of dental education and dental practice. The dental research workforce faces an uncertain future fueled by a volatile funding environment and inadequate mentoring and training of research faculty. Dental schools must forge stronger academic and scientific ties to their university and academic health centers and will be challenged to develop sustainable research and patient care collaborations with other health professions. The changing health care environment will create new opportunities for oral health care providers to expand their scope of practice and focus on prevention and screening for non-communicable chronic diseases. Dental practitioners in the future are likely to place greater emphasis on managing the overall health of their patients while promoting closer integration with other health professionals. All dental schools must develop a sustainable research mission if they hope to graduate dentists who function effectively in a collaborative health care environment. The changing scientific and health care landscape will dramatically alter dental education and dental practice. Dental schools need to reconsider their research and educational priorities and clinical practice objectives. Until dental schools and the practicing community come to grips with these challenges, a persistent attitude of complacency will likely be at the dental profession's peril. [ABSTRACT FROM AUTHOR]

The health care environment in the U.S. is changing. The population is aging, the prevalence of non-communicable diseases (NCDs) is increasing, edentulism is decreasing, and periodontal infection/inflammation has been identified as a risk factor for NCDs. These trends offer an opportunity for oral health care providers to broaden the scope of traditional dental practice, specifically becoming more involved in the management of the general health of patients. This new practice paradigm will promote a closer integration with the larger health care system. This change is based on the realization that a healthy mouth is essential for a healthy life, including proper mastication, communication, esthetics, and comfort. Two types of primary care are proposed: screenings for medical conditions that are directly affected by oral disease (and may modify the provision of dental care), and a broader emphasis on prevention that focuses on lifestyle behaviors. Included in the former category are screenings for NCDs (e.g., the risk of cardiovascular disease and identification of patients with undiagnosed dysglycemia or poorly managed diabetes mellitus), as well as identification of infectious diseases, such as HIV or hepatitis C. Reducing the risk of disease can be accomplished by an emphasis on smoking cessation and dietary intake and the prevention of obesity. These activities will promote interprofessional health care education and practice. While change is always challenging, this new practice paradigm could improve both oral health and health outcomes of patients seen in the dental office. This article was written as part of the project "Advancing Dental Education in the 21st Century." [ABSTRACT FROM AUTHOR]

The health care system is undergoing transformation in which oral health is not only valued as an aspect of overall health, but health care delivery systems are aligning to better deliver total patient care. As a result of this transformation, education for many non-dental professionals incorporates oral health content to prepare them to practice in comprehensive delivery models. While some non-dental professionals already incorporate oral health care in their service, many opportunities exist for expansion of oral health care delivery by other non-dental professionals, including radiologic technicians, nursing staff, and human services professionals. As non-dental professionals take on expanded roles in oral health care, the dental hygiene workforce must be prepared to practice in settings with new types of professionals. Dental hygiene curricula should prioritize interprofessional education to best prepare these students for practice in evolved delivery models. This article was written as part of the project "Advancing Dental Education in the 21st Century." [ABSTRACT FROM AUTHOR]

With the health care delivery system in transition, the way in which oral health care services are delivered in 2040 will inevitably change. To achieve the aims of reduced cost, improved access, and higher quality and to advance population wellness, oral health care will likely become a more integrated part of medical care. An integrated primary care system would better meet the needs of an increasingly diverse and aging U.S. population with uneven access to health care services. By 2040, trends suggest that a smaller proportion of dental hygienists will work in traditional solo dental offices; many more will practice with multidisciplinary health care teams in large-group dental and medical practices and in a variety of non-traditional community settings. This integration will require changes in how dental hygienists are educated. To shape the skill sets, clinical judgment, and knowledge of future practitioners, current dental hygiene curricula must be reexamined, redirected, and enhanced. This article examines some of the factors that are likely to shape the future of dental hygiene practice, considers the strengths and weaknesses of current curricula, and proposes educational changes to prepare dental hygienists for practice in 2040. This article was written as part of the project "Advancing Dental Education in the 21st Century." [ABSTRACT FROM AUTHOR]

Models and systems of the dental care delivery system are changing. Solo practice is no longer the only alternative for graduating dentists. Over half of recent graduates are employees, and more than ever before, dentists are practicing in groups. This trend is expected to increase over the next 25 years. This article examines various models of dental care delivery, explains why it is important to practice in integrated medical-dental teams, and defines person-centered care, contrasting it with patient-centered care. Systems of care in which teams are currently practicing integrated oral health care delivery are described, along with speculation on the future of person-centered care and the team approach. Critical steps in the education of dental and other health care professionals and the development of clinical models of care in moving forward are considered. This article was written as part of the project "Advancing Dental Education in the 21st Century." [ABSTRACT FROM AUTHOR]

This article is based on the following assumptions about dental care in the United States: there is an access to oral health care problem; the number of individuals with dental insurance is increasing; the demographics of the dental profession does not mirror the overall demographics of the U.S. population; and emerging oral health workforce models may help improve access to care. Based on these assumptions, this article explores related licensure and regulatory factors that will influence the education and practice of dentists in the future. The issues discussed are licensure of emerging oral health practitioners, mobility of the dental health care workforce, corporate ownership of dental practices, ethical issues related to use of human subjects in dental licensure examinations, interprofessional education and practice, and health care reform. The licensure and regulatory bodies discussed are the Commission on Dental Accreditation (CODA), state legislatures and boards of dentistry, federal legislative activities, judicial activities, and the Federal Trade Commission. Recommendations based on this discussion are presented. This article was written as part of the project "Advancing Dental Education in the 21st Century." [ABSTRACT FROM AUTHOR]

This executive summary for Section 4 of the "Advancing Dental Education in the 21st Century" project examines the projected oral health care delivery system in 2040 and the likely impact of system changes on dental education. Dental care is at an early stage of major changes with the decline in solo practice and increase in large group practices. These groups are not consolidated at the state level, but further consolidation is expected as they try to increase their negotiating leverage with dental insurers. At this time, there is limited integration of medical and dental care in terms of financing, regulation, education, and delivery. This pattern may change as health maintenance organizations and integrated medical systems begin to offer dental care to their members. By 2040, it is expected that many dentists will be employed in large group practices and working with allied dental staff with expanded duties and other health professionals, and more dental graduates will seek formal postdoctoral training to obtain better positions in group practices. [ABSTRACT FROM AUTHOR]

If a dental student diagnoses a patient in a dental school clinic as being at high risk of prediabetes or diabetes, the patient should be referred to his or her physician for further diagnostic evaluation, and the physician should send back the evaluation results so that the dental team can optimize treatment and health care choices if the diagnosis is confirmed. The primary aim of this study was to evaluate physicians' responses to written and oral requests for information regarding follow-up diabetes testing. A secondary aim was to evaluate patients' compliance with recommendations to seek medical care after being determined to be at high risk of prediabetes or diabetes in the dental clinic. Based on at least one positive risk factor for diabetes, 74 patients in one U.S. dental school's clinic were screened by third- and fourth-year dental students for prediabetes or diabetes and underwent point of care HbA1C (glycalated hemoglobin) blood tests between June 2014 and June 2015. Patients with an HbA1C value of 5.7% or above were referred to their physicians for follow-up testing. The physician was mailed the patient's HIPAA release and a request for updates to the student regarding the patient's diabetes status. If the physician did not provide the requested information, a dental student telephoned him or her to obtain the patient's diabetes status. Of the 74 patients, 34 (46%) tested positive with HbA1C tests and were referred to their physicians. Of those 34 referred patients, 20 (59%) saw their physicians for additional evaluations within six months of referral. None of the 20 physicians responded to the written requests for information on additional diabetes testing. After one or two telephone requests, all 20 physicians provided the test results. This study found that most of the patients (59%) followed their dental practitioner's advice to seek follow-up care with their physician, supporting the value of conducting these tests in a dental clinic. However, the results also suggested that a single written request may be insufficient to prompt physicians to return those results and that follow-up communication in a phone call may be more effective. [ABSTRACT FROM AUTHOR]

Purpose As a means to identify and quantify oral health interprofessional collaborative practice (IPP), we examined participant-described medical-to-dental (M2D) referral networks and how they function across rurality. Methods We conducted a cross-sectional survey on the appraisal of IPP referral systems in 2016. Secondarily, we examined if rural health clinics (RHCs) have different experiences with M2D referrals compared to other practice types. Independent variables included geographic and organizational indicators, referral system attributes, and respondent characteristics. Data were coded by Census region and state Medicaid expansion status. Bivariable and multivariable analyses were conducted using SAS. Findings A convenience cohort (n = 559) from 44 states was examined. Nearly, half (48.7%) reported dependable M2D referral systems. In bivariate analysis, all independent variables were significant except for state Medicaid expansion status. In multivariable analysis, Census region retained significance ( P = .0093). Organization type and practice issues with no shows/missed appointments continued to have significance ( P < .001 and .002, respectively). Accountable care organizations were over 5 times (5.72, P = .001) more likely than RHCs to report dependable M2D referral systems. Federally qualified health clinics were slightly over 3 times more likely than RHCs to report dependable M2D referral (3.04, P < .001). No differences between RHCs and other private practices were observed. Conclusions The importance of IPP continues to be promoted in the current health care environment. Our study demonstrates that, in this motivated study population, M2D referrals can work well, even in rural areas. Organization type, directionality of referral, broken appointment rates, and electronic health information management were all found to significantly impact the respondents' rating on the dependability of an M2D referral process. [ABSTRACT FROM AUTHOR]

Medical providers of all types are beginning to engage in oral health, both academically and in practice. The process has been slow; however, momentum has increased over the past two decades as major health care organizations have emphasized the importance of oral health as a vital part of overall health. This article begins by defining which health providers have and should engage the public in oral health and then briefly reviews the influences that have led health professionals to address oral health in education and practice. This overview is followed by an examination of current trends and successes in oral health education in the health sciences, why oral health is a natural fit for medical care, and the need for a comprehensive approach. The article concludes by exploring roles for each profession and addressing the resources and political will that will be required to meet common goals. This article was written as part of the project "Advancing Dental Education in the 21st Century." [ABSTRACT FROM AUTHOR]

The aims of this study were to develop, implement, and evaluate a novel interprofessional standardized patient exercise (ISPE) with oral-systemic and interprofessional collaborative practice (IPCP) components. Dental students and doctor of nursing practice (DNP) students at one U.S. university participated in the simulation, which was primarily designed to test their teamwork skills. In spring 2014, DNP students worked in the dental clinics with dental students under the supervision of nursing and dental faculty members. To test the teamwork outcomes for both groups of students, a standardized patient (SP) scenario was designed to include multiple chronic medical diagnoses and an oral-systemic component. The exercise was filmed for later review. Outcomes measures included SP and student self-evaluations and faculty evaluation of student documentation. The primary outcome of interest from a dental standpoint was faculty evaluation of IPCP competencies derived from the Core Competencies of Interprofessional Collaborative Practice and were deemed to be observable by faculty when viewing the videotaped scenario. Eight teams of students participated with an SP trained in the scenario. Each team consisted of a DNP student, a fourth-year dental student, and a second-year dental student. All eligible students in the DNP class (n=20) and eight students from each dental class (approximately 110 each) participated. The results showed that the teams scored highest on the role/responsibilities subscale, indicating students were respectful of each other's roles and expertise and effectively engaged each other to develop strategies to meet the patient's needs. Scores on the three other subscales (values/ethics, interprofessional communication, and teams/teamwork) were also high. These findings appeared to support IPCP as a method to foster knowledge and respect for other roles and responsibilities, improve appreciation of teamwork, and encourage better communication among health care providers. The ISPE scenario provided an effective way to evaluate IPCP competencies. [ABSTRACT FROM AUTHOR]

Rationale and Aim While interprofessional practice has been promoted as a solution to the challenges besetting rural health services, current evidence does not offer a clear explanation as to why it is effective in some domains and yet is not successful in others. At the same time, rural clinicians are frequently faced with major workforce pressures and this has a significant influence on professional practice. The aim of this study was to explore how these pressures impact on rural interprofessional practice. Method This study is part of a larger project investigating factors that enhance and detract from effective interprofessional working. We utilised a modified realistic evaluation approach to analyse the context, mechanisms and outcomes of rural interprofessional practice. Approval for this study was granted by an accredited research ethics committee. Semi-structured interviews were conducted with 22 rural clinicians who were purposively recruited from a range of settings, roles, locations and professions. Findings and Discussion We found that clinicians often invested in interprofessional practice because of the need to manage intense workloads and this necessitated sharing of responsibilities across disciplines and blurring of role boundaries. Paradoxically, participants noted that workload pressures hampered interprofessional working if there were long-term skill shortages. Sharing workload and responsibility is an important motivator for rural practitioners to engage in interprofessional practice; however, this driver is only effective under circumstances where there are sufficient resources to facilitate collaboration. In the context of intransient resource challenges, rural health service managers would be best to focus on enabling IPP through facilitating role understanding and respect between clinicians. This is most feasible via informal workplace learning and allowing time for teams to reflect on collaborative processes. [ABSTRACT FROM AUTHOR]

Realizing the vision for integrated children's services will rely on effective collaboration and joined-up working across professional boundaries. One way of achieving this is to open up professional practice to the scrutiny of other professional groups in order that shared understanding can be developed. This brief article describes how we use story telling to model critical reflection and to invite students to reflect on their own constructions of their own and other professional groups. The story telling takes place during one timetabled session as part of a planned interprofessional learning module for students of nursing and social work. The authors, a lecturer in social work and a lecturer in children's nursing, had, by chance, been co-located in the same office. Working together led to many conversations and a realization of how we would often use the same words to make sense of our practice with children and families, but sometimes mean different things. The idea for the story-telling session was developed from these conversations. The story, ‘Telling tales’ (see box 1 ), focuses on the real-life reflections of a children's nurse who worked with a young boy. He had been admitted to hospital and separated from his mother for a period of 1 week. The story is told to the students using the original words of the nurse. In this study, we describe the background to the initiative, how we use the story and what happens when we do. We contend that story telling is a powerful technique for opening up professional practice to the scrutiny of other professional groups. It also provides an effective vehicle to invite the students to critically challenge what they hold dear, just in case they are wrong. [ABSTRACT FROM AUTHOR]

Aims To evaluate stakeholders’ perceptions of the extent to which a research facilitator post was addressing aims of: • providing academic support to enable research involvement of nurses, midwives and allied health professionals; • supporting dissemination of research into practice; • contributing to research strategy development. Background Barriers to research capacity development have been recognized for nurses, midwives and allied health professionals. A project established in a London NHS trust aimed to address these. Methods A mixed methods approach was used. Results Responses were generally very positive. The post effected improvements in the research culture and perceived increase in research-related activities. Conclusion The post made substantial progress towards its aims. This approach may be useful in other healthcare locations to build research capacity. Implications for nursing management Challenged by increasing priority accorded to research capacity and service research implementation yet recognition of barriers to achievement, this study offers insights from one means to address this. [ABSTRACT FROM AUTHOR]

The article offers information on incorporating interprofessional education (IPE). Topics include according to the World Health Organization, 60-90% of school children and 100% of adults worldwide have dental caries; and IPE, collaboration, and practice in community-based care of a change in practice that benefit both the public and practitioners.

A 2011 study evaluating oral health training in pediatric medical residency programs highlighted opportunities to improve residents' oral health competence. The aim of this 2017 follow-up study was to assess progress since 2011 in promoting development of pediatric residents' oral health competence. A survey was sent to all 281 pediatric and med-peds medical residency program directors to assess the structure and determinants of oral health training in their programs. A total of 110 program directors responded to the 2017 survey (response rate 40%). Just over half (54%) of the respondents reported that their residents received one to two hours of oral health education during residency, while 38% received ≥3 hours (compared to 47% and 48%, respectively, in 2011). There was improvement in the proportion of respondents reporting that their residents integrated fluoride varnish application training in 2017 vs. 2011 (83% vs. 43%; p<0.001). Departmental support for integrating oral health and having an oral health elective were significantly associated with satisfaction with residents' oral health competence. These findings suggest that pediatric and med-peds medical residency programs have improved their residents' oral health awareness and training through integration of at least one hour of oral health education and fluoride varnish training. However, given deficiencies in program structure and uneven perceptions of residents' oral health competence found in this study, opportunities remain to improve pediatric residency programs' oral health curricula.

The aim of this study was to investigate the effect that an interprofessional clinical experience (IPCE) had on dental and adult-gerontology primary care nurse practitioner (NP) students' attitudes towards health care collaboration. A survey study was conducted with dental and NP students before and after completing IPCE rotations in a dental clinic and a tertiary care setting in the 2016-17 academic year. All dental students (N=159) and all NP students enrolled in the adult-gerontology primary care program (N=37) participated in the IPCE. Students were asked to complete the Readiness for Interprofessional Learning Scale (RIPLS) survey anonymously prior to and immediately after the experience. All 37 NP students completed both pretest and posttest, for a 100% response rate on both. Among the dental students, 120 completed the pretest, for a 75% response rate, and 106 completed the posttest, for a 67% response rate. The results showed a significant increase in total RIPLS score for both the dental and NP students following the experience (p<0.001). Attitudes about teamwork and collaboration and about roles and responsibilities improved for both the dental and NP students (p<0.001) following the IPCE. There was a difference between dental students' and NP students' teamwork and collaboration subscale scores before IPCE (p=0.006), but it diminished after the intervention (p=0.09). These results suggest the IPCE succeeded in building positive attitudes about interprofessional collaboration between dental and NP students. Clinical rotations should be considered to enhance the scope of students' experiences with interprofessional patient care.