Bernstein Judith, Gebel Christina, Vargas Clemencia, Geltman Paul, Walter Ashley, Garcia Raul, Tinanoff Norman
Center for Research to Evaluate and Eliminate Dental Disparities, Boston University Henry M. Goldman School of Dental Medicine, Boston, Massachusetts, USA.
Department of Community Health Sciences, Boston University School of Public Health, Boston University, Boston, Massachusetts, USA.
BMJ Open. 2017 Mar 29;7(3):e014124. doi: 10.1136/bmjopen-2016-014124.
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.
Nurse managers (NMs), nurse practitioners (NPs), paediatric clinical staff and administrators in six FQHCs in two states were interviewed using a semistructured format.
Grounded theory research. Topics included feasibility of integration, perceived barriers and strategies for incorporating oral health into paediatric primary care.
Qualitative data were coded and analysed using NVivo 10 to generate themes iteratively.
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.
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.
探讨跨专业协作（IPC）在联邦合格健康中心（FQHC）改善儿童口腔健康的机会，确定由IPC主导将口腔健康预防纳入儿童健康检查的挑战，并提出克服障碍的策略。
对两个州六家FQHC的护士经理（NM）、执业护士（NP）、儿科临床工作人员和管理人员进行了半结构化访谈。
扎根理论研究。主题包括整合的可行性、感知到的障碍以及将口腔健康纳入儿科初级保健的策略。
使用NVivo 10对定性数据进行编码和分析，以迭代生成主题。
不同角色的护士认识到口腔健康预防的重要性，但不知道将口腔健康纳入儿科诊疗的专业指南。他们重视协作护理，特别是内部沟通、联合倡议和培训，以及与牙科学院或社区牙科诊所合作。IPC的障碍包括培训不足、跨部门沟通机会少以及电子健康记录中缺乏图表模板。
护士经理、执业护士和儿科护理人员都重视IPC以改善患者的口腔健康，但受到口腔健康培训以及支持性图表和转诊系统缺乏的限制。在获得支持的情况下，他们愿意负责在儿童健康检查中引入口腔健康预防措施，但需要采用IPC方法进行培训和系统变革。如果有政策和行政支持，健康中心环境中的IPC团队可以共同努力，提供口腔健康评估、教育、涂氟和牙科转诊，降低幼儿龋齿患病率，并增加低收入儿童获得牙科之家服务的机会。
