Dental providers and pharmacists: a call for enhanced interprofessional collaboration

Evaluating an interprofessional pharmacy and dental hygiene case-based learning activity with student reflections

BACKGROUND AND PURPOSE

Interprofessional collaboration between dentistry and pharmacy has great value but is often lacking in didactic and experiential education, particularly in dental hygiene programs.

EDUCATIONAL ACTIVITY AND SETTING

A case-based interprofessional assignment was implemented into the dental hygiene curriculum. Students reflected on their experiences and completed the International Collaborative Competencies Attainment Survey (ICCAS) to assess changes in self-reported interprofessional competencies following the activity.

FINDINGS

Reflections revealed knowledge gain themes, with medication-related oral health concerns most frequent (53), followed by systemic adverse effects of medications (31), impact of systemic health on oral health (21), drug-drug interactions (17), and drug information (2). Additionally, students identified both future plans to collaborate with a pharmacist (25) and application of clinical knowledge gained (25). Scores from the ICCAS increased significantly in most of the domain statements following the interprofessional activity.

DISCUSSION

This interprofessional education (IPE) activity increased student knowledge of the pharmacy profession and provided an experience with interprofessional communication. Students identified the impact of medications on oral health, as well as the value of interprofessional collaboration and communication.

SUMMARY

This IPE activity positively impacted student perceptions of interprofessional collaboration with pharmacists.

The Effectiveness of Family Medicine-Driven Interprofessional Collaboration on the Readmission Rate of Older Patients

Interprofessional collaboration (IPC) for older patient care among family physicians, dentists, therapists, nutritionists, nurses, and pharmacists in the rural hospital care of older patients could improve the hospital readmission rate. However, there is a lack of interventional studies on IPC for improving the readmission rate among Japanese older patients in rural hospitals. This quasi-experimental study was performed on patients >65 years who were discharged from a rural community hospital. The intervention was IPC implementation with effective information sharing and comprehensive management of older patients’ conditions for effective discharge and readmission prevention; implementation started on 1 April 2021. The study lasted 2 years, from 1 April 2021 to 31 March 2022 for the intervention group and from 1 April 2020 to 31 March 2021 for the comparison group. The average participant age was 79.86 (standard deviation = 15.38) years and the proportion of men was 45.0%. The Cox hazard model revealed that IPC intervention could reduce the readmission rate after adjustment for sex, serum albumin, polypharmacy, dependent condition, and Charlson Comorbidity Index score (hazard ratio = 0.66, 95% confidence interval: 0.54−0.81). Rural IPC intervention can improve inpatient care for older patients and decrease readmission rates. Thus, for effective rural IPC interventions, family physicians in hospitals should proactively collaborate with various medical professionals to improve inpatient health outcomes.

The impact of clinical pharmacist-physician communication on reducing drug-related problems: a mixed study design in a tertiary teaching Hospital in Xinjiang, China

BACKGROUND

The incidence of drug-related problems (DRPs) has caused serious health hazards and economic burdens among polymedicine patients. Effective communication between clinical pharmacists and physicians has a significant impact on reducing DRPs, but the evidence is poor. This study aimed to explore the impact of communication between clinical pharmacists and physicians on reducing DRPs.

METHODS

A semistructured interview was conducted to explore the communication mode between clinical pharmacists and physicians based on the interprofessional approach of the shared decision-making model and relational coordination theory. A randomized controlled trial (RCT) was used to explore the effects of communication intervention on reducing DRPs. Logistic regression analysis was used to identify the influencing factors of communication.

RESULTS

The mode of communication is driven by clinical pharmacists between clinical pharmacists and physicians and selectively based on different DRP types. Normally, the communication contents only cover two (33.8%) types of DRP contents or fewer (35.1%). The communication time averaged 5.8 minutes. The communication way is predominantly face-to-face (91.3%), but telephone or other online means (such as WeChat) may be preferred for urgent tasks or long physical distances. Among the 367 participants, 44 patients had DRPs. The RCT results indicated a significant difference in DRP incidence between the control group and the intervention group after the communication intervention (p = 0.02), and the incidence of DRPs in the intervention group was significantly reduced (15.6% vs. 0.07%). Regression analysis showed that communication time had a negative impact on DRP incidence (OR = 13.22, p < 0.001).

CONCLUSION

The communication mode based on the interprofessional approach of the shared decision-making between clinical pharmacists and physicians in medication decision-making could significantly reduce the incidence of DRPs, and the length of communication time is a significant factor. The longer the communication time is, the fewer DRPs that occur.

TRIAL REGISTRATION

This trial was approved by the ethics committee of The First Affiliated Hospital of Medical College of Xinjiang Shihezi University Hospital (kj2020-087-03) and registered in the China clinical trial registry (https://www.chictr.org.cn , number ChiCTR2000035321 date: 08/08/2020).

Changes in Dentists' Prescribing Patterns in Norway 2005-2015

BACKGROUND

There is scant knowledge of dentists' total prescribing patterns, and little is published on this internationally. The Norwegian Prescription Database (NorPD) includes data on all dispensed prescription medication in Norway from 2004 and can be used to investigate how dentists' prescribing has changed over time. There are few Norwegian guidelines supporting dentists' prescribing, and Norwegian legislation on dentists' prescribing rights leaves room for interpretation. The aim of this study was therefore to give an overview of all prescribing from dentists in Norway in the period 2005 to 2015 and to identify trends in their prescribing pattern over this time span. We also give characteristics of the prescribing dentists.

METHODS

The study had a retrospective pharmacoepidemiologic design. Data on all medication prescribed by dentists and dispensed from Norwegian pharmacies in the time period 2005 to 2015 were extracted from the NorPD. Changes over time in the prescribers, patients, and medications are reported.

RESULTS

There was an increase of 50% in total number of prescriptions from dentists in Norway from 2005 to 2015; adjusted for the growth in population, there was a 33% increase. The majority of prescriptions from dentists were for antibiotics and analgesics; however, the data reveal that the dentists prescribed from all major therapeutic groups. Dentists increased antibiotic prescribing in a period when total antibiotic prescribing in Norway decreased.

CONCLUSIONS

Our study finds antibiotics and analgesics dominate prescriptions from Norwegian dentists and shows an increase in use over time. It highlights the need for creating evidence-based prescribing guidelines for dentists and for ensuring that existing guidelines are implemented.

Pharmacy participation in dental and oral health care: a scoping review protocol

OBJECTIVE

The aim of the review is to identify and describe the characteristics and associated outcomes of dental and oral health advice and support provided by members of the pharmacy profession. Research exploring the role, attitudes, and knowledge of pharmacists, pharmacy students, and support staff relating to dental and oral health care, as well as stakeholder perceptions, will also be examined.

INTRODUCTION

With the increasing prevalence of dental and oral health disorders and resource constraints within health care systems, other avenues for oral health promotion and care provision are warranted. Pharmacists, as primary care professionals working across various practice settings, could play a significant role in promoting good oral health. Yet, there is limited insight about the role, attitudes, and knowledge of members of the pharmacy profession towards dental and oral health care, as well as what stakeholders, such as consumers and other health care professionals, think about their role in this context.

INCLUSION CRITERIA

Any full-text publication that describes outcomes related to pharmacist, pharmacy assistant, or student involvement, knowledge, or attitudes towards dental or oral health care in any setting, and stakeholder perspectives of this role, will be included. Reviews, protocols, and commentaries will be excluded, as will studies specifically focused on smoking cessation or that do not describe the related health promotion activity.

METHODS

Articles published in English will be sought from health and educational databases with no date restrictions, with additional references identified via snowballing using citations and reference lists. Data searching and screening processes will follow JBI methodology, involving two independent reviewers, and data extraction presented in a narrative form.

Interprofessional education between dentistry and pharmacy students: delivery, barriers and facilitating implementation

Interprofessional education (IPE) between dentistry and pharmacy students is an approach to teach effective collaborative practice between a team of future health care providers. It relies on the support and motivation of students, staff and professionals to implement a variety of educational strategies and might involve evaluating student progression before and after delivery. Many barriers exist towards the implementation of IPE between dentistry and pharmacy health disciplines and outlining experiences across educational/clinical practice settings and possible solutions would assist in reducing those walls to realization. Implementation of IPE between pharmacy and dentistry undergraduate programs might lead to improved workplace collaborations and reduce medication errors, adverse events and increase in cross-referrals. Interprofessional education within undergraduate training forms the first steps towards reducing the burden on health care systems by enabling effective collaboration to improve patient outcomes. This narrative review describes IPE strategies used between pharmacy and dentistry undergraduate disciplines to enable collaboration, discusses the barriers and facilitators towards implementing IPE, and future directions for IPE education between these two disciplines.

Community Pharmacist's Role in Providing Oral Health-care Services: Findings from Malaysia

Introduction

Pharmacists have been well recognized as an active and have a more integrated role in the preventive services within the National Health Services. This study assessed the community pharmacists' attitudes, beliefs, and practices toward oral health in the Malaysian setting.

Materials and Methods

A cross-sectional survey-based study was used to conduct this project. An anonymous self-administered questionnaire was developed and distributed among community pharmacists within Kuala Lumpur and Selangor states areas, Malaysia. The data collection was carried out from the beginning of November to the end of December 2018.

Results

Of the 255 pharmacists, 206 agreed to participate in the study, yielding a response rate of 80.8%. Overall, approximately half of the pharmacists provided two to five oral health consultations per week and two to five over the counter (OTC) oral health products recommendations per week. The main services provided by community pharmacists in were the provision of OTC treatments (93.7%), referral of consumers to dental or medical practitioners when appropriate (82.5%), and identify signs and symptoms of oral health problems in patients (77.2%). In addition, more than 80% of the pharmacists viewed positively and supported integrating oral health promotion and preventive measures into their practices. The most commonly reported barriers to extending the roles of pharmacists in oral health care include lack of knowledge or training in this field, lack of training resources, and lack of oral health educational promotion materials.

Conclusion

The study shows that community pharmacists had been providing a certain level of oral health services and play an important role in oral health. The findings highlighted the need of an interprofessional partnership between the pharmacy professional bodies with Malaysian dental associations to develop, and evaluate evidence-based resources, guidelines, the scope of oral health in pharmacy curricula and services to deliver improved oral health care within Malaysian communities.

Analyzing Medication Documentation in Electronic Health Records: Dental Students' Self-Reported Behaviors and Charting Practices

The aim of this two-part study was to assess third- and fourth-year dental students' perceptions, self-reported behaviors, and actual charting practices regarding medication documentation in axiUm, the electronic health record (EHR) system. In part one of the study, in fall 2015, all 125 third- and 85 fourth-year dental students at one U.S. dental school were invited to complete a ten-item anonymous survey on medication history-taking. In part two of the study, the EHRs of 519 recent dental school patients were randomly chosen via axiUm query based on age >21 years and the presence of at least one documented medication. Documentation completeness was assessed per EHR and each medication based on proper medication name, classification, dose/frequency, indication, potential oral effects, and correct medication spelling. Consistency was evaluated by identifying the presence/absence of a medical reason for each medication. The survey response rate was 90.6% (N=187). In total, 64.5% of responding students reported that taking a complete medication history is important and useful in enhancing pharmacology knowledge; 90.4% perceived it helped improve their understanding of patients' medical conditions. The fourth-year students were more likely than the third-year students to value the latter (p=0.0236). Overall, 48.6% reported reviewing patient medications with clinic faculty 76-100% of the time. The respondents' most frequently cited perceived barriers to medication documentation were patients' not knowing their medications (68.5%) and, to a much lesser degree, axiUm limitations (14%). Proper medication name was most often recorded (93.6%), and potential oral effects were recorded the least (3.0%). Medication/medical condition consistency was 70.6%. In this study, most of the students perceived patient medication documentation as important; however, many did not appreciate the importance of all elements of a complete medication history, and complete medication documentation was low.

Assessment of knowledge, attitude and practice among community pharmacists towards dental care: A national cross sectional survey

Background

Community pharmacists' contribution in health maintenance and promotion is significant but more studies are still needed to evaluate their role as healthcare providers.

Objectives

Our primary objective was to assess knowledge, attitude, and practice among community pharmacists in Lebanon towards dental care. Secondary objectives included assessing the barriers to a good dental care practice and assess their educational needs for oral health counseling.

Methods

A national cross-sectional study was carried out using an online questionnaire and targeting community pharmacists in Lebanon. Five, three and six questions were used to assess pharmacists' perceived knowledge, attitude and practice respectively. Stepwise linear regressions were conducted taking each time a different scale score as the dependent variable.

Results

497 (78.88%) pharmacists completed the survey (62% females). More than half (53.3%) exhibited good perceived knowledge, 39% a positive attitude and 47.3% a good practice regarding oral health. Pharmacists reported a good perceived knowledge regarding common oral conditions (good, very good and excellent knowledge: 73.2%). Most of the pharmacists (86.52%) perceived oral health promotion as an important part of their services. Moreover, 28.77% (n = 143) of pharmacists declared having difficulties in obtaining oral health information. The main barriers to a good practice included limited interaction between dentists and pharmacists and lack of training regarding oral health. The multivariable analyses showed a significant positive intercorrelation between perceived knowledge, attitude and practice. Working in the pharmacy for more than 40 h a week was associated with higher perceived knowledge (Beta = 2.846). Having a PhD degree was associated with lower practice scores (Beta = 3.676), whereas female gender was associated with lower practice scores (Beta = 2.334).

Conclusions

Pharmacists have the overall required knowledge and attitude to play an important role in the patients' counseling towards dental care.

A Pharmacist's Role in a Dental Clinic: Establishing a Collaborative and Interprofessional Education Site

BACKGROUND

Dental patients often have comorbidities and take multiple medications, some of which could impact their dental health and treatment. A pharmacist in a dental clinic can assist with the gathering, documentation and evaluation of a dental patient's medication history as it pertains to their dental visit and overall health.

PURPOSE

To develop and implement a collaborative and interprofessional education program with a pharmacist providing services in a dental school clinic.

SUMMARY

Creighton University School of Dentistry, a student-operated dental clinic located in Omaha, Nebraska, provides dental care by student dentists, faculty and staff to the surrounding community in a learning-focused environment. A pharmacist was incorporated into the dental clinic to create and establish an interprofessional relationship with both dental students and faculty beginning August 2014. Pharmacy students on an ambulatory care advanced pharmacy practice experience rotation were eventually added to the team. The pharmacy team provided medication therapy management services including disease state and medication counseling, medication reconciliation, identifying drug-related problems and dental implications of medications, and recommendations for prescribed medications.

CONCLUSION

The pharmacy team's presence was largely accepted by dental faculty, staff, dental students, and patients. Pharmacists can play an important role in a dental clinic by performing thorough health and medication histories and communicating with dental and medical providers involved in a patient's care.