Nurses' and general practitioners' perspectives on oral health in primary care: a qualitative study

Introduction Integrating oral health into primary health care (PHC) is recommended, thereby ensuring comprehensive patient care. Primary care teams are well placed to promote and protect patients' oral health, and frequently see oral health-related complaints, and so need to be sufficiently knowledgeable to manage such presentations. There is limited local evidence to inform acceptable and feasible ways of integrating oral health into PHC in Aotearoa New Zealand. Aim To explore the views of doctors and nurses on the place of oral health, and how to improve its inclusion, in PHC. Methods Focus groups with nurses and doctors from six practices were conducted. Data were analysed thematically. Results Several factors influenced the inclusion of oral health in PHC and management of oral health presentations, at individual, professional and system levels: low oral health knowledge, skill and confidence in managing presentations, and lack of communication with local dental services (individual level); considering oral health as out-of-scope of practice, competing priorities, time constraints and ethical considerations (professional level); and lack of affordable and timely definitive oral health care and referral pathways (systems level). Suggestions to facilitate integration of oral health in PHC included information sessions on oral health, developing relationships with local dental professionals, and health system changes. Discussion Primary care practitioners are open to incorporating oral health into their practice; however, several barriers exist to do so sustainably. For effective integration, a series of individual-, professional- and system-level changes are likely required.