Uptake of best practice recommendations in the management of patients with diabetes and periodontitis: a cross-sectional survey of healthcare professionals in primary care

Objectives To investigate the practices of healthcare professionals in relation to best practice recommendations for the multidisciplinary management of people with diabetes and periodontitis, focusing on two clinical behaviours: informing patients about the links between diabetes and periodontitis, and suggesting patients with poorly controlled diabetes go for a dental check-up. Design Cross-sectional design utilising online questionnaires to assess self-reported performance and constructs from Social Cognitive Theory (SCT) and Normalisation Process Theory. Setting Primary care medical practices (n=37) in North East, North Cumbria and South West of England Clinical Research Networks. Participants 96 general practitioners (GPs), 48 nurses and 21 healthcare assistants (HCAs). Results Participants reported little to no informing patients about the links between diabetes and periodontitis or suggesting that they go for a dental check-up. Regarding future intent, both GPs (7.60 +/- 3.38) and nurses (7.94 +/- 3.69) scored significantly higher than HCAs (4.29 +/- 5.07) for SCT proximal goals (intention) in relation to informing patients about the links (p<0.01); and nurses (8.56 +/- 3.12) scored significantly higher than HCAs (5.14 +/- 5.04) for suggesting patients go for a dental check-up (p<0.001). All professional groups agreed on the potential value of both behaviours, and nurses scored significantly higher than GPs for legitimation (conforms to perception of job role) in relation to informing (nurses 4.16 +/- 0.71; GPs 3.77 +/- 0.76) and suggesting (nurses 4.13 +/- 0.66; GPs 3.75 +/- 0.83) (both p<0.01). The covariate background information (OR=2.81; p=0.03) was statistically significant for informing patients about the links. Conclusions Despite evidence-informed best practice recommendations, healthcare professionals currently report low levels of informing patients with diabetes about the links between diabetes and periodontitis and suggesting patients go for a dental check-up. However, healthcare professionals, particularly nurses, value these behaviours and consider them appropriate to their role. While knowledge of the evidence is important, future guidelines should consider different strategies to enable implementation of the delivery of healthcare interventions.