Position Statement – Interprofessional collaborative practice Interprofessional collaborative practices Endorsed November 2023 Page 1 of 5 EXECUTIVE SUMMARY ADAQ recognises the value of collaborative practices in primary care. We commit to support members in fostering interprofessional collaboration and agility in their own areas of practice. We commend the Australian Health Practitioner Regulation Agency Board (Ahpra)’s Accreditation Committee for their decision to embed interprofessional collaborative practice (IPCP) goals for health professions in the future. When barriers are sufficiently lowered, interprofessional collaboration greatly benefits patient outcomes and positively impacts public health expenditure. It also has the potential to increase the level of trust other health professions and health consumers place in the expertise and skills of Queensland dentists and their teams. As the most decentralised state in Australia, Queensland needs more collaborative programs that integrate oral health screening and literacy within chronic disease management, mental health, geriatric and palliative care, and pre-natal care. A future common education framework at undergraduate level is desirable for medical and dental pathways, to develop better baseline competencies for interprofessional work in the health sector. Health professionals’ organisations can work together now to create referral networks, co-design patient education, and facilitate collaborative CPD opportunities for up-skilling existing practitioners. STRATEGIC ALIGNMENT Building and developing effective relationships. Support members to deliver high quality care to their patients and communities. ADA Inc. corresponding Policy Statements: 3.16 - Collaborative Practice; 3.12 – Benefits of Defined Health Professions. CONTEXT As per Ministerial Council Policy Direction 2020-1 , Ahpra established an Accreditation Committee (the Committee) to provide independent and expert advice on accreditation matters. The Committee included IPCP within the 16 professions regulated by the National Registration and Accreditation Scheme in its priority workplan. A Statement of Intent on IPCP is currently open for comment (August 2023) to gather support. IPCP aims to provide effective, culturally safe, person-centred care through active collaboration across the health workforce. IPCP has been tested in hospital and primary care settings with positive results. In Australia, within Community Controlled Health Services (CCHS), an interprofessional system of care has been used successfully in primary care settings, to deliver integrated health and social support services in a culturally responsive way for First Nations. An example is the Institute for Urban Indigenous Health (IUIH) Network in Southeast Position Statement – Interprofessional collaborative practice Interprofessional collaborative practices Endorsed November 2023 Page 2 of 5 Queensland. 1 IUIH was also involved in facilitating interprofessional education experiences for future health practitioners through a collaboration with the University of Queensland. In the UK, Canada and the United States, examples of collaborative programs that integrate chronic disease or pre-natal care with oral health care and patient education have been trialled successfully 2 IPCP benefits 3 identified include: Better patient outcomes: curb incidence of avoidable adverse events. This is especially true for geriatric patients and those who deal with systemic conditions, such as diabetes. Increased team morale, and boost to practitioner confidence and knowledge. Potential to clarify scope of practice in some areas and cater for changing needs of health services, including role redefinitions. Lower overall health costs and less gaps in service provision, especially for rural and remote populations. IPCP unifies public health budget and can reduce the incidence of preventable hospitalisations due to oral health issues. Barriers to effective IPCP 4 include: Issues with consent to discuss patient care across multiple practices and professions. Professional liability and insurance (medical vs dental) issues when overarching responsibilities for patient care is potentially unclear. Outdated legislation and structural segmentation in state and federal healthcare delivery systems. Records management and additional data privacy challenges. Dynamics between health professionals. Difficulties with switching from ‘volume to value’ 5 service provision Discrepancies with patient/carer’s perception of health need 6 In many countries, including Australia, peculiarities in the history of professional dentistry have led to a disjointed approach to patient care, where ‘care of the mouth is seen as separate from the body’. 1 Turner et al., 2019. 2 For example, Linebarger et al; 2021; Cardenas et al., 2023; Vernon et al.; 2021; Adeniyi et al. 2021; Regan et al; 2015 3 Harnagea et al, 2017 4 Regan et al. 2015 and Harnagea et al, 2017. 5 See for example: Queensland Clinical Senate Meeting Report March 2016: Value-based healthcare – shifting from volume to value : https://www.health.qld.gov.au/__data/assets/pdf_file/0028/442693/qcs-meeting- report-201603.pdf 6 Dolce et al., 2020. Position Statement – Interprofessional collaborative practice Interprofessional collaborative practices Endorsed November 2023 Page 3 of 5 Today, dental professionals should be working within an interprofessional system of care, for chronic disease management, geriatric care, mental health and palliative care. Dental professionals can leverage their unique expertise in oral health and benefit of the opportunity to expand their own systemic health literacy. IPCP benefits dental patients in many ways, through safer prescribing, better approaches to pain management and dental anxiety. The concept of interprofessional collaboration goes beyond systems of care delivery to include strategies for knowledge integration 7 and improving patients and carers’ health literacy. 8 As in other settings, the recent COVID-19 pandemic has dramatically expanded the value of interprofessional agility and integration in healthcare for emergency response. The potential for dentists to contribute more widely to medical efforts during national crises or widespread emergencies has been highlighted 9 Early undergraduate communal training has been suggested as a future baseline for health professionals, with subsequent choice of specialised clinical training in medicine or dentistry. STATEMENT • ADAQ recognises the value of collaborative and coordinated practice to harmonise the work of regulated health professionals in primary care settings, for improved service delivery. Oral health should be integrated within primary care 10 . IPCP is an opportunity to overcome the historical compartmentalisation of dental and medical care, which has no place in a modern, patient-centred health system ( return the mouth to the body ). • ADAQ believes that IPCP approaches embedded in primary care can help reduce the oral health access gap in Queensland by leveraging patient’s relationship with their GP or allied health practitioners for basic risk assessments, preventative services, and education 11 Coordination and integration of services through new technologies and telehealth are essential. • A legislative mandate for IPCP should exist, which is clear in expectations and allocates sufficient funding for training and implementation to ensure benefits are maximised and barriers lowered from the beginning. 7 For example, the dental team can provide crucial support for eating disorders/disordered eating behaviours, including early referral. See for example ADA’s resources here: https://ada.org.au/ADA/media/Teeth_org_au/files/ADA2022- Factsheet-Eating-Disorders-talking-to-your-dentist.pdf and the NEDC Resources for dentists and patients on eating disorders: https://nedc.com.au/assets/NEDC-Resources/Dentistry-and-eating-disorders.pdf 8 An example of this is the European ADEA diabetes pathway. Poignantly, these resources do not include dentists in the care pathways! https://www.adea.com.au/resources/diabetes-care-pathways/ 9 See for example: Sacoor et al., 2020 10 FDI, 2015. 11 Hummel et al., 2015. Position Statement – Interprofessional collaborative practice Interprofessional collaborative practices Endorsed November 2023 Page 4 of 5 • ADAQ commits to supporting its members to foster IPCP in their area of practice, and to working with other professional bodies, state government and public health agencies to: design primary care protocols and pathways that include the perspective of dental professionals, create opportunities for interprofessional continuing education, and explore ways to minimise existing barriers to effective IPCP in Queensland. • ADAQ advocates for the creation of IPCP pathways and guidelines, that include dental professionals, starting with the most needed: for example, patients living with chronic disease and cancer, geriatrics and pre-natal care, and other complex needs. 12 • IPCP frameworks should not see the dental team as a mere extension of the wider medical team. However, co-location of dental and medical services, or integrating dental hygienists in medical practices may be advantageous for patients in some settings. • A common framework to develop baseline competencies for IPCP should be developed at undergraduate level in all health professions and delivered through redesigned curricula. This is important to bridge knowledge gaps and foster understanding of IPCP environments and scopes of practice. Universities should fund and support mandatory opportunities for students in medical schools to collaborate with dental students and vice versa. Such opportunities could take the form of realistic care-based parallel learning activities, and flexible elective subject choices across disciplines. Non-clinical learning including developing communication style and teamwork is also crucial. TERMINOLOGY Primary care : dentistry, medicine, midwifery, nursing, nutrition, occupational therapy, pharmacy, physical education, physiotherapy, psychology, social work, and speech therapy. Interprofessional collaborative practice (IPCP): healthcare practices where health workers from different professional backgrounds align and coordinate their work with patients, carers, and communities to deliver high quality and ethical care that is culturally safe 13 Interprofessional education (IPE) : experiences that occur when students from two or more professions learn about, from, and with, each other 14 12 See for example, the British Society of Periodontology and Implant Dentistry campaign on the link between gum disease and diabetes: https://www.bsperio.org.uk/patients/gum-disease-and-diabetes. 13 WHO, 2010. 14 WHO, 2010. ADAQ acknowledges the Traditional Owners across Australia and their continuing connection to land, sea, and community. We pay respect to First Nations’ Peoples and their Elders, past, present, and emerging. Position Statement – Interprofessional collaborative practice Interprofessional collaborative practices Endorsed November 2023 Page 5 of 5 CONTACTS For queries relating to this Position Statement, please contact us: adaq@adaq.com.au or 07 3252 9866. REFERENCES & BIBLIOGRAPHY Bogossian, F. (2022). Learning together to work together. Best practice framework for interprofessional education for health disciplines . University of the Sunshine Coast. https://doi.org/10.25907/00141 FDI World Dental Federation (2015) Optimal Oral Health through Inter-Professional Education and Collaborative Practice. Cardenas K, Weilnau T, Aguilar C, et al. Partnering for Integrated Care: A Learning Collaborative for Primary Care and Oral Health Teams. Ann Fam Med. 2023;21 (Suppl 2): S22-S30. Dolce, MC, Barrow, J, Jivraj, A, Pham, D, Da Silva, JD. Interprofessional value-based health care: Nurse practitioner-dentist model. J Public Health Dent. 2020; 80: S44– S49. https://doi.org/10.1111/jphd.12419 Dolce MC, Parker JL, Marshall C, et al. Expanding collaborative boundaries in nursing education and practice: The nurse practitioner-dentist model for primary care. J Prof Nurs. 2017;33 (6) :405-409. Geurs NC, Jeffcoat MK, Tanna N, et al. A Randomized Controlled Clinical Trial of Prenatal Oral Hygiene Education in Pregnancy-Associated Gingivitis. J Midwifery Womens Health. 2023. Gilbert, J. (2018b). Enhancing patient safety – the relationship between IPE/IPCP and patient safety . Paper presented at the Securing an interprofessional future for Australian health professional education and practice, University of Technology, Sydney. Harnagea H, Couturier Y, Shrivastava R, Girard F, Lamothe L, Bedos CP, Emami E. Barriers and facilitators in the integration of oral health into primary care: a scoping review. BMJ Open . 2017 Sep 25;7(9):e016078. doi: 10.1136/bmjopen-2017-016078. PMID: 28951405; PMCID: PMC5623507. Hummel J., Phillips KE. Holt B, Hayes C. Oral Health: An Essential Component of Primary Care . Seattle, WA: Quallis Health. 2015. [white paper] Johnson, K.L., Fuji, K.T., Franco, J., Castillo, S., O'Brien, K.K., & Begley, K.J. (2018). A Pharmacist's Role in a Dental Clinic: Establishing a Collaborative and Interprofessional Education Site. Innovations in Pharmacy, 9 Monash University. (2017). Collaborative Care Curriculum Framework Regan S, Orchard C, Khalili H, Brunton L, Leslie K. Legislating interprofessional collaboration: a policy analysis of health professions regulatory legislation in Ontario, Canada. J Interprof Care 1-6. 2015. DOI 10.2109/13561820.2014.1002907. Sacoor S, Chana S, Fortune F. The dental team as part of the medical workforce during national and global crises. Br Dent J . 2020 Jul;229(2):89-92. doi: 10.1038/s41415-020-1854-6. PMID: 32710053; PMCID: PMC7380139. Ticku S, Savageau JA, Riedy CA, Harvan RA, Silk H. 100 Million Mouths Campaign: Creating a Pilot Program to Advance Oral Health Equity. Ann Fam Med. 2023;21 (Suppl 2): S86-S91. Turner Lyle, Albers Tim, Carson Adrian, Nelson Carmel, Brown Renee, Serghi Marianna (2019) Building a regional health ecosystem: a case study of the Institute for Urban Indigenous Health and its System of Care. Australian Journal of Primary Health 25, 424-429 https://doi.org/10.1071/PY19038 Valle-Oseguera, C. S., & Boyce, E. G. (2015). Dentists and pharmacists: paradigm shift and interprofessional collaborative practice models. Journal of the California Dental Association, 43(10), 591–595. https://scholarlycommons.pacific.edu/phs-facarticles/265 Vieira CL, Caramelli B. The history of dentistry and medicine relationship: Could the mouth finally return to the body? Oral Dis 2009;15(8):538–46. doi: 10.1111/j.1601-0825.2009.01589. x. WHO World Health Organisation (2010). Framework for action on interprofessional education and collaborative practice. Retrieved from http://who.int/hrh/