Implementing Clinical Practice Guidelines for Oral Care for (Frail) Older Patients: Facilitators, Barriers, and Recommendations.

INTRODUCTION

The Dutch organisation for the development of clinical practice guidelines (CPGs) in oral care known as the Kennisinstituut Mondzorg (KIMO) developed three CPGs to support professionals in oral care for (frail) older patients: (1) treatment of root caries, (2) xerostomia and hyposalivation related to medication and polypharmacy, and (3) oral care for homebound frail older adults. However, actual CPG use in practice is not guaranteed. This study aims to assess adherence to these CPGs among Dutch dentists, identify opportunities and barriers for implementation, and formulate recommendations for an effective implementation strategy.

METHODS

A modified two-round Delphi study investigated current practices and opinions of dentists; 260 dentists were invited to participate. For round one, an online survey was developed based on the KIMO CPG recommendations. Round two, informed by round one results, explored perceived facilitators, barriers, suggestions for adapting less-followed recommendations, and preferences regarding CPG information and accessibility.

RESULTS

In round one 41 dentists responded and in round two 44 responded. While the value of CPGs was acknowledged, adherence to several recommendations was limited due to practical barriers, such as time, equipment, training, and reimbursement. Further, communication with other healthcare providers was infrequent. Dentists preferred e-mail notifications and on-demand webinars. Digital availability via a website or app was favoured, though half still appreciate paper versions.

CONCLUSION

Practical barriers hinder the use of CPG recommendations in oral care for (frail) older patients. Involving clinicians in guideline development is essential to improve feasibility and implementation.