Stuck in the Middle: Navigating the Primary Care/Specialist Interface

Objectives: Background:
There is a paucity of evidence researching the interface between primary dental care and specialist dental services compared to medical care. This abstract reports a qualitative exploration of this interface applied to children with cleft lip and/or palate (CLP).
Children with CLP are high risk of developing caries. In the United Kingdom (UK), the National Health Service (NHS), reports an expectation that dental care is 'shared' between primary care dentists and specialist paediatric dentists in the Cleft service, this arrangement has never been formally defined and children with cleft and their parents report that they feel 'stuck in the middle' between both teams.

Objectives:
To identify enabling factors and barriers to the provision of dental care between general and specialist dental teams.
Methods: Semi-structured interviews were undertaken with primary care based dentists and specialist paediatric dentists working in a cleft unit. The interviews were conducted online or face-to-face using a topic guide developed with Patient and Public Involvement (PPI). Transcripts were doubled-coded and analysed using thematic approaches, based in constant comparison methods derived from grounded theory, a reflexive interview log was maintained during the study. PPI contributors aided in the study development and data analysis.
Results: The study included (n = 8) primary care dentists and (n = 7) specialist paediatric dentists working in the UK. Enabling factors included a dual emphasis on the importance of preventative interventions and a common knowledge regarding the high risk status of this group. Findings related to barriers included the referral process, communication between clinicians and variation in role expectation.
Conclusions: There is evidence of a shared common goal in achieving oral health stability in this priority group, but there is a gap between skill perception and corresponding roles. Future co-designed research should be undertaken to establish and formalise this shared care arrangement.