Oral health and COPD: a qualitative study exploring the knowledge, attitudes and practices of patients and primary healthcare professionals in São Paulo, Brazil
Problem
Poor oral health is associated with worse clinical outcomes in Chronic Obstructive Pulmonary Disease (COPD). This is of particular relevance to Brazil, where COPD is the third leading cause of death among adults and over 50% of 65-74-year-olds are edentulous, with the remainder having some degree of periodontal disease. To date, evidence exploring the attitudes of healthcare professionals (HCPs) towards delivering oral healthcare to COPD patients and the oral health views and practices of COPD patients is sparse. Therefore, this qualitative study aimed to investigate the knowledge, attitudes and practices of COPD patients and primary HCPs in Brazil, to provide information to design future care.
Approach
Semi-structured interviews with COPD patients (n=9) and three semi-structured focus groups with primary HCPs (n=25) were conducted in five primary care practices in São Paulo, Brazil, with the aid of a local interpreter. Convenience sampling was used to recruit participants. Interviews were audio recorded, transcribed and analysed using an inductive approach with the Framework Method. Patient and HCP transcripts were coded separately by the lead researchers and circulated within the wider team. Differences of opinion in the analysis were discussed and resolved to limit any personal biases the researchers might have, and a final coding framework agreed for indexing the remaining transcripts. Data were then summarised and charted, with separate themes identified for each participant group. The patient and HCP themes were found to be very similar, after detailed comparison and discussion within the team, the themes for the two sets of data were then merged.
Findings
Despite a high prevalence of edentulism, patients viewed tooth loss and decay as a norm and neglected preventative oral health practices. Knowledge of the relationship between oral health and COPD was lacking among HCPs and patients, but all participants were receptive to oral health education. HCPs blamed patients for avoiding preventative opportunities, whilst patients discussed significant barriers to oral healthcare – including poor past experiences, cost and limited access to services. Practitioners identified the need for a COPD primary care pathway that integrates oral health protocols.
Consequences
This study emphasises that as part of COPD management, better information should be available to patients about oral health and its importance. For this to be accomplished, Brazil needs to expand the coverage of public dental services and allocate more public resources to fund facilities. Additionally, practitioners in the study requested training around COPD and oral health alongside new protocols that integrated medical and dental services. As suggested by the World Health Organisation, such inter-professional education should begin with students in training to develop a collaborative, practice-ready health workforce. Such education initiatives need support from a new national policy in Brazil, to help incorporate preventative oral health into COPD management.