Exploring the inclusion of dental providers on interprofessional healthcare teams treating patients with chronic obstructive pulmonary disease: a rapid review

Chronic obstructive pulmonary disease (COPD) is the third leading cause of death in the world. Emerging concepts like One Health, integrated models for COPD, and associations between oral and respiratory health are innovative ways to approach COPD treatment. This study explored contemporary evidence on the inclusion of dental providers on interprofessional healthcare teams treating patients with COPD. The first objective was to explore the current state of interprofessional care for COPD treatment, and the second objective was to explore dentistry used in interprofessional care scenarios. A rapid review was conducted from March–June 2020 using Scopus and PubMed. Upon assessing for duplication and relevance, 85 articles remained for Objective 1, and 194 for Objective 2. The literature strongly suggests that dental providers should be included on interprofessional healthcare teams to best approach COPD as a multi-morbid, chronic disease. The papers collected for review claim that educational and clinical hospital programs should implement interprofessional collaboration when treating chronic diseases. Healthcare teams can utilize the expertise of professionals outside the medical field to better understand their patients’ needs. Healthcare administration should consult a One Health framework when developing COPD treatment guidelines. These proposed recommendations are feasible and transferable to the Canadian healthcare system; however, it is anticipated that implementation will be gradual. The collaborative nature of a One Health approach exposes novel ways to develop treatment guidelines that effectively address the burden of COPD.

Methods
A rapid literature review was conducted from January through June 2020. Rapid reviews are a synthesis of the most current evidence in the literature by exercising elements of systematic reviews in a timely fashion to inform and support public health decision-making. Papers describing interprofessional care approaches to treat COPD were categorised as Objective 1, and interprofessional care approaches incorporating dentistry were categorised as Objective 2. We gathered papers based on each objective by following a sequence of steps: literature search, appraisal, synthesis, and analysis. Papers collected at each step were screened by all authors and reviewed by the senior author (SLS) to assess for bias and accuracy. The articles were analysed through a One Health framework, which focuses on the importance of comprehensive, holistic care. 

Literature search 

A literature search for each objective was conducted on PubMed and Scopus. Inclusion criteria included primary and secondary studies and practise guidelines published between January 2015-May 2020 in either Canada or the United States. Given the nature of a rapid review and the relatively novel topic of this paper, any range shorter than five years may not have produced many results. Papers were excluded if they did not mention any keywords in the title or abstract, were not written in English, were not accessible electronically, were not available in full text, were classified as grey literature, and were not final publications. Search query strings and collected articles were documented on a Microsoft Excel document and Mendeley citation management software. Duplicate papers were removed. For the remaining articles, titles and abstracts were assessed for eligibility by the lead author (NIN), which included whether the paper aligned with the aim of this study or not. The literature search step is summarized in Figure 1. Search query strings for Objectives 1 and 2 are shown in Table 1. The last search was run on the databases on May 1st, 2020.

Appraisal

Appraisal checklists specific to each article type were used from the Critical Appraisal Skills Program (CASP) developed by Oxford Centre for Triple Value Healthcare. Examples include checklists for systematic reviews, cohort studies, and qualitative studies. We used the CASP checklists to assess the quality of study methods to determine if the findings of the eligible articles are trustworthy and meaningful. Articles were examined in more detail during this step. As a result, 12 were removed for Objective 1 and 58 for Objective 2 because they did not align with inclusion or exclusion criteria, or the aim of this study. 

Synthesis

Relevant data from the appraised papers for each objective were extracted based on the aim(s), population/setting(s), methods, results, limitations, relevance to the aim, and applicability to the Canadian healthcare context. The co-authors established conclusions and recommendations for each objective by evaluating the commonalities and differences across the studies, weighting the results by their methodological quality, and assessing their relevance to One Health principles.

Analysis

These conclusions were then analysed for feasibility within the Canadian healthcare context using McMaster University’s Applicability and Transferability Tool. The tool is designed to capture important issues related to proposed policy or program interventions within a given healthcare context.