Better Together: How Interprofessional Learning and Practice Benefits Patients

In medical school, Anthony Marchlewski, MD, didn’t learn much about oral health. But as a resident at ProHealth Care, a community-based health care system in Waukesha County, Wisconsin, he had the chance to dive into the world of dentistry. 

He participated in a two-week rotation with Community Smiles Dental, a nonprofit safety-net organization located in the same building as a ProHealth Care clinic. During the rotation, residents shadow the dental providers, participate in dental exams, and learn how to ask basic dental triage questions. 

“Probably the biggest advantage is being able to pull back that curtain and getting a better idea of exactly what the colleagues you’re referring people to are actually doing,” Dr. Marchlewski says of the invaluable experience. 

He vividly recalls the “hands-on experiences, seeing dental abscesses, and seeing tooth removal.” And since completing the rotation, Dr. Marchlewski has consistently applied what he learned in his day-to-day practice. 

“I’m better able to understand what [dentists] are capable of doing and what questions to ask,” he says. “And I can counsel patients better on what to expect and make them better prepared or less nervous about it.” 

This partnership is just one example of what’s known as interprofessional practice (IPP). According to the World Health Organization (WHO), IPP refers to clinical care in which “multiple health workers from different professional backgrounds provide comprehensive services by working with patients, their families, carers, and communities to deliver the highest quality of care across settings.” 

Interprofessional education (IPE), in which students from various health care disciplines learn to deliver collaborative care, provides an essential foundation for IPP. Both have gained traction in recent years — as showcased in CareQuest Institute’s latest white papers — which is critical to providing whole-person, integrated care. 

Connecting Oral Health and Systemic Health 

Oral health and systemic health are deeply interconnected across the lifespan. For example: 

• Periodontal disease in pregnant people is associated with preterm births and low birth weights.
• Frequent consumption of sugar-sweetened drinks raises the risk of both obesity and tooth decay among children and adults.
• Improving oral hygiene among medically fragile seniors can reduce rates of hospital-acquired pneumonia. 

When health care providers from multiple professions collaborate, they can bridge the gap between the mouth and the body, offering care that improves patient outcomes, strengthens chronic disease management, and advances public health. IPP is one aspect of a broader medical-dental integration that aims to treat the whole person. 

The two CareQuest Institute white papers capture examples and perspectives from providers who are focused on providing that whole person care every day. 

“Efforts to break down professional silos and increase interprofessional practice have enabled us to remove barriers to care, meet our patients where they are, and provide a higher quality of care and patient experience,” says Christopher Brendemuhl, DMD, CDIPC, at Valleywise Health in Maricopa County, Arizona. 

Moving Dental Care Out of Its Silo

Historically, dental care has been separate from other health disciplines, with dentists’ offices siloed from the broader health care system. This isolation was reinforced by structural factors such as separate medical and dental insurance, electronic health records (EHRs) that did not communicate across professions, and a dearth of interprofessional training. 

In the mid-20th century, however, understanding of the links between oral health and systemic health deepened. The American Dental Association (ADA) and other dental organizations began to promote the idea that oral health was essential to overall health. The natural next step was to integrate medical and dental care. 

Today, interprofessional collaboration links oral health care with multiple different types of other health care professions. (You can read about several examples below and in the newest CareQuest Institute white paper.) Even more promising, virtually all oral health education programs engage in IPE activities. In fact, the Commission on Dental Accreditation (CODA) requires dental and dental hygiene programs to integrate IPE into their curricula to ensure that students graduate with the ability to collaborate effectively within health care teams. 

Implementing Interprofessional Care

Care teams are already providing interdisciplinary, collaborative care in a wide variety of settings. Here are some examples from the white papers of how IPP is already benefiting patients: 

• At federally qualified health centers (FQHCs), primary care physicians and other non-dental health professionals provide oral health screenings, fluoride varnish, and referrals to dental providers.
• Integrated school-based health centers deliver preventive dental services such as oral health screenings and referrals, application of fluoride varnish and sealants, as well as primary care services, behavioral health services, and nutrition counseling.
• At long-term care facilities, oral health care providers work alongside facility staff to deliver care to older adults and/or adults with disabilities.
• Mobile integrated care clinics deliver comprehensive care, including oral health care, primary care, vaccinations, and other screenings, to rural communities using mobile health equipment. 

Although all patients can benefit from IPP, it can be particularly critical for individuals with intellectual and developmental disabilities and those who experience dental anxiety. For these patients, behavioral and oral health providers can collaborate on strategies to dramatically improve access to care and patient comfort. 

Obstacles and Opportunities in Practice 

Despite remarkable progress, barriers remain to expanding IPP to its full potential. These barriers include: 

• Fragmented financing structures, especially the separation of dental and medical insurance
• Incompatible billing systems
• Non-integrated EHRs
• Limited interprofessional training 

However, there is strong momentum for change. There has been a move toward shared EHRs and co-located, aligned workflows, which are facilitating integration. For example, the Mayo Clinic Health System (MCHS) represents a pioneering model of integrated health care. Established in 2019 through a collaboration with Minnesota State University (MSU), Mankato, MCHS brings together dental professionals, primary care physicians, and pediatric health specialists under one roof. At the center of the MCHS model is a multidisciplinary team of dental, medical, and pediatric professionals working collaboratively to provide seamless, patient-centered care. A shared EHR system ensures that all providers can access the most current patient information, including clinical notes, labs, and treatment plans. 

Innovative models such as Medicaid pay-for-quality programs, accountable care organizations (ACOs), and targeted grants have shown that integrated care can improve outcomes and lower costs. 

All of this incentivizes further progress in IPP. 

“The integration of oral health into IPP is not just a logistical step,” Fábio Renato Manzolli Leite, DDS, MS, PhD, notes in the paper. “It is a change in thinking that redefines how we view and deliver holistic care.” 

With a continued focus on IPP and IPE, health care organizations, educational institutions, and policymakers can bring us closer to a system that works for everyone — a system that serves the whole person. 

“All the different specialties are all connected to the same person, and they definitely play off each other,” says Dr. Marchlewski. “Interprofessional practice has given me a better idea of how each system works, which will help us address problems promptly and appropriately.”