Non-Clinical Factors Associated With Referrals to Periodontal Specialists: A Systematic Review

• Autores: Jennifer Kraatz, Ha Hoang, Saso Ivanovski, Leonard A. Crocombe
• Localización: Journal of periodontology, ISSN 0022-3492, Vol. 88, Nº. 1, 2017, págs. 89-99
• Idioma: inglés
• Texto completo no disponible (Saber más ...)
• Resumen

  • Background: Comprehensive understanding of the referral process and factors associated with it will assist general dentist (GD)–periodontist relationships and benefit patient care and services. Non-clinical factors (NCFs) influence clinical decision making but are rarely considered. The objective of this review is to identify NCFs found to be associated with referrals to periodontal specialists.

    Methods: A systematic review of English-language literature was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. An electronic search was carried out using the Cumulative Index to Nursing and Allied Health Literature, Dentistry and Oral Sciences Sources, and PubMed. Search terms used included: 1) refer; 2) referral; 3) periodontal; and 4) periodontist. Potentially relevant publications were analyzed in detail using predetermined inclusion and exclusion criteria. Selected papers were assessed using the Mixed Methods Appraisal Tool, and data extracted were thematically synthesized.

    Results: Ten studies that examined NCFs fulfilled inclusion criteria. Four NCF themes identified were practice-, GD-, patient-, and periodontist-related factors.

    Conclusions: Limited literature is available on NCFs associated with referrals to periodontal specialists. Within the limits of this systematic review, NCFs affecting the referral process are practice-, GD-, patient-, and periodontist-related factors. These vary among different GD populations studied. Factors that could be targeted to improve referral processes include geographic location, undergraduate training, and continuing professional development.

    Periodontitis is defined as inflammation of gingival tissues in conjunction with pathologic detachment of collagen fibers from cementum, apical migration of surrounding junctional epithelium, and subsequent resorption of alveolar bone required for tooth support.1 The Council of Dental Education and Licensure, American Dental Association, Chicago, Illinois, defines periodontics as, “… prevention, diagnosis, and treatment of diseases of the supporting and surrounding tissues of teeth or their substitutes and the maintenance of the health, function and esthetics of these structures and tissues.”2 There is variation of documented periodontal disease (PD) prevalence,3,4 which can be affected by case definition and the population in question.3,4 There is inconsistency within the literature regarding provision of treatment and prevalence of disease within studied populations.3,5,6 For example, in a private practice population Oliver and Heuer5 found that ≈40% of diagnosed cases did not receive periodontal therapy (PT), suggesting under-treatment of PD.

    The general dentist (GD) is often first to diagnose PD and, therefore, plays a crucial role in detection and management of patients with PD.7 There are suggested guidelines outlining the role of periodontal specialists in management of patients with PD regarding diagnosis and patient risk factors.8 Aspects giving GDs a guide to which therapeutic decisions can be made include:9,10 1) evidence-based dentistry; 2) integration of appropriate research evidence; 3) patient preferences and views; and 4) clinical expertise.9 Considerable variation in periodontal referrals has been reported among populations,11 and perspectives of GDs and periodontal specialists differ with regard to factors that most significantly influence referrals.12 Referral patterns are based not solely on clinical factors (CFs) but also on non-clinical factors (NCFs) relating to: 1) patient;13-18 2) GD;11,13-20 3) practice demographics;13 4) level of GD training;11,14,15,19 5) feedback from patients;15 6) accessibility; 7) fees;14 and 8) working relationships with specialists.15,17 There is a gray area between what is considered clinical and non-clinical; for example, age of a patient may be considered a CF because of its association with physical ability or comorbidities, or a NCF due to difficulties with transportation or making follow-up appointments in the case of elderly patients.21 For the most effective treatment and management of PD, periodontists prefer their GD referral base to have sound understanding of when to appropriately refer,8 and this may be inhibited by NCFs associated with referrals to periodontists. This systematic review aims to identify NCFs reported in the literature associated with referrals to periodontists by GDs.