Orthodontic referrals: why do GDPs get it wrong?

• Published in: British dental journal 2016-11, Vol.221 (9), p.583-587
• Main Authors: Reddy, S., Derringer, K. A., Rennie, L.
• Format: Article
• Language: English
• Subjects: 692/700/3032/3053; 692/700/3032/3145; Audit cycles; Audits; Clinics; Dental Caries; Dentistry; Dentists; Education; Humans; Medicine; Oral hygiene; Orthodontics; Patient satisfaction; Prospective Studies; Questionnaires; Referral and Consultation; Teaching
• ISSN: 0007-0610; 1476-5373
• DOI: 10.1038/sj.bdj.2016.826

Key Points Discusses the role and responsibility of GDPs in referring patients for orthodontic treatment to primary and secondary care. Highlights an audit aiming to identify causes of inappropriate orthodontic referrals by GDPs. Suggests the need for further education of GDPs and the implementation of improved guidelines and proformas to improve the referral process. Aim & objectives A clinical audit was carried out to assess suitability of orthodontic referrals at Kings College Hospital Orthodontic Department with the objective to investigate the reasons and seek solutions to inappropriate orthodontic referrals. Design and setting Prospective audits of consecutive new patient referrals to the King's College Hospital Orthodontic department diagnostic teaching clinics. Methodology Two hundred and twenty-eight patients referred to the orthodontic diagnostic teaching clinics over a 5-month period were assessed. Data were collected using a questionnaire, completed by the undergraduate dental student and checked by the supervising clinical teacher. A second audit cycle was carried using the same methods after implementation of an action plan devised for referral guidelines and pathway to be sent back to the referring practitioner. Results At the initial audit cycle, 37.2% of patients met the standards, dropping to 33.3% at second audit cycle demonstrating high levels of inappropriate referrals. Our results showed: poor use of IOTN, patients presenting with IOTN scores too low for treatment, poor oral hygiene and caries; patients presenting too early for treatment, adult patients; and incorrect referral pathway implementation. Targeted education of referring practitioners via referral guidelines were found ineffective. We suggest that other methods to improve the quality of referrals are required, such as proformas and improving education among the profession.