Implementing and evaluating a primary care service for oral surgery: a case study

Abstract

BackgroundA primary care oral surgery service was commissioned alongside an electronic referral management system in England, in response to rising demand for Oral Surgery services in secondary care. It is important to ensure that standards of quality and safety are similar to those in existing secondary care services, and that the new service is acceptable to stakeholders. The aim of this study is therefore to conduct an in depth case study to explore safety, quality, acceptability and implementation of the new service.MethodsThis case study draws on multiple sources of evidence to report on the commissioning process, implementation, treatment outcomes and acceptability to patients relating to a new oral surgery service in a primary care setting. A combination of audit data and interviews were analysed.ResultsMost referrals to the new service consisted of tooth extractions of appropriate complexity for the service. There were issues with lack of awareness of the new service in a primary care setting within referring primary care practices and patients at the start of implementation, however over time the service became a fully integrated part of the service landscape. Complications reported following surgery were low.ConclusionPatients liked the convenience of the new service in terms of shorter waiting time and geographical location and their patient reported experience measures and outcomes were similar to those reported in secondary care. Providing appropriate clinical governance was in place, oral surgery could safely be provided in a primary care setting for patients without complex medical needs. Attention needs to be paid to communication with general dental practices around changes to the service pathway during the early implementation period to ensure all patients can receive care in the most appropriate setting.

Oral surgery waiting lists at an Australian university dental school

“…22,23 This is evidence of an effective service. Also, most patients were seen for a consult and/or treatment in 1-2 weeks with 3.8% (n = 9) able to be treated on the same day of the referral (Table 2), which is another positive finding as it has been shown in the literature 24 that patients prefer shorter waiting times for appointments and generally to be assessed and treated at the same time when possible. Additionally, Tuominen and Eriksson 21 showed that those who had waited less than 3 months expressed less inconvenience than those that had waited for more than 3 months.…”

Satisfação dos pacientes com o atendimento odontológico

“…Quanto ao ano de publicação, os anos de 2019 6,8,11,16,21-27 e 2018 [28][29][30][31][32][33][34][35][36][37][38] tiveram o maior número de artigos, onze em cada ano; seguidos de 2015 com sete artigos publicados 14,[39][40][41][42][43][44] , 2020 com cinco [45][46][47][48][49] , 2017 com quatro 1-52 , 2010 [53][54][55] , 2012 [56][57][58] , 2014 2,59,60 e 2016 15,61,62 com três artigos cada; 2005 63,64 , 2011 65,66 e 2013 7,67 com dois artigos cada ano, e 2008 12 com apenas um artigo publicado.…”

“…No que se refere às abordagens metodológicas das pesquisas utilizadas, 51 estudos utilizaram abordagem metodológica quantitativa 1,6-8,11,15-16,21-31,34,36-57,59-63,65-67 , quatro estudos a abordagem metodológica qualitativa 12,35,58,64 e, nos outros dois estudos, abordagem mista (qualitativa e quantitativa) 32,33 . Dessa forma, a pesquisa com abordagem quantitativa foi mais frequente do que a qualitativa ou a mista, com predomínio de questionários estruturados e escalas.…”

An eReferral Management & Triage System for minor Oral surgery referrals from primary care dentists: a cost-effectiveness evaluation

“…It is possible that, by freeing up capacity at hospitals, the use of the e-referral system and triage may have reduced waiting times. There is evidence from interviews with referral patients in this triage system that some had perceived shorter waiting times and more choice in out of hours’ appointment times [ 9 ]. The system also provides transparent information on the flows of referrals through the healthcare system.…”

“…After excluding from the study practices that did not refer any patients, for example because they mainly use private oral surgeons who are not a part of the NHS system, the total number of practices available to contribute to the study was 27. Referrals could be directed for surgical treatment at one of the hospitals or from a specialist oral surgeon specialist operating at two primary dental service sites (further details of this specialist service can be found in a published case study) [ 9 ].…”