Variation in periodontal referral by general dental practitioners

Abstract

This study investigated the extent of and reasons for variation in the periodontal referral patterns of general dental practitioners in Northern Ireland. A questionnaire was circulated to all general dental practitioners in Northern Ireland. This questionnaire investigated the management of periodontal disease in the general dental service and referral for specialist periodontal advice and treatment. A usable return was made by 355 (68%) of those surveyed. The mean number of periodontal referrals by each respondent in the past year was 6.5 (SD 7.7), range 0 to 80. Backward stepwise logistic regression analysis indicated that independent predictors of high referral rate were practice location close to the referral centre (p<0.0001); dissatisfaction with ability to treat periodontal disease under the National Health Service (p=0.001); that previous refusals of referral had not dissuaded a dentist from continuing to offer referral (p=0.002); not offering root planing as a treatment (p=0.005); and perceived inadequate postgraduate education in periodontology (p=0.03). It is concluded that considerable variation exists between general dental practitioners working in Northern Ireland in relation to the referral of patients for specialist periodontal advice and treatment. It is further concluded that in many cases non-disease factors, such as the accessibility of the specialist service, have powerful effects on the decisions made by dentists and patients in relation to periodontal referral.

Attitudes regarding specialist referrals in periodontics

“…2,7 Our results appear to reinforce this phenomenon and confi rm the demand for local specialist referral services in periodontics. 5,12 They also suggest that information regarding existing referral services should be more effectively disseminated.…”

“…2,7,14 Poor communication between primary and secondary care providers was an issue, even if GDPs were satisfi ed with the treatment provided. The reputation and ability of specialists are valued highly by GDPs, but it was widely felt that patients would perceive the academic status of specialists to be of greater signifi cance.…”

“…This was attributed to the complexity of the NHS Previous research has highlighted that the current NHS fee structure is perceived not to reward complex treatment. 2,9 Even in the management of mild chronic periodontitis, research has shown that many GDPs felt unable to allocate the time they believed was necessary, due to hopelessly inadequate NHS fees for such patients. 10 As a result, it would appear that periodontal diseases are being under-managed within primary care dentistry.…”

“…Most studies have examined the characteristics of patients referred to specialist clinics rather than the actual referral process. 2 Earlier research into specialist referrals in dentistry has generally been conducted from a secondary care perspective. [3][4][5][6] Much of this work consists of simple cross-sectional studies of referrals to consultants in restorative dentistry.…”

Referral for secondary restorative dental care in rural and urban areas of Scotland: findings from the Highlands & Islands Teledentistry Project

“…2 Earlier studies have considered the demographic factors and treatment needs of patients attending a particular receiving centre. [3][4][5] Latterly concern has moved towards issues concerned with general dental practitioners' referral practise [6][7][8][9][10][11] and their opinions of their secondary referral service. 2 A concern in the NHS at present is the need to provide better, fairer access to services.…”