An audit of 600 referrals to a primary care based oral surgery service

Bell, Garmon W

doi:10.1038/bdj.2007.571

Cited by 22 publications

(21 citation statements)

References 30 publications

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“…The fi ndings are consistent with earlier research which reported satisfaction with oral surgery provided in primary care. 8,9 Bell 8 and Clark 9 cited various reasons for this, including a simplifi ed appointment process, shorter waiting times, familiarity and personal nature of the service and their geographical convenience, which are consistent with the fi ndings reported here. However, patient satisfaction surveys often report high levels of satisfaction, even when further investigation reveals dissatisfaction with aspects of a service.…”

Section: Resultssupporting

confidence: 83%

“…Although the proportion of each procedure undertaken differed, the case-mix and fi ndings are similar to those reported earlier. [7][8][9][10] Overall 12.7% patients did not attend appointments and 11.6% of those who attended were not treated after their initial appointment. Although the reasons for patients not proceeding to treatment were recorded (Table 1), nothing is known of the reasons for failed attendance.…”

Section: Discussionmentioning

confidence: 99%

“…In the light of earlier data, 8,21,22 postoperative review appointments were not routinely arranged. Only 12 (2.3%) patients attended with postoperative complications.…”

Section: Discussionmentioning

confidence: 99%

“…10 However, this study was undertaken under different contractual and remunerative arrangements. Previously, contractual constraints and lack of funding have been seen as barriers to providing such services in primary care, 8,9 potentially increasing the likelihood that specialist services would be restricted to the private healthcare market. As well as increasing patient costs this could also create inequity of access.…”

Section: Discussionmentioning

confidence: 99%

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Evaluation of an NHS practice-based minor oral surgery service

Dyer

Dhamija

2009

Br Dent J

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Section: Resultssupporting

confidence: 83%

Section: Discussionmentioning

confidence: 99%

“…In the light of earlier data, 8,21,22 postoperative review appointments were not routinely arranged. Only 12 (2.3%) patients attended with postoperative complications.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Evaluation of an NHS practice-based minor oral surgery service

Dyer

Dhamija

2009

Br Dent J

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“…Kendall provided one of two such descriptions of how a Level 2 provider might work 14 and this is described below, while Bell describes a retrospective audit of a primary care scheme designed to address issues in provision of services to remote areas. 16 Utilising two GDP practices in the Croydon area, combined with a simple referral management system, all non-urgent referrals for oral surgery procedures were captured and then subjected to a two-stage triage process. The first was an administrative check of the paper referral form and the second was a clinical assessment of a patient's suitability for primary care treatment.…”

Section: Primary Care (Level 2) Servicesmentioning

confidence: 99%

An evaluation of a referral management and triage system for oral surgery referrals from primary care dentists: a mixed-methods study

Goldthorpe

Walsh

Tickle

et al. 2018

Health Serv Deliv Res

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BackgroundOral surgery referrals from dentists are rising and putting increased pressure on finite hospital resources. It has been suggested that primary care specialist services can provide care for selected patients at reduced costs and similar levels of quality and patient satisfaction.Research questionsCan an electronic referral system with consultant- or peer-led triage effectively divert patients requiring oral surgery into primary care specialist settings safely, and at a reduced cost, without destabilising existing services?DesignA mixed-methods, interrupted time study (ITS) with adjunct diagnostic test accuracy assessment and health economic evaluation.SettingThe ITS was conducted in a geographically defined health economy with appropriate hospital services and no pre-existing referral management or primary care oral surgery service. Hospital services included a district general, a foundation trust and a dental hospital.ParticipantsPatients, carers, general and specialist dentists, consultants (both surgical and Dental Public Health), hospital managers, commissioners and dental educators contributed to the qualitative component of the work. Referrals from primary care dental practices for oral surgery procedures over a 3-year period were utilised for the quantitative and health economic evaluation.InterventionsA consultant- then practitioner-led triage system for oral surgery referrals embedded within an electronic referral system for oral surgery with an adjunct primary care service.Main outcome measuresDiagnostic test accuracy metrics for sensitivity and specificity were calculated. Total referrals, numbers of referrals sent to primary care and the cost per referral are reported for the main intervention. Qualitative findings in relation to patient experience and whole-system impact are described.ResultsIn the diagnostic test accuracy study, remote triage was found to be highly specific (mean 88.4, confidence intervals 82.6 and 92.8) but with lower values for sensitivity. The implementation of the referral system and primary care service was uneventful. During consultant triage in the active phases of the study, 45% of referrals were diverted to primary care, and when general practitioner triage was used this dropped to 43%. Only 4% of referrals were sent from specialist primary care to hospital, suggesting highly efficient triage of referrals. A significant per-referral saving of £108.23 [standard error (SE) £11.59] was seen with consultant triage, and £84.13 (SE £11.56) with practitioner triage. Cost savings varied according the differing methods of applying the national tariff. Patients reported similar levels of satisfaction for both settings, and speed of treatment was their over-riding concern.ConclusionsImplementation of electronic referral management in primary care can lead, when combined with triage, to diversions of appropriate cases to primary care. Cost savings can be realised but are dependent on tariff application by hospitals, with a risk of overestimating where hospitals are using day case tariffs extensively.Study limitationsThe geographical footprint of the study was relatively small and, hence, the impact on services was minimal and could not be fully assessed across all three hospitals.Future workThe findings suggest that the intervention should be tested in other localities and disciplines, especially those, such as dermatology, that present the opportunity to use imaging to triage.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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Is perioperative antibiotic prophylaxis in the case of routine surgical removal of the third molar still justified? A randomized, double-blind, placebo-controlled clinical trial with a split-mouth design

et al. 2022

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Introduction Since antimicrobial resistance, caused by various factors including antibiotic overuse and abuse, is a severe challenge, the necessity of perioperative antibiotic prophylactic for surgical third molar removal remains a contentious topic. This study determined whether perioperative antibiotic prophylaxis can reduce surgical site infections (SSIs), swelling, and pain in the case of surgical removal of wisdom teeth. Material and methods A randomized, double-blind, placebo-controlled clinical trial with a split-mouth design. A study medication of 2 g amoxicillin, administered 1 h before the third molar removal, followed by 1.5 g each for the first 3 postoperative days, was compared with placebo medication. The primary outcome variable (SSI), secondary clinical parameters (swelling and trismus), and patient-centered outcome measures (bleeding, swelling, pain, and pain medication intake) were documented until postoperative day 7. Statistical analyses were done with a paired t test, t test for independent samples, Chi-square test, and McNemar test, including effect sizes. Results Primary outcome SSI, in total 11%, and clinical parameters swelling and trismus were not significantly different between the two groups. The patient-centered outcome measures (bleeding, swelling, and pain) did not significantly differ, except for postoperative bleeding in the EG on day 0. No significant result was found with pain medication intake postoperative on days 0–7. Conclusions Perioperative administration of oral antibiotics neither revealed additional benefits in patient-related outcome measures nor reduced postoperative complications compared with the placebo group indicated at routine surgical removal of noninflamed wisdom teeth. Clinical relevance Taking antimicrobial resistance into account, clear recommendations for administering drugs, particularly antibiotics, are critical in oral surgery.

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An audit of 600 referrals to a primary care based oral surgery service

Abstract: Acknowledging the small sample, it was safe and effective to diagnose and treat a broad spectrum of patients and oral surgical problems in the primary health care setting.

Cited by 22 publications

References 30 publications

Evaluation of an NHS practice-based minor oral surgery service

Evaluation of an NHS practice-based minor oral surgery service

An evaluation of a referral management and triage system for oral surgery referrals from primary care dentists: a mixed-methods study

Is perioperative antibiotic prophylaxis in the case of routine surgical removal of the third molar still justified? A randomized, double-blind, placebo-controlled clinical trial with a split-mouth design

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