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

Abstract

Objective Oral surgery referrals from NHS dental practices are rising, increasing the pressures on available hospital resources. We assess if an electronic referral system with consultant or peer (general dental practitioner) led triage of patient referrals from general dental practices can effectively divert patients requiring minor oral surgery into specialist led primary care settings at a reduced cost whilst providing care of the same or enhanced quality. One year of no triage (all referrals treated in secondary care) was followed by one-year of consultant led triage, which in turn was followed by year of peer-led triage. Method A health economic evaluation of all patient referrals from 27 UK dental practices for oral surgery procedures. The follow-up is over a three-year period at hospital dental services in two general hospitals, one dental hospital, and a single specialist oral surgeon based in two primary care practices. The evaluation is a comparison of mean outcomes in the hospitals and in specialist primary care dental services between the study periods (i.e. periods with and without the triage system). The main outcomes of interest are mean NHS cost saving per referral (costs to the NHS and costs to broader society), proportion of diverted referrals, case-mix of referrals and patient reports of the quality of dentistry services received at their referral destination. Results The proportion of referrals diverted to specialist primary care was similar during both periods (45% under consultant-led triage and 43% under GDP-led triage). Statistically significant savings per referral diverted were found (£116.11 under consultant-led triage, £90.25 under GDP-led triage). There were no statistically significant changes in the case-mix of referrals. Cost savings varied according to the coding (and hence tariff) of referred cases by the provider hospitals. Patients reported similarly high levels of satisfaction scores for treatment in specialist primary care and secondary care settings. Conclusions Implementation of electronic referral management in primary care, when combined with triage, led to appropriate diversions to specialist primary care. Although cost savings were realised by referral diversion these savings are dependent on the particular tariff allocation (coding) practices of provider hospitals.

Patient Referrals for Hernia Consultations through the International Hernia Collaboration (IHC) Online Social Media Platform

“…The authors again found that an electronic referral management system led to allocation to appropriate care for patients. 4 There are several limitations to this study. First, our study evaluated only one social media platform, the IHC, which is specifically targeted to hernia surgery and surgeons and our results cannot be extrapolated to other sites.…”

“…Several groups have evaluated triage-based telehealth systems as a method of referral. One of these groups is Hardman et al 3 who prospectively evaluated a symptom-based risk stratification telehealth triage strategy for referrals made to ENT specialists in the United Kingdom for suspected head and neck cancers. The authors sought to evaluate the safety of telemedicine referral in this population.…”

“…The authors again found that an electronic referral management system led to allocation to appropriate care for patients. 4…”