Retrospective Study of the Reasons and Time Involved for Dental Providers' Medical Consults

Abstract

BackgroundPatient-reported medical histories and medical consults are primary approaches to obtaining patients' medical histories in dental settings. While patient-reported medical histories are reported to have inconsistencies, sparse information exists regarding the completeness of medical providers' responses to dental providers' medical consults. This study examined records from a predoctoral dental student clinic to determine the reasons for medical consults; the medical information requested, the completeness of returned responses, and the time taken to receive answers for medical consult requests.MethodsA random sample of 240 medical consult requests for 179 distinct patients were selected from patient encounters between 1 January 2015 and 31 December 2017. Descriptive statistics and summaries were calculated to determine the reasons for the consult, the type of information requested and returned, and the time interval for each consult.ResultsThe top two reasons for medical consults were to obtain more information (46.1%) and seek medical approval to proceed with treatment (30.3%). Laboratory and diagnostic reports (56.3%), recommendations/medical clearances (39.6%), medication information (38.3%), and current medical conditions (19.2%) were the frequent requests. However, medical providers responded fewer times to dental providers' laboratory and diagnostic report requests (41.3%), recommendations/medical clearances (19.2%), and current medical conditions (13.3%). While 86% of consults were returned in 30 days and 14% were completed after 30 days.ConclusionsThe primary reasons for dental providers' medical consults are to obtain patient information and seek recommendations for dental care. Laboratory/diagnostic reports, current medical conditions, medication history, or modifications constituted the frequently requested information. Precautions for dental procedures, antibiotic prophylaxis, and contraindications included reasons to seek medical providers' recommendations. The results also highlight the challenges they experience, such as requiring multiple attempts to contact medical providers, the incompleteness of information shared, and the delays experienced in completing at least 25% of the consults.Practical ImplicationsThe study results call attention to the importance of interdisciplinary care to provide optimum dental care and the necessity to establish systems such as integrated electronic dental record-electronic health record systems and health information exchanges to improve information sharing and communication between dental and medical providers.

Discrepancy in medications reported by elderly patients in the dental office and in their electronic medical records: A pilot study

“…59 Among the most common reasons for dental providers to seek medical consults, almost 40% are related to medication information and 1 out of every 4 requests concern medication lists. 60 However, this is ineffective given that numerous attempts are typically required to contact medical providers, the information is often incomplete, and the process is markedly delayed in 25% of cases. 60 It has been suggested that the intervention of pharmacists in the medication conciliation process might help to improve the accuracy of the medication lists available to dentists.…”

“…60 However, this is ineffective given that numerous attempts are typically required to contact medical providers, the information is often incomplete, and the process is markedly delayed in 25% of cases. 60 It has been suggested that the intervention of pharmacists in the medication conciliation process might help to improve the accuracy of the medication lists available to dentists. 16 It has also been proposed that, to avoid discrepancies between DMR and MMR, information concerning medications should be shared between medical and dental health record data, 61 or better still, the medical and dental information for each patient should be included in a single unified electronic health record.…”

“…Implementation of the electronic medical record has not resulted in the absence of discrepancies in medication lists 59 . Among the most common reasons for dental providers to seek medical consults, almost 40% are related to medication information and 1 out of every 4 requests concern medication lists 60 . However, this is ineffective given that numerous attempts are typically required to contact medical providers, the information is often incomplete, and the process is markedly delayed in 25% of cases 60 .…”

Determinants of Clinical Decision Making under Uncertainty in Dentistry: A Scoping Review

“…Several papers—in addition to those included in this review—have advocated for the use of computer-aided diagnosis (CAD) as a means of providing an interface for managing and simplifying complex variables involved in the traditional clinical diagnosis process [ 19 , 21 , 69 , 74 , 85 ]. The use of computer programs in dentistry has been rapidly evolving for quite some time now with the advent and popularisation of digital workflow systems providing a way to improve communication—both between practitioners and with patients—as well as a means of improving overall efficiency and decreasing laboratory workload [ 70 , 71 , 86 , 87 ].…”

Characterizing clinical findings of Sjögren’s Disease patients in community practices using matched electronic dental-health record data

“…As the existing AECG criteria [ 21 , 22 ] incorporate only the complete manifestation of the disease, and since they are not particularly relevant to detect SD in clinical practice, it is necessary to characterize these patients’ clinical characteristics using EHR data for research studies. The digitization of dental care data and the establishment of regional and state-wide health information exchanges (HIE), with increased interoperability between EHRs, offer the opportunity to link EDR and EHR data to identify a larger cohort of SD patients and study their oral health [ 36 , 37 ]. Therefore, in this study, we matched and linked the Indiana University School of Dentistry’s (IUSD) patients’ EDR data with their EHR data available through the state-wide Indiana Health Information Exchange (IHIE).…”