Referral Patterns of General Dental Practitioners for Oral Surgical Procedures
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Periodontist
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Background: As the first in the line of contacts between patients and the health system, family physicians have an important role in improving the health status of a society. Referring the patients to specialized care or special health services is one of the important duties for this group. Objective: To better understand referral services, this study aimed at evaluating the referral function of family physicians in Damavand City. Materials and methods: This cross-sectional descriptive study was carried out in five health care centers with eight family physicians in Damavand City from April to September 2013. The main variables included the number of referred patients to laboratory and radiology centers and specialist physicians and the provided feedback. Results: The findings revealed that three out of eight family physicians referred patients to the laboratory more than the set cap. As for referrals to specialists, only one physician had more than ten percent of the cap. The feedback was zero for all patients, except for one case who had unknown status and another who had five percent feedback. Conclusions: According to the results, it can be concluded that the existing referral potential is not optimally fulfilled by family physicians of Damavand City. Increasing the usage of the available potentials is hence recommended. Key Words: Referral System, Family Physicians, Damavand
Family health
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Patient referral
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Prosthodontist
Oral Surgeon
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Despite the fact that the proportion of immigrant and minority women who consult a general practitioner about their health is similar to that of their Canadian-born counterparts, studies suggest that they are less likely to be screened for breast cancer. This study examines physician characteristics associated with mammography referral and perceived barriers to mammography among family physicians serving the Caribbean community of Toronto.The study consisted of a mail-back family physician survey.Among the 64 physicians who responded to the survey, over half reported that they were "very likely" to refer women for mammography during a regular preventive check-up. Among physician variables, only the amount of time spent on patient education was significantly associated with the likelihood of referral. Regarding perceived barriers, for male physicians, patient refusal and intervention causing patient discomfort were significantly associated with referral. For female physicians, only forgetting to provide service was identified as a significant barrier to referral.An increased emphasis on patient education may help to increase screening referral among all physicians. Gender differences in perceived barriers to referral suggest that the gender of the physician is of major importance to the Caribbean community.
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In many countries, the referral-consultation process faces a number of challenges from inefficiencies and rising demand, resulting in excessive wait times for many specialties. We collected referral data from a sample of family doctors across the province of Ontario, Canada as part of a larger program of research. The purpose of this study is to describe referral patterns from primary care to specialist and allied health services from the primary care perspective.We conducted a prospective study of patient referral data submitted by primary care providers (PCP) from 20 clinics across Ontario between June 2014 and January 2016. Monthly referral volumes expressed as a total number of referrals to all medical and allied health professionals per month. For each referral, we also collected data on the specialty type, reason for referral, and whether the referral was for a procedure.PCPs submitted a median of 26 referrals per month (interquartile range 11.5 to 31.8). Of 9509 referrals eligible for analysis, 97.8% were directed to medical professionals and 2.2% to allied health professionals. 55% of medical referrals were directed to non-surgical specialties and 44.8% to surgical specialties. Medical referrals were for procedures in 30.8% of cases and non-procedural in 40.9%. Gastroenterology received the largest share (11.2%) of medical referrals, of which 62.3% were for colonoscopies. Psychology received the largest share (28.3%) of referrals to allied health professionals.We described patterns of patient referral from primary care to specialist and allied health services for 30 PCPs in 20 clinics across Ontario. Gastroenterology received the largest share of referrals, nearly two-thirds of which were for colonoscopies. Future studies should explore the use of virtual care to help manage non-procedural referrals and examine the impact that procedural referrals have on wait times for gastroenterology.
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In a special article entitled, "Impacted Maxillary Canines: A Review," Samir E. Bishara states: "The ectopic eruption and impaction of maxillary permanent canines is a frequently encountered clinical problem. The diagnosis and treatment of this problem usually requires the expertise and cooperation of the general practitioner, the paediatric dentist, the oral surgeon, and the periodontist, as well as the orthodontist." We will review the etiology, diagnosis and treatment of impacted maxillary canines. A technique will be outlined that allows a competent orthodontic clinician to singly, efficiently and reliably treat this common problem without reference to a myriad of specialists.
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Impaction
Maxillary canine
Oral Surgeon
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To examine family physicians' referral decisions, which we conceptualized as having 2 phases: whether to refer followed by to whom to refer.Prospective cohort study.All visits (N = 34,519) and new referrals (N = 2534) occurring during 15 consecutive business days in the offices of 141 family physicians in 87 practices located in 31 states.Rates of referral, reasons for referral, practitioners referred to, health problems prompting referral, and reasons for selecting particular specialists.Approximately 1 in 20 (5.1%) office visits led to referral. Although 68% of referrals were made by physicians during office visits, 18% were made by physicians during telephone conversations with patients, 11% by office staff with input from the physician, and 3% by staff without physician input. Physicians endorsed a mean of 1.8 reasons for making a referral. They sought specialists' advice on either diagnosis or treatment for 52.1% of referrals and asked the specialist to direct medical management for 25.9% and surgical management for 37.8%. Patient request was one reason for 13.6% of referrals. Fifty conditions accounted for 76% of all referrals. Surgical specialists were sent the largest share of referrals (45.4%), followed by medical specialists (31.0%), nonphysician clinicians (12.1%), obstetrician-gynecologists (4.6%), mental health professionals (4.2%), other practitioners (2.0%), and generalists (0.8%). Physicians recommended a specific practitioner to the patient for most (86.2%) referrals. Personal knowledge of the specialist was the most important reason for selecting a specific specialist.Referrals are commonly made during encounters other than office visits, such as telephone conversations or staff-patient interactions, in primary care practice. Training in the referral process should ensure that family physicians obtain the skills necessary to expand their scope of practice, when appropriate; determine when and why a patient should be referred; and identify the type of practitioner to whom the patient should be sent.
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Oral medicine is a clinical discipline, practiced by periodontists, which concerns itself mostly with the non surgical management of oral mucosal diseases. Many of these diseases are rare and the discipline less well known – making it essential to identify the obstacles this discipline faces. The purpose of this study was to describe the private and academic practice of Oral Medicine. A self-administered, internet-based, questionnaire was distributed to South African periodontists which questioned the clinician’s competency, diseases managed, special investigations performed, referral sources, proportional time and monetary distribution of the discipline, and perceived barriers to the practice. Twenty-six periodontists completed the questionnaire. In comparison to periodontology and implantology, periodontists generally feel less competent, spend less time on, and receive less money from Oral Medicine. Lack of awareness of the speciality (55.6% - 59.3%) was identified as the biggest constraint, with only 11.2% of referrals received from medical doctors. Immune-mediated diseases (29.3%) and benign neoplasms (26.5%) are managed the most, and surgical biopsies (80.2%) are used most regularly to diagnose oral mucosal disease. Oral Medicine is still a lesser-known clinical speciality. Despite the heavy burden of HIV-related oral disease and oral mucosal malignancies, this speciality remains underutilised.
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Oral medicine
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This study assessed Australian clinicians’ knowledge, attitudes and referral patterns of patients with suspected Lynch syndrome for genetic services. A total of 144 oncologists, surgeons, gynaecologists, general practitioners and gastroenterologists from the Australian Medical Association and Clinical Oncology Society responded to a web-based survey. Most respondents demonstrated suboptimal knowledge of Lynch syndrome. Male general practitioners who have been practicing for ≥10 years were less likely to offer genetic referral than specialists, and many clinicians did not recognize that immunohistochemistry testing is not a germline test. Half of all general practitioners did not actually refer patients in the past 12 months, and 30% of them did not feel that their role is to identify patients for genetic referral. The majority of clinicians considered everyone to be responsible for making the initial referral to genetic services, but a small preference was given to oncologists (15%) and general practitioners (13%). Patient information brochures, continuing genetic education programs and referral guidelines were favoured as support for practice. Targeted education interventions should be considered to improve referral. An online family history assessment tool with built-in decision support would be helpful in triaging high-risk individuals for pathology analysis and/or genetic assessment in general practice.
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