Referral Pathways for Patients Receiving Care in a University Oral Medicine Clinic

Abstract

BACKGROUND: In the United States healthcare system, primary care providers and general dental practitioners are responsible for referring their patients to Oral Medicine (OM) providers for orofacial and oral mucosal diseases. Referral streams may be inefficient, as patients are seen by other specialists such as otolaryngologists and dermatologists before being seen in OM clinics. Few studies have investigated the referral pattern to university-based OM clinics, and knowledge of the pattern may ultimately help improve referral efficiency. METHOD: This was a retrospective, cross-sectional chart review study that provided a snapshot of the patients referred to a university dental school OM specialty clinic. We investigated referral patterns and referral efficiency, and the correlation between them, patients’ demographics, and other psychosocial conditions. We reviewed 161 electronic health records of patients seen for their first visit at the Oral Medicine Clinical Service (OMCS) at the University of Washington between December 1, 2019, and February 28, 2020. RESULTS: The sample was mostly female (n=115, 71.4%; male n=46, 28.6%), and the mean age of patients in the study sample was 53.2 years (SD=18.1; range=18-93). Our results found that 42% of patients were referred by dentists, including general and specialist dentists, with medical doctors referring another 40% of patients (mostly general practitioners, fewer specialists). Patients saw 5-6 providers of different specialties before their OMCS visit, with an average of 6-7 visits before coming to the OMCS. Referral efficiency was not significantly different between males and females, but it differed among the diagnostic categories. In general, patients with TMD concerns and oral mucosal disease experienced an average of 39- and 29-month referral efficiency, respectively, versus obstructive sleep apnea and headaches, which were 85 and 61 months, respectively. Somatization with pain significantly increased with slow referral efficiency. CONCLUSIONS: Referral efficiency should be improved. To that end, general dentists and medical providers should be more aware of the OM specialty and insurance eligibility should be more inclusive. More studies are needed to understand the provider prospective for referring or not referring their patients to OM providers.