RESUMEN
OBJECTIVES: To evaluate referral patterns to secondary care and categorise referrals by complexity level. To assess compliance with commissioning guidelines for cases accepted for treatment in secondary care, comparing complexity to Index of Orthodontic Treatment Need (IOTN) data. DESIGN: Service evaluation of all referrals during study period recorded prospectively. The standard was set that >85% of cases offered treatment in secondary care should be complexity level 3b. SETTING: Seven NHS orthodontic departments within a regional clinical effectiveness group in secondary care in England. PARTICIPANTS: All patients seen as new referrals during the three-month study period. METHODS: Data recorded at clinic appointment on data collection proforma including referral information, complexity, IOTN and outcome of the first appointment. Data were collated on a spreadsheet and simple statistics were applied. RESULTS: A total of 493 patients were included in data analysis. Median waiting time for a new patient appointment was 11.0 weeks. For the whole study group, 53.8% were IOTN 5, 30.8% IOTN 4, 9.7% IOTN 3; complexity levels were 54.2% complexity 3b, 37.1% 3a and 6.7% 2. Of the patients, 30.0% were offered treatment in secondary care at their first attendance; of these, 74.3 % were IOTN 5, 93.2% were complexity level 3b. CONCLUSION: The gold standard has been met in the region as a whole and at each individual unit. There is a large discrepancy between the IOTN score and complexity level in those patients offered orthodontic treatment in secondary care. Routine recording of complexity level is recommended for all patients seen in the secondary care setting.
Asunto(s)
Maloclusión , Atención Secundaria de Salud , Humanos , Indice de Necesidad de Tratamiento Ortodóncico , Derivación y ConsultaRESUMEN
INTRODUCTION: Intraoral elastics are commonly used in orthodontics and require regular changing to be effective. Unfortunately, poor compliance with elastics is often encountered, especially in adolescents. Intention for an action and its implementation can be improved using "if-then" plans that spell out when, where, and how a set goal, such as elastic wear, can be put into action. Our aim was to determine the effect of if-then plans on compliance with elastics. METHODS: To identify common barriers to compliance with recommendations concerning elastic wear, semistructured interviews were carried out with 14 adolescent orthodontic patients wearing intraoral elastics full time. Emerging themes were used to develop if-then plans to improve compliance with elastic wear. A prospective pilot study assessed the effectiveness of if-then planning aimed at overcoming the identified barriers on compliance with elastic wear. Twelve participants were randomized equally into study and control groups; the study group received information about if-then planning. The participants were asked to collect used elastics, and counts of these were used to assess compliance. RESULTS: A wide range of motivational and volitional factors were described by the interviewed participants, including the perceived benefits of elastics, cues to remember, pain, eating, social situations, sports, loss of elastics, and breakages. Compliance with elastic wear was highly variable among patients. The study group returned more used elastics, suggesting increased compliance, but the difference was not significant. CONCLUSIONS: The use of if-then plans might improve compliance with elastic wear when compared with routine clinical instructions.