Referral pathways from general dental services to other primary dental care services in the UK: A systematic review and critical interpretive synthesis

Objectives: To define the characteristics of referrals from general dental services (GDS) to other primary dental care services (PDCS) and to identify factors which influence the decisions leading to these referrals.
Methods: The review has a configurative approach. A systematic literature search was conducted in Medline, CINAHL and Embase. All articles meeting the inclusion criteria were analysed using critical interpretive synthesis, extracting first and second order constructs and generating synthetic constructs.
Results: The search identified 16,109 articles, of which 73 were included in the review. Key constructs influencing patients’ journeys and care outcomes were: policy change, contractual systems, geography, communication barriers and dentists’ perceptions about the quality and accessibility of referral services. Some authors described referrals as ‘inappropriate’ if they included poor documentation, unsuitable treatment planning or patient selection. This term was usually applied by dentists receiving referrals into services managing a high demand with limited resources.
The literature described two principal referral pathways originating in the GDS. Referrals were made to specialists for their technical skills and knowledge and represented a temporary shared-care arrangement. Referrals were made to Community Dental Services for patient management reasons and represented a semi-permanent transfer of responsibility for patients whose care was considered by referring dentists to be outside their GDS role.
Conclusions: Diverse non-clinical factors are involved in decisions about making and accepting referrals from the GDS to other PDCS. These factors have not been adequately considered in designing and implementing interventions to optimise the management of referral processes. There is limited information in the literature exploring patients’ and policymakers’ perceptions of referral within primary dental care and this merits further research.