Qualitative Exploration Of Factors Associated With Dental Provider-Initiated Medical Consultations

Objectives: In an effort to personalize oral health care, dental providers request that patients provide an up-to-date medical and medication history. Studies indicate patient-reported medical histories are often out-of-date and incomplete. In these cases, dental providers seek consultation with medical providers. The objective of this study was to determine the reasons that trigger dental providers to initiate medical consultations in an academic setting. Methods: Annotation guidelines were created based on prior studies and medical consultation forms. Four team members reviewed 5 common medical consultations using the annotation guidelines with high inter-rater agreement. Two-hundred and forty medical consultations were reviewed from 179 unique patients dated January 2015 through December 2017. Frequency distributions were calculated for multiple variables, such as patient age, gender, medical specialty of provider consulted, and medication and medical information. Results: Among 179 patients, 52.5 percent were males, 46.9 percent females, and 0.55 percent indicated as other gender. Majority of the medical consults were for the age groups 51-65 years (39%) and 66-80 years (39%). The most frequently consulted medical specialties were family medicine (45%), internal medicine (33%), and cardiology (13%). Dental providers most frequently requested their patients’ recent laboratory values (51%), recommendations and contraindications (23.5%) regarding the planned dental treatment/s, and medical condition status (10%). Among the laboratory values, they requested HbA1c (37.5%) most often. They also requested medication information in 108 (49%) of medical consultations. Medical providers shared medication information in 54% (119) of medical consultations irrespective of dental providers’ request. Conclusions: Study results indicate that dental providers sought additional information such as laboratory values and medication information from their patients’ physician offices, which they may not have obtained from their patients. With an increase of dental patients with multiple chronic conditions, efficiently gathering information from multiple medical providers for personalized oral health care is critical.