Referral Compliance Following a Diabetes Screening in a Dental Setting: A Scoping Review
Abstract
:1. Introduction
- the rates of referral compliance following diabetes screening in the dental setting
- the barriers and facilitators to patients’ referral compliance following diabetes screening in the dental setting
- behavioural models that have been developed to explain patient compliance to referral recommendations from OHPs following diabetes screening.
2. Methodology
- dysglycaemia or dysglyc* or type 2 diabetes or type two diabetes or diabetes mellitus type 2 or diabetes mellitus type two or type II diabetes or prediabetes or pre-diabetes or prediabetic or prediabetic state
- screen* or detect* or test or testing or diagnos* or assess*
- oral or dental or dentist* or oral hygienist* or dental hygienist* of oral health therapist* or dental therapist*
- refer* or follow-up
- comply or adhere* or attend*
3. Results
3.1. Rates of Referral Compliance following Diabetes Screening in the Dental Setting
3.2. Barriers and Facilitators to Patients’ Referral Compliance following Diabetes Screening in the Dental Setting
3.3. Behavioural Models Developed to Explain Patient’s Compliance to Referral Recommendations from OHPs following Diabetes Screening
4. Discussion
4.1. Rates of Referral Compliance
4.2. Barriers and Facilitators to Referral Compliance in the Dental Setting (Patient Factors)
4.3. Barriers and Facilitators to Referral Compliance in the Dental Setting (OHP Factors)
4.4. Behavioural Model That Explains Patient’s Compliance to Referral Recommendations
4.5. Strengths and Limitations of This Review
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Abbreviations
IDF | International Diabetes Federation |
GP | General Medical Professional |
AUSDRISK | Australian Type 2 Diabetes Risk Assessment Tool |
HbA1c | glycosylated haemoglobin |
OHP | oral health care professional, which includes dentist, dental hygienist, dental therapist and oral health therapist |
HCP | healthcare professional |
BCRA | breast cancer risk assessment |
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Main Author Date | Objectives | Country | Screening Instruments Used | % Referral Compliance | Barriers and Facilitators to Referral Compliance | Results and Conclusions |
---|---|---|---|---|---|---|
Bossart et al., 2015 [21] | Assess the effectiveness, convenience and cost of POC diabetes screenings performed by a dental hygienist for patients with periodontitis. | USA | Periodontal exam, risk assessment and POC-Hb A1c | 53% | Waiting for next GP visit and time constraints | 34% (n = 17) participants screened positive for dysglycaemia. Diabetes screening by dental hygienists is effective and convenient for identifying dyglycaemia. |
Engstrom et al., 2013 [22] | Test the effectiveness of diabetes screening in a collaborative framework between oral and primary health care. | Sweden | Risk assessment using BMI, RCBG, and RPG. | 90% | Not reported | 9 individuals were diagnosed with T2D. Diabetes screening was successful in terms of response rate and referral compliance. |
Franck et al., 2014 [23] | To investigate the ability to screen dental patients for T2D or PD. | USA | Risk assessment Survey. High-risk received POC and labor Hb A1c | 55% | Not reported | 28 participants had prediabetes. identified patients with dysglycaemia. |
Bould et al., 2016 [24] | To determine dental patients’ uptake of two screening tools FR and POC-HbA1c. in general dental practice. | UK | FR screening tool and POC-HbA1c | 60% | Significant association between number of ‘at risk’ screening results received and whether or not patient attended follow-up. | 258 participants identified as at risk of diabetes. A two-step method of diabetes screening was acceptable to patients, and the majority complied with referral advice. Patients were three times more likely to contact their GP if they received a positive risk result on both screening tools. |
Wright et al., 2013 [25] | To assess the feasibility of implementing a T2D diabetes risk assessment screening in dental settings using the NICE guidance tool | UK | Risk assessment | 26% (30.6% moderate-risk and 20% of high-risk patients attended follow-up) | Barriers to medical follow-up: misplacing the referral letter, being too busy, being away, delaying the appointment until after Ramadan and perception condition was not ‘serious enough’ to visit their GP. | Diabetes screening is feasible in dental settings. Amongst the challenges to this approach for the OHPs are time constraints, limited manpower and low referral compliance |
Ziebolz et al., 2019 [26] | Investigate the efficacy of T2D screening based on questionnaire replies | Germany | FR-positive patients were referred to a specialist | 55% | Not reported | The survey tool identified patients with T2D and prediabetes and is suitable for diabetes screening in dental practices. Difficult to motivate individuals to attend medical follow-up |
Biethman et al., [27] | To evaluate GPs’ responses to requests for information regarding follow-up results after diabetes screening in a dental setting. A secondary aim was to evaluate patients’ referral compliance. | USA | POC Hb A 1C | 59% | Unable to predict patients’ compliance with seeking follow-up with their GPs. | Most patients complied with their OHP’s advice to seek medical follow-up after diabetes screening. A single written request from an OHP to the GP to share the results may be insufficient and a phone call may be a more effective communication method. |
Rosedale et al., 2017 [28] | To examine patient experiences after receiving positive diabetes screening results at a dental clinic, whether they attended medical follow-up and facilitators and barriers to referral compliance. | USA | Hb A1c | 54 % | Facilitators: positive screening result viewed as an opportunity to act, 3-month follow-up/ reminder call from OHP. Barriers: Positive screening results perceived as a burden, lack of knowledge about diabetes, not understanding the importance of follow-up, busyness, financial concerns, fear and denial. | Patients and OHPs believe the dental setting is an acceptable and feasible site for diabetes screening. A limitation of diabetes screening is the extent to which patients’ follow-up positive screening results with their GPs. |
Herman et al., 2015 [29] | To develop and validate a tool to screen for PD and T2D in dental practices | USA | Risk assessment survey, RCBG and periodontal exam | 26% | Those that complied were significantly older than those who did not. More likely to comply if a previous history of tooth loss or dyslipidaemia | 30 % of patients ≥30 years old seen in general dental practices had dysglycaemia. Screening for dysglycaemia can be used to identify high-risk patients. |
Genco et al., 2014 [30] | To assess patient compliance with referral to GPs for diabetes diagnosis | USA | Risk assessment and POC-HbA1c | 35% | 78.8 % of patients from community clinics and 21.5 % were referred from private dental clinics attended medical follow-ups. Patients reported they declined to seek follow-up without giving an explicit reason. | Patients and OHPs support diabetes screening in the dental setting. Low referral compliance occurred in the private dental setting and good compliance in the community health centre setting. The reasons for low referral compliance need to be investigated and addressed before screening for diabetes in the dental setting can be advocated. |
Al Ghamadi et al., 2013 [31] | To assess the efficacy of the dental setting for T2D and PD screening | Saudi Arabia | Random blood glucose levels (RBGLs) were recorded. | 84% | Not reported | 16.4 % undiagnosed T2D and 15.8 % PD among patients visiting dental clinics |
Marino et al., 2020 [32] | To develop and evaluate an innovative approach for identifying pre-diabetes and type 2 diabetes within the private oral health setting. | Australia | AUSDRISK risk assessment tool | 25% | Cost, personal issues, other health concerns taking priority and COVID-19, were named as barriers to attending medical follow-ups. | Six individuals were diagnosed with prediabetes. T2D screening in a dental setting is well-accepted and effective. However, developing referral pathways, both to and from GPs, as well as maximising follow-ups is required. |
Montero et al., 2020 [33] | To evaluate the efficacy of different screening protocols for undiagnosed dysglycaemia in the dental setting | Spain | FR screening tool and periodontal exam and POC-HbA1c | Results of 23 referred patients were unknown, for some, this may be due to referral non-compliance. | Not reported | 8.5% of individuals were diagnosed with dysglycaemia. The screening protocol was feasible and effective in identifying participants with dysglycaemia in the dental setting. |
Lalla et al., 2015 [34] | To assess an approach to improving behavioural and glycaemic outcomes in dental patients with diabetes risk factors and previously undiagnosed hyperglycaemia | USA | Risk assessment, periodontal exam, and Hb A1c | 84% | Not reported | At 6 months most of the participants reported having attended a GP and 49% reported at least one positive lifestyle change. In participants identified as at risk of diabetes, HbA1c was significantly reduced. |
Barriers to Referral Compliance | Study |
---|---|
Referral pathway issues (e.g., negative perception of services losing the referral, no longer in the country) | [21,25,32] |
Too busy to attend | [21,25,28] |
Cultural/religious reasons (e.g Ramadan) | [25] |
Lack of knowledge and awareness of the condition | [25,28] |
Fears and distress about the results | [28] |
Cost of follow-up appointment | [28,32] |
Other health issues took priority | [32] |
Patient perceived positive screening result as a burden | [28] |
Facilitators to Referral Compliance | Study |
---|---|
Good HCP–patient interaction | [28] |
Good interprofessional communication between dental and medical professional | [28] |
Patient perceiving positive screening as an opportunity to act | [28] |
Observing family members with diabetes or desire to be a role model for family members | [28] |
History of tooth loss and dyslipidaemia | [28] |
Location of screening; Community dental clinic | [30] |
Receiving a reminder to follow-up | [28] |
Multiple ‘at risk’ screening results received | [24] |
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Priede, A.; Lau, P.; Darby, I.; Morgan, M.; Mariño, R. Referral Compliance Following a Diabetes Screening in a Dental Setting: A Scoping Review. Healthcare 2022, 10, 2020. https://doi.org/10.3390/healthcare10102020
Priede A, Lau P, Darby I, Morgan M, Mariño R. Referral Compliance Following a Diabetes Screening in a Dental Setting: A Scoping Review. Healthcare. 2022; 10(10):2020. https://doi.org/10.3390/healthcare10102020
Chicago/Turabian StylePriede, Andre, Phyllis Lau, Ivan Darby, Mike Morgan, and Rodrigo Mariño. 2022. "Referral Compliance Following a Diabetes Screening in a Dental Setting: A Scoping Review" Healthcare 10, no. 10: 2020. https://doi.org/10.3390/healthcare10102020