Shared Care Between General & Periodontal Practices
Are You Making the Best of It or Making It the Best?
Are You Making the Best of It or Making It the Best?
by Jokie Heimbach, RDH
I have worked for 25 years in general dentistry. Then, five years ago, I took a leap into the unknown: I accepted a position in a periodontal practice. When I think back to my first experiences as a newly graduated hygienist in a general practice, the periodontal office was mysterious and almost frightening. What did they do there, anyway? Sometimes we never saw our patients again once we referred them to the periodontist, like those socks you lose in the dryer, some patients just disappeared. After losing track of a few of them, naturally we became afraid to make referrals.
Over the last five years, I have come to learn that optimal communication between the general practice and periodontal offices is essential for successful patient care. Communication in verbal, written, and electronic form will prevent last-minute cancellations, unnecessary treatment, and will keep treatment running smoothly, which, in turn, benefits both the patient and the provider.
The Initial Referral
Communication between general dental practices and any specialist starts with the initial referral. The specialist should provide referral forms or cards to all referring offices. Forms can easily be created on a computer and customized to fit your needs. When both parties use this type of communication, it allows the referring dental health-care provider to include specific reasons why the patient is being referred. Is it for one particular area (localized), or is it for a comprehensive exam to evaluate the level of generalized periodontal disease?
It is critical that the referral form include whether recent radiographs are available, with date and areas taken. Forms can be faxed or mailed to the periodontist’s office. In addition, radiographs should be mailed or e-mailed to the periodontist’s office before the appointment (e-mail is great for digital radiographs).
To communicate best with the patient, it always helps for the periodontist to receive and review details of the proposed treatment in advance. This is also a great opportunity to share such information as proposed treatment plan, history of periodontal disease/treatment, and any special concerns (i.e., patient anxiety, medical considerations, etc.).
We’ve all been in the situation when there is a last-minute referral or an emergency visit, and there isn’t time to fill out a referral form. A phone call from the referring office explaining the nature of the problem will help in a pinch to schedule the patient properly. This simple phone call can save the day for the staff member who schedules the appointment.
Once the patient has been evaluated in the periodontal office, it is critical that a comprehensive letter be sent to the referring office in a timely manner. The letter should include the diagnosis, prognosis, treatment plan, proposed length of treatment, and a copy of any radiographs available. A delay in correspondence can cause a delay in needed treatment (as well our production). Updating the general office as treatment progresses also benefits the patient. For example, if a procedure with regeneration is performed, then no periodontal probing or subgingival scaling may be done in that area for six months.
A faxed letter or memo would be sufficient to keep the general office informed. Here are some examples of clear, simple messages:
- Osseous surgery in the UL completed on Jan. 14, 2007, with regeneration of No. 14. No subgingival scaling or probing for six months from date of surgery.
- Crown lengthening surgery performed Jan. 14, 2007. This area will be reevaluated in two weeks; it will be OK for permanent prosthetics in six weeks.
Maintenance = working together
It is important for the periodontal practice and general practice to have the same treatment philosophies about periodontal maintenance for shared care to be successful. Both doctors should agree on a maintenance schedule that will benefit the patient the most. Furthermore, if a patient is to be on an alternating three-month maintenance schedule, both practices must reinforce this regimen. Maintenance reports to notify the general office when a patient has deviated from his or her maintenance schedule are helpful, and the next appointment date will need to be adjusted accordingly.
Maintenance reports should be sent by the periodontal office after each visit including the following information:
- Date of service
- Treatment provided
- Tissue condition
- What radiographs have been taken and copies sent
- Periodontal treatment recommended
- Areas of concern: i.e., No. 6 - 6 mm today, will reevaluate at next periodontal maintenance
- Restorative concerns or recommendations to the general dental provider - i.e., caries, defective restorations
- Full-mouth probe chart
- Oral hygiene condition/home-care instruction - include any new or recommended products
- Date due in general office for next maintenance
- Whether or not patient has accepted, declined, or delayed treatment, such as a patient delaying treatment due to out of insurance benefits
In turn, general dental offices may also send maintenance reports informing the periodontal office of any areas of concern. The periodontal office can easily provide customized, simple reports to the general office. In this way, the periodontal office will know if the patient is not on time for maintenance and can adjust the next appointment. Whenever bitewings or full-mouth X-rays are taken in the general office, a copy should be sent to the periodontal office (easily done with double film packets) or e-mailed if using digital radiography.
In order for shared care to be a win-win situation, communication is of the utmost importance. It helps when the teams in both offices know each other. Invite them for an informative workshop on new products or techniques, a lunch-and-learn, observation of a procedure in your office, or out to lunch. Don’t assume that if you haven’t seen a patient in a while, he or she has probably been to the periodontist or vice versa. The patient may not have been to either office. Notify the referring office if you haven’t seen a patient in a while or if the patient has not complied with treatment. This will give the general practice an opportunity to reinforce recommended treatment, as would the periodontal office about restorative or prosthetic needs.
We’re all on this team together, and with better written, verbal, and electronic communication, patients and providers will both be the winners.
About the Author
Jodie Heimbach, RDH, is a 1977 graduate of Fones school of Dental Hygiene and has been practicing clinical dental hygiene for 30 years. For the past five years she has worked in a periodontal practice in Ocean, N.J. Jodie is a proud member of the ADHA, two dental hygiene study clubs, and amyrdhlisters.com. She resides in Howell, N.J., with her husband and two daughters. You may reach Jodie at firstname.lastname@example.org where she will be happy to assist you in designing maintenance reports for your office.