Comparing Afterhours Call Protocol of Pediatric and General Dentists

Winston Lin, D.D.S. and Donna Kritz-Silverstein, Ph.D. Section of Pediatric Dentistry, University of California, Los Angeles
Background
Dental emergencies are best handled by trained dentists in a dental setting Dental clinics typically keep traditional business hours making it problematic to obtain care afterhours Patients often turn to hospital ERs to meet emergent dental needs State Dental Boards dictate practitioner responsibility in afterhours situations The ADA states that all dentists are obliged to make reasonable arrangements for the emergency care of their patients of record and also when consulted on patients not of record A dentist should determine whether a patient needs immediate dental treatment, should go to a hospital ER, or can wait until the following morning for treatment. Little information is available on how dentists interpret the term reasonable arrangements in regard to emergency dental care No studies examine how general or pediatric dentists manage afterhours emergency dental care

Table 1 Participant Characteristics

_____________________________________________________ Dentist Type N % Pediatric (PD) 74 48.7 General (GD) 78 51.3 Practice Role Owner 103 67.8 Associate 28 18.4 Unknown 21 13.8 Gender Male 98 64.5 Female 54 35.5 Website Yes 120 78.9 No 32 21.1 Mean (SD) Range Years since Grad 20.24 11.3 2 to 55 _____________________________________________________

Table 3 Comparisons of factors affecting Mean Call Seconds

___________________________________________________________ Mean Call Sec t p-value Dentist Type 0.71 .48 Pediatric 52.0 General 50.4 Years since D-school ALL <20 20 Years since D-school Pediatric <20 20 Years since D-school General <20 20 Website ALL No Yes Website Pediatric No Yes Website General No Yes 0.12 51.3 51.0 -1.33 50.3 55.2 1.44 53.1 48.8 -0.32 50.5 51.4 -0.13 51.6 52.2 -0.21 49.8 50.5 .83 .90 .75 .15 .19 .90

Results
TABLE 1 48.7% PD vs. 51.3% GD, 64.5% Male, 67.8% Owners 20.2 Years since graduation TABLE 2 More GD were owners 71.8% vs. 63.5% (p=.0001) More GD were men (3:1), PD divided even (p=.0018) GD had 6.1 more years since graduation (p=.0007) TABLE 3 Mean call seconds was 52.0s in PD and 50.4s in GD No differences in mean call seconds by years since graduation, having website or gender in PD and GD FIGURE 1 GD more likely to give emergency # than PD (66.7% vs. 41.9%, p=.004); PD more likely to use paging system than GD (36.5% vs. 41.9%, p=.0013) No differences in live message service, emergency message, general message, phone continues to ring, or mailbox full Positive processes = emergency #, pager, live messaging service, or emergency message. Negative processes = general message, phone continues to ring, mailbox full PD had higher rate of positive call processes (98.6% vs. 89.7%, p=.05) FIGURE 2 No differences in afterhours call process by years since dental school graduation for GD and PD Within PD, grads 20 yrs were more likely to use paging system (50% vs. 29.2%), grads <20 yrs were more likely to give emergency # (47.9% vs. 30.8%)

Table 2 Comparisons of Characteristics by Practice Type

____________________________________________________________ Pediatric (n=74) General (n=78) % % 2 p-value Practice Role 15.23 <.0001 Owner 63.5 71.8 Associate 33.7 3.8 Unknown 2.7 24.4 Website (%yes) 83.7 74.4 1.5 .22 Gender 9.75 .0018 Male 51.4 76.9 Female 48.6 23.1 Mean Mean t p-value

Gender Pediatric 1.26 .73 Male 52.7 Female 51.5 Gender General 0.78 .44 Male 49.7 Female 52.4 ___________________________________________________________

Purpose
To compare how general dentists versus pediatric dentists process afterhours emergency calls

Years since Dental School 17.1 23.2 -3.45 .0007 ____________________________________________________________

Limitations and Strengths

Figure 2 Afterhours Call Process: Years Since Dental School
80

Figure 1 Afterhours Call Process: Pediatric vs. General Dentists

100 Ped 90 80 70 60
% % p = .004 p = .05

LIMITATIONS Relatively small sample from one local region; may affect generalizability of results No follow through with afterhours instructions STRENGTHS First study to examine dental afterhours emergency processes used by PD and GD

Methods
Collected listed phone information from the San Diego County Dental Society Directory Phone calls October 2012, Weeknights, 7pm-9pm Private practice offices (numbers to corporate dental offices or community health clinics were excluded) At least 2 calls per office All pediatric dentists (PD) listed (N = 74) and random sample of listed general dentists (GD) (N = 78) were included Data Analysis Comparisons performed with Chi square analysis and Independent t-tests Performed with Vassarstats & Excel

Gen 70

Ped <20y

Ped 20y

Gen <20y

Gen 20y

60

Conclusions
50 40
p = .0013

50 40 30

Most PD and GD had acceptable afterhours emergency process calls but PD percentage was significantly higher; ideally this should be 100% PD may be more comfortable using a paging system as they likely used a paging system during residency PD take afterhours call as part of residency; may be more aware of the importance of appropriate afterhours emergency protocols Afterhours emergency training is likely minimal across dental schools and should be increased
Number Pager Live Em Gen Message Message After Hours Process Rings Mailbox Full

30

20 20 10 0 Number Pager Live Em Gen Continues Mailbox Message Message to Ring Full After Hours Process Postive Negative Process Process 10

Larger sample sizes across larger regions needed.