Biethman Rick Ken, Pandarakalam Cyril, Garcia M Nathalia, Whitener Sara, Hildebolt Charles F
Dr. Biethman is Assistant Professor, Department of Restorative Dentistry, School of Dental Medicine, Southern Illinois University; Dr. Pandarakalam is Assistant Professor, Department of Restorative Applied Dental Medicine, School of Dental Medicine, Southern Illinois University; Dr. Garcia is Assistant Professor, Department of Applied Dental Medicine, School of Dental Medicine, Southern Illinois University; Dr. Whitener is Assistant Professor, Department of Applied Dental Medicine, School of Dental Medicine, Southern Illinois University; and Dr. Hildebolt is Professor Emeritus of Radiology, School of Medicine, Washington University in Saint Louis.
J Dent Educ. 2017 Sep;81(9):1062-1067. doi: 10.21815/JDE.017.059.
If a dental student diagnoses a patient in a dental school clinic as being at high risk of prediabetes or diabetes, the patient should be referred to his or her physician for further diagnostic evaluation, and the physician should send back the evaluation results so that the dental team can optimize treatment and health care choices if the diagnosis is confirmed. The primary aim of this study was to evaluate physicians' responses to written and oral requests for information regarding follow-up diabetes testing. A secondary aim was to evaluate patients' compliance with recommendations to seek medical care after being determined to be at high risk of prediabetes or diabetes in the dental clinic. Based on at least one positive risk factor for diabetes, 74 patients in one U.S. dental school's clinic were screened by third- and fourth-year dental students for prediabetes or diabetes and underwent point of care HbA1C (glycalated hemoglobin) blood tests between June 2014 and June 2015. Patients with an HbA1C value of 5.7% or above were referred to their physicians for follow-up testing. The physician was mailed the patient's HIPAA release and a request for updates to the student regarding the patient's diabetes status. If the physician did not provide the requested information, a dental student telephoned him or her to obtain the patient's diabetes status. Of the 74 patients, 34 (46%) tested positive with HbA1C tests and were referred to their physicians. Of those 34 referred patients, 20 (59%) saw their physicians for additional evaluations within six months of referral. None of the 20 physicians responded to the written requests for information on additional diabetes testing. After one or two telephone requests, all 20 physicians provided the test results. This study found that most of the patients (59%) followed their dental practitioner's advice to seek follow-up care with their physician, supporting the value of conducting these tests in a dental clinic. However, the results also suggested that a single written request may be insufficient to prompt physicians to return those results and that follow-up communication in a phone call may be more effective.
如果牙科专业学生在牙科学院诊所诊断出患者有糖尿病前期或糖尿病的高风险，应将该患者转介给其医生进行进一步的诊断评估，医生应反馈评估结果，以便在确诊后牙科团队能够优化治疗和医疗保健选择。本研究的主要目的是评估医生对关于后续糖尿病检测信息的书面和口头请求的回应。次要目的是评估患者在牙科诊所被确定为糖尿病前期或糖尿病高风险后对寻求医疗护理建议的依从性。基于至少一项糖尿病阳性风险因素，美国一所牙科学院诊所的74名患者由三、四年级牙科专业学生进行糖尿病前期或糖尿病筛查，并于2014年6月至2015年6月期间接受即时糖化血红蛋白（HbA1C）血液检测。HbA1C值为5.7%或以上的患者被转介给其医生进行后续检测。向医生邮寄了患者的《健康保险流通与责任法案》（HIPAA）授权书以及向学生更新患者糖尿病状况的请求。如果医生未提供所请求的信息，牙科专业学生就会打电话给他或她以获取患者的糖尿病状况。在这74名患者中，34名（46%）HbA1C检测呈阳性并被转介给其医生。在这34名被转介的患者中，20名（59%）在被转介后的六个月内去看了医生进行进一步评估。20名医生中没有一人回复关于额外糖尿病检测信息的书面请求。经过一两次电话请求后，所有20名医生都提供了检测结果。本研究发现，大多数患者（59%）听从了牙科医生的建议，寻求医生的后续护理，这支持了在牙科诊所进行这些检测的价值。然而，结果还表明，单一的书面请求可能不足以促使医生反馈这些结果，而电话跟进沟通可能更有效。
