Who get referred to gerodontology and special care dentistry clinic, Thammasat Hospital, Thailand, and why: a mixed-method study

There has been no study addressing referral reasons to Gerodontology and special care dentistry (GD/SCD) clinic in Thailand. This study aims for studying GD/SCD patient’s profile of GD/SCD clinic of Thammasat University Hospital (TUH), and explored referral reasons from perspectives of dentists and dental supporting staff. We first reviewed electronic medical record (EMR) of the year 2019 and later conducted in-depth interviews with 12 dentists and supporting staff. EMR reported that the majority of TUH GD/SCD patients were a young-old group who had 5.1±3.8 medical comorbidities and took 8.2+5.5 medications on average (mean age = 69.1±10.1, min-max=13-92 years old). The majority of our patients (70%) were eligible for a civil servant health insurance; while 20% of the all patients unfortunately had to pay out-of-pocket even though they had some type of health insurance. Almost 1/3 of the EMR did not reveal referral reasons. For those with written consultation notes available, we found common themes also with the interview findings such as complex dental problem (rampant caries), being dependent, and uncooperative behaviors. Shorter waiting time for denture fabrication was also identified. In addition, interview findings revealed further detail that dentists were struggled with the proper treatment planning, competing agenda of efficiency and productivity under the time limit, and the influence of specialty-oriented schedule. Unlike existing reports from elsewhere, we found no barriers from ageism or lack of financial incentive; our participants showed empathy/sympathy towards the patients and referred to GD/SCD as they explained that GD/SCD had 1) specialized equipment and skills, 2) availability and ease of referral, and 3) comprehensive care approach.