Referral patterns, lesion prevalence, and patient care parameters in a clinical oral pathology practice

Objective, The purpose of this study was to determine the following paramet ers in a referral-based private practice oral and maxillofacial pathology c linic: (1) sources of clinical referrals; (2) types of problems referred; a nd (3) clinical effectiveness of treatment. Study design. Clinical charts were reviewed for a cohort of 362 patients se en over a 2 1/2-year period (1993-1995). From these charts, we determined t he source of referral and the final diagnosis for each patient. In addition , 50 patients were randomly selected and surveyed by telephone; each was as ked a series of questions to determine the following: (1) the number of hea lth care practitioners previously seen with regard to the patient's conditi on; (2) the length of time that the condition had been present before the p atient came to the oral and maxillofacial pathology clinic; (3) the costs a ssociated with medications and office visits that had been incurred before the patient came to the oral and maxillofacial pathology clinic; (4) the co sts associated with medications and office visits that were incurred at the oral and maxillofacial pathology clinic; and (5) the patient's level of sa tisfaction with the oral and maxillofacial pathology clinic. Results. Fifty-five percent of the referrals came from dentists, and 45% ca me from physicians. The 3 problems most commonly seen were candidiasis (12% ), burning mouth syndrome (10%), and lichen planus (8%). For the 50 patient s who were interviewed, the mean number of health care practitioners seen p reviously was 2.2 (range, 1-9). The mean time from initial symptoms to eval uation by an oral pathologist was 15 months. The mean approximate cost of m edications and office visits before evaluation by an oral pathologist was $ 350 (range, $30-$4,000; median, $100); this compared with a cost of $94 (ra nge, $50-$300; median, $70) for the patient visit and medications associate d With the oral pathology appointment. The difference was statistically sig nificant (P less than or equal to.001). Conclusions. This preliminary study suggests that the clinical evaluation o f oral lesions by an oral pathologist appears to be cost-effective and shou ld be an integral part of a comprehensive health management system. These r esults should be corroborated by similar multicenter studies.