PATHWAYS TO ORTHODONTIC CARE

Background The research described in this paper arose out of the need to address the growing waiting list for orthodontic treatment in North amptonshire. Although the prevalence of dento-facial anomalies is the same across time, sex, race and socio-economic class, studies in the U nited States and this country suggest that certain groups are over-rep resented among patients who receive orthodontic treatment. The introdu ction of valid and reliable indices of therapeutic need such as the In dex of Orthodontic Treatment Need (IOTN) will allow improved focusing of services. The aim of the the study was to determine the variables a ffecting access to orthodontic care, and the extent to which services were delivered according to objective measures of need. Methods Analys es were undertaken for speed, appropriateness, timing of referral, dur ation and complexity of the pathway for new referrals to specialist or thodontic care. Possible explanations for the length of pathway were e xamined, including socio-demographic factors, location of residence an d the IOTN. Results A total of 405 patients were approached, of whom 4 00 (99 per cent) agreed to participate. There was an overrepresentatio n among socio-economic groups I and V among patients referred to ortho dontic treatment. By contrast, those of male sex and from socio-econom ic class IV were under-represented. This appeared to be the case irres pective of treatment setting. There was also a wide range of waiting t imes to treatment and complexity of pathway. Over a quarter of the sam ple had been inappropriately referred, and objective need as measured by the IOTN was not a determinant in the speed of access to specialist treatment. Adult patients waited longer for treatment. Conclusions Th ese results suggest that the delivery of care is neither based on obje ctive need nor equitably distributed. More appropriate directing of re sources is required, using the IOTN and agreed protocols, so that refe rrals are made to the most suitable provider.