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’Where did the time go?’ – an analysis of orthodontic care in a district general hospital over a 24-year period Lance R O Hale Dental Update 2024 7:4, 707-709.
A longitudinal prospective analysis was carried out within a District General Hospital's Orthodontic Department over the entire career of a Consultant Orthodontist, using the IOTN and PAR indices, to monitor continuously the ‘appropriateness’ and ‘quality’ of orthodontic treatment undertaken. Following the retirement of that Consultant, the cumulative results are presented. The results confirm that referrals to the Department were appropriate, demonstrate a generally high standard of treatment for a large number of patients over that period, and a trend towards the treatment of more complex cases, enabling some conclusions to be drawn.
Clinical Relevance: This paper demonstrates the recent level of activity and quality of an Orthodontic Service within a District General Hospital.
Article
Over the last 20 years or so it has become increasingly important for clinicians to be able to justify their treatment and demonstrate a high standard of outcome in that treatment. Quite apart from any natural wish on the part of the service provider that this should be so, this has now come to be encompassed by government objectives such as Clinical Governance, and the need to be able to demonstrate clinical effectiveness in the annual appraisal process.
Orthodontics was an early leader in this process with the development in the late 1980s of two indices, to allow reproducible qualitative assessment of orthodontic treatment need, and the clinical outcome of that treatment.
These two indices, the Index of Orthodontic Treatment Need (IOTN)1,3 and the Peer Assessment Rating (PAR)2,4 were developed from 1987 onwards by Shaw et al, and are now so well known as not to require detailed description. Briefly, the IOTN is an index of treatment need for individual patients, and can also be used to assist in their allocation to an appropriate treatment facility. It has two parts:
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