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Persistent Orofacial Pain Attendances at General Medical Practitioners

Patients with persistent orofacial pain (OFP) can go through complex care pathways to receive a diagnosis and management, which can negatively impact their pain. This study aimed to describe 44-year trends in attendances at Welsh medical practices for persistent OFP and establish the number of attendances per patient and referrals associated with OFP and factors which may predict whether a patient is referred. A retrospective observational study was completed using the nationwide Secure Anonymised Information Linkage Databank of visits to general medical practices in Wales (UK). Orofacial and migraine Read codes were extracted between 1974 and 2017. Data were analysed using descriptive statistics, univariate, and multivariable logistic regression. Over the 44-year period there were 468,827 persistent OFP and migraine Read codes, accounting for 468,137 patient attendances, or 301,832 patients. The overall attendance rate was 4.22 attendances per 1000 patient-years (95% CI 4.21-4.23). The attendance rate increased over the study period. Almost one-third of patients (n=92,192, 30.54%) attended more than once over the study period and 15.83% attended more than once within a 12-month period. There were 20,103 referral Read codes which were associated with 8,183 patients, with over half these patients being referred more than once. Odds of receiving a referral were highest in females (OR 1.23; 95% CI 1.17-1.29), in those living in rural locations (OR 1.17; 95% CI 1.12-1.22) and in the least deprived quintile (OR 1.39; 95% CI 1.29-1.48). Odds also increased with increasing age (OR 1.03; 95% CI 1.03-1.03). The increasing attendance may be explained by the increasing incidence of persistent OFP within the population. Current care pathways when these patients do seek care from their GMP could be improved. Referrals could be encouraged at an earlier point and made to the most appropriate place to streamline care pathways which could result in improved patient outcomes.