By Claudia L. Cruz, DDS, MPH
Why is the external transfer process for orthodontic patients so important?
- Concomitant increase in immigrant population and mobility of society.
- Prolific growth of orthodontic profession and variety in appliance therapy.
- Lack of treatment continuation may be detrimental to oral health.
- It is critical to raise awareness of the transfer process among local, international professionals and external transfer subjects.
- To improve the manageability of treating transfer patients.
A large number of people immigrate due to Lee’s “push-pull” factors. Push factors cause the people to move out of their countries, and pull factors attract them to other areas. The most significant pull factors are education, jobs, and better economic opportunity. Based on whether the migration is permanent or temporary, immigrants can be classified into one of four categories:
- Naturalized
- Student's Visa
- Work Permit Holders
- Visitors
In 2009, 37 million people immigrated to the United States. Big cities are the initial resettlement areas for refugees and immigrants. The immigrant population faces challenges in access to health care in dense urban areas: less likely to have insurance and a primary care provider, difficulty getting needed care, language barriers, duration of residence in the United States, income, and legal status.
A study conducted by Pollick et al. in 1987 reported that the mean time from immigration to a first dental screening was 10.8 months for refugees and 5.3 for nonrefugees.
To obtain an outlook of the current external transfer process of active orthodontic patients to New York City from the perspective of orthodontists practicing across New York City’s five boroughs, a project was designed to gather qualitative data through a structured dual moderator focus group comprised of orthodontists who agreed in advance to participate. Participants had an average private practice experience of 24 years in the area, representing communities of different boroughs from different social backgrounds.
Results demonstrated the external transfer sources: international students, seasonal workers, and employees working in more than one country with or without children. The referral sources consisted of general practitioners, international orthodontists, friends, and relatives of the patient. Among considerations when accepting active external transfer patients, orthodontists considered quality of records transferred, treatment and oral health status, financial status of the case, and patient willingness to continue.
The most difficult aspects when accepting external transfer patients were the accuracy of the treatment plan and managing the existing treatment plan together with the diagnosis having been previously made. In the case of long unsupervised external transfer cases, participants stated that the quality of treatment is compromised when compared to cases done in a timely manner. The participants recommended creating guidelines for external transfer cases, which would include transfer of records and fee scheduling.
Even though an overseas colleague can find a good match for patients to continue care in the United States, it is not enough to overcome all the needs of the immigrant patient (case diagnosis, technique, location, finances, language, and other important aspects). Knowing the challenges of a community is important, as with the presence of foreign-born population or a specific foreign-born subgroup. The nonexistence of guidelines for external transfer patients — subjects from another country along with the growing challenge in practice management due to the prolific growth of the orthodontic profession, the variety in appliance therapies, and insurance coverage of the treatment — make the transfer process a challenge for both orthodontists and immigrant patients.
A proper transfer of immigrant patients is essential for a smooth transition, especially with an increasingly mobile society. Well-defined guidelines are needed to have a streamlined process for orthodontic external transfer patients.
Author bio
Dr. Claudia L. Cruz, DDS, MPH, became a clinical assistant professor of orthodontics in the postgraduate orthodontic program at New York University School of Dental Medicine after completing her residency in orthodontics. She recently obtained a global MPH degree from New York University. As clinical professor and assistant director of the International Orthodontic Program at the NYU College of Dentistry. For almost a decade, Dr. Cruz has trained many orthodontists in early treatment along with one of the most disseminated orthodontic techniques around the world, the Alexander Technique. In addition to her experience as a practicing orthodontist, her current research activities include diverse ethnic backgrounds, esthetic evaluation and final outcome, the transfer process of active orthodontic patients to the United States, quality of life in orthodontic populations, and implementation of orthodontic care programs in underserved areas. Dr. Cruz lectures at a variety of meetings and universities in South America and Europe. She is an active member of the American Association of Orthodontics and The World Federation of Orthodontics.
References
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New York City Department of City Planning. Foreign-born in the New York Metropolitan Region. Accessed on Oct. 9, 2010.
National Geography Xpeditions. MIGRATION: WHY PEOPLE MOVE. Accessed on Oct. 9, 2010.
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Pollick FH, Rice JA, Echenberg D. Dental health of recent immigrant children in the Newcomer schools, San Francisco. American Journal of Public Health, June 1987; 77(6).
