Objective Primary health care (PHC) professionals must care for patients with oral problems while performing gatekeeping for specialized care. We explored the effect of a strategy combining referral protocols and teleconsultations on a waiting list.

Study design This retrospective cohort study analyzed data from PHC to specialized oral medicine care from May/2014 to May/2016. The program started in May/2015, and referrals were divided into control and exposed groups. The median waiting time for in-person consultation and the proportion of referrals managed in PHC were analyzed for general and priority cases.

Results There were 1464 referrals. The median waiting time for specialized consultation was reduced from 212 days (95%CI 196-227) to 131 days (I95%CI 95-166). For priority referrals, the control group had 37 days (95%CI 0 - 89) of median waiting time, and the exposed group had 12 days (95%CI 6 - 17).

Conclusions Structured referral protocol and professional-to-professional consultations for oral disease improve referral waiting times. This benefit seems related to improving PHC efficacy.

As a potential conflict of interest, the authors declare that they are collaborators of TelessaúdeRS.

This research was supported by grants and material support from the following Brazilian agencies: Committee for the Development of Higher Education Personnel (CAPES), National Council for Scientific and Technological Development (CNPq), Postgraduate Program in Epidemiology at the School of Medicine of the Federal University of Rio Grande do Sul, Postgraduate Research Group at the Hospital de Clinicas de Porto Alegre - FIPE HCPA. TelessaudeRS is funded by multiple sources, including Brazilian Ministry of Health and Rio Grande do Sul state health agency.

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

Ethics committee/IRB of Hospital de Clinicas de Porto Alegre gave ethical approval for this work. Due to the nature of the data, direct patient consent was exempted.

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I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

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I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.

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The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request and clear analysis plan.