Oral fluoride supplementation: improving practitioner compliance by using a protocol

Despite its proven benefit, oral fluoride supplementation has received little attention in the family practice literature. This study describes how one academically affiliated family practice, staffed by physicians knowledgeable in fluoride supplementation, failed to prescribe fluoride appropriately until a specific protocol was developed. Initially a pilot study consisting of a chart review and a mail and telephone survey was performed. The results indicated a compliance problem involving the physicians as much as the patients. Next, a detailed protocol for improving fluoride supplementation was developed that delegated responsibilities not only to the physicians but also to the receptionists, the nurses, and a physician's assistant. The protocol was initiated in July 1982. From July to October 1982, 40 at-risk children visited the clinic for assorted health care needs. A follow-up chart audit on these children revealed that 23 (58 percent) were currently taking fluoride, and 27 families (79 percent) had had their wells checked for fluoride. This study demonstrates the advantage of using a protocol with a team approach for increasing compliance with respect to oral fluoride supplementation.