Nicolas Giraudeau

ASSESSING PATIENT'S PERCEPTION OF ORAL TELECONSULTATION

OBJECTIVES The evaluation of telemedicine from the patients point of view has focused on the patient pathway and patient satisfaction. However, research in this field does not provide us with the means to assess a patients perception of the procedure if their reasoning ability is impaired. In this study, we use direct observation of a patients behavior and mood to assess their perception of an oral teleconsultation procedure. METHODS This study has been conducted in the context of a pilot project using an asynchronous teleconsultation to improve access to dental care for the dependent elderly, disabled people, and prisoners, some of whom may be cognitively impaired. We use a direct observation form consisting of five behavioral variables and eight affect variables to reflect the patients experience of the oral teleconsultation procedure. RESULTS A total of 135 patients were evaluated; 10 refused the procedure. Psychotic patients (n = 33) had a somewhat negative experience during the oral teleconsultation procedure. Patients who were not psychotic had a positive experience; this decreased as we moved from the autonomous to the semi-autonomous and then to the dependent sub-group. Some gender differences were also noted. CONCLUSIONS Improving evidence on evaluating the acceptance of the cognitively impaired is required to improve the technology development process so that it can be translated into an improved patient experience and adherence. Although the study was specifically focused on teledentistry, the approach described in this study could be adapted to other forms of teleconsultation.

Teledentistry and Orthodontics

Teledentistry can be considered as a valuable tool to assist isolated or disadvantaged populations and to improve access to oral healthcare. The application of teledentistry has demonstrated interesting results in many fields of Dentistry. The objective of this chapter is to review the literature on the attempt to associate teledentistry and orthodontics. Most of the collected studies described and evaluated teledentistry as a means to improve effectiveness of orthodontic referrals and consultancy. Other researches focused on evaluating the use of teledentistry for remote diagnosis, monitoring, and motivation of orthodontic patients. After critically reviewing the collected evidence, it was considered that teledentistry might be used as a helpful tool for referring patients or providing consultancy to general practitioners. The possible benefits included the ability of decreasing the number of inappropriate referrals and encouraging previously trained general practitioners to treat cases. Minor issues, such as the small likelihood of patients being neglected, as well as the lack of standardization during records preparation, are still a concern. There is a clear trend among professionals toward a supportive position of teledentistry use allied with orthodontic practice. Nevertheless, most of the general practitioners still present concerns in relation to workload increase. Literature is still scarce on cost studies of teledentistry. It is therefore suggested that future researchers address that gap in addition to conduct methodologically stronger studies focused not only on the financial aspects of teledentistry, but also on the clinical outcomes of the treatment provided with the aid of this system.

Licensing, Regulation, and International Movement of Oral Health Professionals (OHPs)

Oral health practice is subject to specific laws and regulations. Clinicians need to be aware of a range of issues involving malpractice and complaints that impact on operations and the provision of health services to their patients. This chapter presents an overview of some of the licensing and regulatory practices for Oral Health Professionals (OHPs) around the world, including some specific examples from Australia and Chile, as case studies. The chapter also provides an overview of major areas of the law from a global perspective, with attention to oral health. The primary objective of these laws and regulations is the protection of the health and safety of the public. As the political and socio-demographic framework or conditions change, these guidelines, laws, and regulations should also evolve, but must continue to ensure high standards of safety in health service delivery.

Patient satisfaction with E-Oral Health care in rural and remote settings: a systematic review protocol

BackgroundIndividuals living in rural and remote settings face oral health problems and access-to-care barriers due to the shortage of oral health care providers in these areas, geographic remoteness, lack of appropriate infrastructure and lower socio-economic status. E-Oral Health technology could mitigate these barriers by providing the delivery of some aspects of health care and exchange of information across geographic distances. This review will systematically evaluate the literature on patient satisfaction with received E-Oral Health care in rural and remote communities.MethodsThis systematic review will include interventional and observational studies in which E-Oral Health technology is used as an intervention in rural and remote communities of any country worldwide. Conventional oral health care will be used as a comparator when provided. Patient satisfaction with received E-Oral Health care will be considered as a primary outcome for this review. Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE and Global Health will be searched using a comprehensive search strategy. Two review authors will independently screen results to identify potentially eligible studies and independently extract the data from the included studies. A third author will resolve any discrepancies between reviewers. Two independent researchers will assess the risk of bias and the Grading of Recommendations Assessment, Development, and Evaluation.DiscussionThe potential implications and benefits of E-Oral Health care can inform policymakers and health care professionals to take advantage of this technology to address health care challenges in these areas.Systematic review registrationPROSPERO CRD42016039942.