Teleconsultation – the pandemic mantra or the new norm?

V Shwetha; S Sujatha; N Rakesh; T Pavan Kumar; P Vaishnavi; P Sreekanth

doi:10.4103/jhnps.jhnps_4_21

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ORIGINAL ARTICLE

Year : 2021 | Volume : 9 | Issue : 2 | Page : 142-146

Teleconsultation – the pandemic mantra or the new norm?

V Shwetha, S Sujatha, N Rakesh, T Pavan Kumar, P Vaishnavi, P Sreekanth
Department of Oral Medicine and Radiology, Faculty of Dental Sciences, Ramaiah University of Applied Sciences, Bengaluru, Karnataka, India

Date of Submission	16-Jan-2021
Date of Acceptance	16-Feb-2021
Date of Web Publication	17-Dec-2021

Correspondence Address:
Dr. V Shwetha
Department of Oral Medicine and Radiology, Faculty of Dental Sciences, Ramaiah University of Applied Sciences, New BEL Road, Bengaluru - 560 054, Karnataka
India

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/jhnps.jhnps_4_21

Abstract

Background: December 2019 witnessed an outbreak of coronavirus disease. This disease soon intensified its spread as a pandemic engulfing the health and economic status of countries worldwide. The route of transmission of this virus is through droplet spread or contact with secretions or infected surfaces. The health-care professionals were the most vulnerable group for contracting and spreading the infection. The dental professionals who come in close contact with oral secretions during various operative procedures were also at high risk of contracting the infection. Governments across the globe issued a lockdown to curtail the spread of the infection. To render essential and emergency health services, teleconsultation provided a lot of assistance in health management. Methodology: A descriptive cross-sectional study utilizing a validated questionnaire survey was used to assess the perceptions of dental health professionals regarding the utility of teleconsultation during the pandemic. The survey also assessed the drawbacks of teleconsultation and its implications on practice in the near future. 504 dentists answered the questionnaire and descriptive statistical analyses were used to analyze the data. Results: The response rate was 63% (504 out of 800). 90.1% of the dentists felt that teleconsultation was definitely better than traditional care services during the pandemic. Majority (61.15%) of dentists felt that teleconsultation was extremely helpful during the pandemic period to manage patient-related queries and provided the satisfaction of discharging their duties toward the patient. They felt that teleconsultation services could be extended even beyond the pandemic period and could have promising implications in future. Conclusion: Teleconsultation proved to be a feasible alternative to in-person appointments during the pandemic and helped in reducing viral transmission and compliance with social distancing measures. It also holds promise for future implications in routine dental practice. With further improvements in technology and application of artificial intelligence in teleconsultation could improvise remote patient monitoring and diagnosis and treatment planning in the near future and prove us a useful tool.

Keywords: Lockdown, pandemic, teleconsultation

How to cite this article:
Shwetha V, Sujatha S, Rakesh N, Kumar T P, Vaishnavi P, Sreekanth P. Teleconsultation – the pandemic mantra or the new norm?. J Head Neck Physicians Surg 2021;9:142-6

How to cite this URL:
Shwetha V, Sujatha S, Rakesh N, Kumar T P, Vaishnavi P, Sreekanth P. Teleconsultation – the pandemic mantra or the new norm?. J Head Neck Physicians Surg [serial online] 2021 [cited 2023 Jun 4];9:142-6. Available from: https://www.jhnps.org/text.asp?2021/9/2/142/332717

Introduction

India and other nations globally witnessed an outbreak of SARS CoV-2 infection in January 2020. Although the cases were initially detected in Wuhan China. Virus has spread to many countries worldwide. The transmission of the virus occurs primarily through the respiratory droplets or aerosols and also through infected surface contact. The respiratory transmission catapulted the number of infected people with the disease. Due to the nature of the virus to attack the lower respiratory tract, patients may initially present with symptoms of fever, dry cough, and dyspnea. However, the symptoms could range from mild to significant hypoxia resulting in acute respiratory distress syndrome. These respiratory symptoms could be progressive and could also result in death within a short span of time. Considering the higher mortality rate associated with the disease, the World Health Organization declared this disease as a pandemic and Public Health Emergency of International Concern, and governments across the world announced a lockdown and social distancing to control the spread of this disease.^[1],[2]

In this situation, escalating the virtual care or consultation as a replacement for physical appointments for outpatients became the need of the hour.^[3] Although telemedicine is not a new concept and has been used in health care, many dental health-care professionals were aware of the benefits and use of teledentistry.^[2],[3],[4] This study explores the use of teleconsultation and its use by dentists during the COVID-19 pandemic lockdown and its future implications in Bengaluru city.

Methodology

A cross-sectional survey-based study was developed to obtain information about feasibility of teleconsultation, its advantages, disadvantages, and future implications to the dentists across Bangalore. The electronic questionnaire was designed by two oral medicine specialists and was validated by an external subject expert. The survey gathered information regarding perceptions and attitudes regarding the application of teleconsultation during the pandemic lockdown period and its future implications.

A mailing list of practicing dentists across Bengaluru was obtained from the available records of dental association bodies. A total of 800 dentists were registered for the survey after obtaining informed consent for participation. The data were stratified according to gender, qualification, and practice-related information to obtain a representative sample of the dental professionals in Bangalore. The survey was circulated to all dentists through E-mail. A consent to participate in the survey was sought along with the e-questionnaire. 21 questions regarding teleconsultation and its feasibility were included in the questionnaire. The responses were analyzed using descriptive statistics.

Results

Of the 800 mailed participants, only 504 responses were complete as around 190 did not respond and the rest 106 dentists did not practice or were only associated with academic institutions or other jobs and replied of not using teleconsultation yet. Of the 504 responses, 242 (48%) of them were specialist who had completed their postgraduation and were practicing, 197 (39%) were general practitioners, while 65 (13%) were postgraduates still pursuing their postgraduate studies in various institutes.

55% of dentists had used teleconsultation even before the lockdown. However, 45% had started using it only after the lockdown was called as it was the only means to communicate with their patients for emergency reasons. Tooth pain (63.1%) was the dominant reason for patients to consult dentists through teleconsultation, while ulcers constituted 17.9%, tooth replacements and TMJ pain constituted 41%, and tooth fractures and other complaints such as avulsions constituted a smaller proportion of 5%. Odontogenic or tooth-related pains are often extremely painful. Medical management of these emergency conditions through teleconsultation helped alleviate pain to many patients during the pandemic.

Many practitioners (362 = 71.8%) felt that more number of patients consulted them regarding dental health-related queries during the pandemic lockdown while 140 (27.8%) felt that there was no increase in patient queries during the lockdown period. Majority of the practitioners (367 = 72.8%) did not face any difficulties in time scheduling for teleconsultation, while 137 (27.2%) had some hiccups in scheduling for teleconsultation.

Although 310 (61.5%) were comfortable to face the camera and conduct the teleconsultation, a few 194 (38.5%) expressed concern over being at ease during teleconsultation. 78.4% of the dentists felt that teleconsultation services addressed the chief complaint of patients, while 11.7% felt that teleconsultation could address chief complaint of patient to some extent and 9.9% felt that teleconsultation was not able to address the chief complaint of the patient.

A major proportion (90.5%) of dentists felt that no important patient details were missed out in the case history taking during teleconsultation, while 9.5% felt that there were chances of missing out important patient details during teleconsultation interviews. 95.4% of the clinicians did not find any errors while gathering digital records of patient-related data through teleconsultation but 23% felt that there could errors in data interpretation in teleconsultation.

62.1% of dentists felt that digital copy of investigations and blood test could suffice for accurate diagnosis without in-person clinical examination while 29.2% did not agree to this and felt that clinical examination could not be overlooked. However, a small portion 8.7% felt that sometimes, the clinical examination could be overlooked and the necessary investigations could be sufficient for arriving at a diagnosis. They felt that in emergency situations for pain control, digital radiographs could help in diagnosing the disease. 90.1% of the dentists felt that teleconsultation was definitely better than traditional care services during the pandemic, 5% did not agree completely, while another 5% felt the advantage of teleconsultation over traditional care services to some extent. 95% of the dental professionals agreed to have the technical skills required for online patient management while 5% denied having any technical skills for online patient management. 90.4% felt that necessity of having a questionnaire handy to forward to patients before the actual in-person teleconsultation interview, 9.9% denied on this and felt that the details could be gathered during the teleconsultation interview itself. 54.8% of dentists felt the need for medical transcription during their teleconsultation services, and 45.2% did not feel the necessity for any such services. When considering the barriers faced during the teleconsultation services offered, 64.3% felt that patients preferred physical and in-person examination over teleconsultation, 15.9% opined that dentistry is a skill-based profession which requires manual work and cannot be done online, 6.9% expressed concerns over lack of computer skills among dentists, and 3% expressed concerns over high costs to develop the system.

81.9% of the dentists did not refer the patient to any other specialist following teleconsultation, while18.1% referred the patients for needful treatment to concerned specialists. Most of the dentists (71.8%) expressed their teleconsultation experience to be satisfactory, while 28.2% were not satisfied with their teleconsultation experience. 63.1% of dentists revealed that they were able to build a good rapport with their patients through teleconsultation while 36.9% faced difficulties with rapport building through teleconsultation for new patients. 63.5% of dentists found the technical quality of their teleconsultation very good, while 24.6% rated it as good, 8.3% rated it as fair, and 3.6% rated it as poor. 63.75% were satisfied with the quality of treatment advocated through teleconsultation while 9.3% rated it as very good, 3% rated it as excellent, 205 graded it as fair, and 4% rated it as poor. Overall, 61.15% of dentists felt that teleconsultation could be used routinely in dental practice even after the pandemic, while 38% did not feel the necessity to continue teleconsultation after the pandemic was over. The results have been summarized in [Table 1].

Table 1: Descriptive statistics

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Discussion

Tele means remote and teledentistry is the delivery of dental diagnosis, care, and guidance through information technology.^[2] Dealing with the corona crisis has put all health-care workers at the upfront to manage the disease. The imposed lockdown to curtail the spread of the disease and to promote social distancing leads to many repercussions on the daily dental health needs of various patients. The risk of contracting the viral infection during routine dental procedures generating aerosol was high among dentists.^[2] Hence, scaling up virtual care or teledentistry became a necessity during these trying times.^[3],[4]

Replacing physical appointments with virtual teleconsultation will significantly help in reducing or restraining the spread of viral infection. Teleconsultation has added advantages of visual connectivity which enables the clinician not only listen to the patients' query but also visually see it to complement his diagnosis. Teleconsultation enables initial screening and triaging of patients into infectious and noninfectious category, so the clinicians can provide services to the noninfectious category of patients. Patients with any form of symptoms of COVID-19 infection confirmed through teleconsultation can be deferred treatment with symptomatic management of dental infections and followed up at a later date for in-person management.^[3],[5],[6]

Teleconsultation services helped in maintaining virtual care services to the needy patients and helped them cope with their emergency dental health needs. Appropriate medical management and home care instructions could be delivered through teleconsultations for patients whose dental treatment can be delayed.^[4] Teledentistry has not only enhanced the quality of management of dental patients but also made possible their partial or complete management at distances of kilometers away from health-care centers or dental clinics.^[4],[7],[8]

The majority of dental practitioners included in our study opined that teleconsultation facilitated better delivery of their services during the pandemic crisis. It gave them the satisfaction of discharging their duties in these trying times along with safeguarding their own health too. Some practitioners expressed that a few of their patients also insisted on using teleconsultation before their personal appointments even after the pandemic is over as it gave them an insight for the appointment and their expectations from the treatment could be addressed.

Some of the barriers faced by practitioners in this study included the installation of dedicated softwares for integration of electronic patient health records and related data. Ensuring safety and confidentiality of patient information were some of the other challenges confronted by the dental health professionals. Merging patient appointments, laboratory data, revisits, and establishing secure internet and video calling facilities were other barriers. Although as reported in other studies, our study also reported some discrepancy in opinion regarding accurate diagnosis.^[8],[9] This could be overcome by following set protocols and suitable training sessions to equip the dental practitioners to diagnose the disease through real-time video consultation. Additional photography skills to reproduce the clinical scenario for further discussions or referrals may also be an added requirement.

Teledentistry holds promise in monitoring postoperative treatment outcomes through video consultation, provide educational videos for future maintenance, and also, record oral health status for further follow-up. Remote diagnosis as well as follow-up is a reality today due to teleconsultation. Home maintenance instructions as well as demonstrations and videos can be delivered through teleconsultation.^[4],[10]

Interdigitation of teledentistry comprising telescreening, teletriage, and teleconsultation which can be accomplished through telephonic conversations with the patients helps in segregation of patients into infective and noninfective categories. Recording patients' detailed medical history, current medical status and determining the status of the present dental complaint, the emergency of the dental procedure sought, remote assessment of the clinical condition with suitable radiographs and photographs shared digitally and suitable medical management with prescription of medications, and home care instructions can be accomplished via teleconsultation.^[5],[6],[11]

Enquiring about patients symptoms during reminder calls and rescheduling nonurgent appointments will reduce the footfall into the dental office and reduces the risk of cross infection between patients and between patients and clinicians.^{[5],[12],[13]}

Conclusion

Our study also highlighted the benefits of teleconsultation over in-person appointments during the pandemic era. Majority of dentists included in our study felt that more number of patients consulted dentists through teleconsultation during the pandemic, and most of them also felt that teleconsultation was able to address the chief complaint of the patients. The benefits of remote screening and emergency medical management through teleconsultation were heralded as the primary advantages in the study. With the risk of cross contamination during the pandemic, teleconsultation was able to render essential medical services despite the lockdown. Although some dentists did face communication problems, internet connectivity, lack of readymade questionnaires for teleconsultation, maintaining patient confidentiality and apprehension regarding costs and lack of hands on training as barriers, teleconsultation helped most dentists in triaging and emergency management of patients. Most practitioners included in the study also felt that teleconsultation services could also help in postoperative follow-up and its use could be extended beyond the lockdown also for routine clinical practices in the future. Teleconsultation which achieved a giant leap during this pandemic has definitely proven beyond doubt the usefulness and utility during such crisis situations. More so, its proven advantages definitely imply its future applications to routine dental practice.

Newer strains of the virus are being discovered every day, and the fact that more complex strains of the virus may be hiding in the environment adds to the uncertainty. It's even more likely to stick to practises like teleconsultation and be prepared to deal with challenging clinical situations. The day may not be far when teleconsultation could become a norm in our routine clinical practice in the near future.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

Disclosure

This material has never been published and is not currently under evaluation in any other peer-reviewed publication.

Ethical approval

The permission was taken from the Institutional Ethics Committee before starting the project. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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