Readiness for Teledentistry: Validation of a Tool for Oral Health Professionals

Telepsychiatry readiness assessment at the Department of Psychiatry, Dr. Soeharto Heerdjan Hospital, Indonesia

Background: The Dr. Soeharto Heerdjan Hospital, Jakarta, Indonesia, has deployed telepsychiatry since May 2022 to ensure continuity of care for its psychiatric patients. This model of service has not functioned optimally, owing to obstacles, including the absence of a registration officer, no designated consultation room, scheduling issues and challenges for patients or their representatives in using the telepsychiatry application.

OBJECTIVE

This study aimed to assess telepsychiatry readiness at Dr. Soeharto Heerdjan Hospital.

METHOD

An observational survey was conducted in April-May 2022, with a sample of 40 members of the telepsychiatry workforce, using the Telehealth Readiness Assessment (TRA) tool. Five key domains of the TRA tool are associated with the successful implementation of telehealth, including core readiness, financial considerations, operations, staff engagement and patient readiness. This tool includes a questionnaire, scoring sheet, supporting guidance and additional resources. The overall readiness score is a weighted average of the concept scores included within each of the five domains.

RESULTS

Of 40 respondents, 72.5% were females and 42.5% were between 31 and 40 years. From the total of five domains of telepsychiatry readiness, the level of telepsychiatry readiness at Dr. Soeharto Heerdjan Hospital was 70.05% or a moderate level.

CONCLUSION

Aspects of readiness that need to be improved include providing a workforce for telepsychiatry patient registration; drug delivery; scheduling; designated consultation rooms; user-friendly telepsychiatry applications and electronic media for information on telepsychiatry services.

Exploring challenges and mitigation strategies towards practicing Teledentistry

BACKGROUND

Since the beginning of the COVID-19 pandemic, many dentists have opted for Teledentistry as a mechanism for patient consultation, oral lesion evaluation, diagnosis, and monitoring. The current study explores the challenges faced and potential solutions proposed by dentists practicing Teledentistry in a developing country like Pakistan.

METHODS

A qualitative case study was carried out from January to December 2021. A purposive maximum variation sample of 10 dentists was interviewed in two focus groups. The interview guide was developed using the technology-organization-environment framework. The data was transcribed verbatim using otter.ai. The analysis involved immersion in the data and open coding. The conceptually related codes were synthesized into themes and subthemes.

FINDINGS

The study found various Personnel, Technological and Organizational challenges, and potential solutions from those practicing Teledentistry. The challenges included operational cost, minimal financial returns, lack of awareness, hardware and software support, and other challenges related to the availability of specialization, accessibility, and institutional encouragement. They suggested Institutional Based Practice, staff training, hiring, development of government regulations, and supporting infrastructures such as designated space, central registry, internet, and using/building software to provide 3D images as solutions.

CONCLUSION

Teledentists face Personnel, Technological and Organizational challenges and related potential solutions from those practicing Teledentistry in Pakistan. Government should encourage Teledentistry to reduce long-term costs, encourage preventive services and enable rural access to dental care. They should also involve all stakeholders to develop regulations for practicing Teledentistry in Pakistan.

Teledentistry as an Effective Tool for the Communication Improvement between Dentists and Patients: An Overview

Teledentistry is an online dental care service that allows patients and dentists to meet in real time, safely, without being at the same location. During the COVID-19 pandemic, real-time videoconferencing has gained popularity in the field of teledentistry, with numerous benefits for both patients and dentists. Online consultations can minimize costs, maximize time, and provide more convenient care options for both patients and dentists. When practicing teledentistry, a dentist must establish a good doctor–patient relationship. Dentists must ensure that the telecommunication solution that they choose meets their clinical requirements and complies with privacy laws. Dentists should provide adequate information to patients about the limitations, advantages, and disadvantages that may occur during online consultation. Dentists must follow guidelines and procedures regarding informed consent, patient details, personal communications, and consultancies’ privacy and confidentiality. The patient should be aware of the limitations of teledentistry, and dentists will provide the best advice possible in the absence of a face-to-face consultation. This article discusses how teledentistry could be an effective tool for dentists and patients.

Machine learning for technical skill assessment in surgery: a systematic review

Accurate and objective performance assessment is essential for both trainees and certified surgeons. However, existing methods can be time consuming, labor intensive, and subject to bias. Machine learning (ML) has the potential to provide rapid, automated, and reproducible feedback without the need for expert reviewers. We aimed to systematically review the literature and determine the ML techniques used for technical surgical skill assessment and identify challenges and barriers in the field. A systematic literature search, in accordance with the PRISMA statement, was performed to identify studies detailing the use of ML for technical skill assessment in surgery. Of the 1896 studies that were retrieved, 66 studies were included. The most common ML methods used were Hidden Markov Models (HMM, 14/66), Support Vector Machines (SVM, 17/66), and Artificial Neural Networks (ANN, 17/66). 40/66 studies used kinematic data, 19/66 used video or image data, and 7/66 used both. Studies assessed the performance of benchtop tasks (48/66), simulator tasks (10/66), and real-life surgery (8/66). Accuracy rates of over 80% were achieved, although tasks and participants varied between studies. Barriers to progress in the field included a focus on basic tasks, lack of standardization between studies, and lack of datasets. ML has the potential to produce accurate and objective surgical skill assessment through the use of methods including HMM, SVM, and ANN. Future ML-based assessment tools should move beyond the assessment of basic tasks and towards real-life surgery and provide interpretable feedback with clinical value for the surgeon.PROSPERO: CRD42020226071.

Awareness and readiness to use telemonitoring to support diabetes care among care providers at teaching hospitals in Ethiopia: an institution-based cross-sectional study

OBJECTIVES

This survey aimed to assess the awareness and readiness of healthcare providers to use telemonitoring (TM) technologies for managing diabetes patients as well as to identify associated factors in Ethiopia.

DESIGN

An institution-based cross-sectional quantitative survey was conducted by using a pretested self-administered questionnaire from February to March 2020. Data analysis used a binary logistic regression and partial proportional odds model for factor identification.

PARTICIPANTS

Randomly selected 423 study physicians and nurses.

SETTING

This study was conducted at the University of Gondar and Tibebe Ghion specialised teaching referral hospitals.

OUTCOME MEASURES

Awareness and readiness towards TM in diabetes care.

RESULT

Out of 406 healthcare providers (69.7%, n=283 nurses and 30.3%, n=123 physicians) who completed the survey, 345 (38.7%) heard about TM, when it came to readiness, 321 (25.1%) and 121 (65.5%) of respondents had average and low readiness towards TM, respectively. The result of regression analysis shows that awareness towards TM was higher among respondents who had access to a computer (adjusted OR (AOR): 2.8 (95% CI 1.1 to 7.1)), computer-related training (AOR: 4.6 (95% CI 1.63 to 12.95)) and those who had the experience of supporting patients through digital tools (AOR: 1.7 (95% CI 1.0 to 2.8)). Self-perceived innovators and those who had access to a computer, computer-related training and favourable attitude towards TM had significantly higher readiness to use TM.

CONCLUSION

The findings of this survey revealed low awareness and readiness of participant's towards TM. However, this study suggests the need of improving participant's attitudes, access to smartphones and computers and technical skills to fill this gap.

Factors Influencing Telehealth Implementation and Use in Frontier Critical Access Hospitals: Qualitative Study

Background

Telehealth has potential to help individuals in rural areas overcome geographical barriers and to improve access to care. The factors that influence the implementation and use of telehealth in critical access hospitals are in need of exploration.

Objective

The aim of this study is to understand the factors that influenced telehealth uptake and use in a set of frontier critical access hospitals in the United States.

Methods

This work was conducted as part of a larger evaluation of a Centers for Medicare & Medicaid Services–funded demonstration program to expand cost-based reimbursement for services for Medicare beneficiaries for frontier critical access hospitals. Our sample was 8 critical access hospitals in Montana, Nevada, and North Dakota that implemented the telehealth aspect of that demonstration. We reviewed applications and progress reports for the demonstration program and conducted in-person site visits. We used a semistructured discussion guide to facilitate conversations with clinical, administrative, and information technology staff. Using NVivo software (QSR International), we coded the notes from the interviews and then analyzed the themes.

Results

Several factors influenced the implementation and use of telehealth in critical access hospitals, including making changes to workflow and infrastructure as well as practitioner acceptance and availability. Participants also cited technical assistance and support for implementation as supportive factors.

Conclusions

Frontier critical access hospitals may adopt telehealth to overcome challenges such as distance from specialty practitioners and workforce challenges. Telehealth can be used for provider-to-patient and provider-to-provider interactions to improve access to care, remove barriers, and improve quality. However, the ability of telehealth to improve outcomes is limited by factors such as workflow and infrastructure changes, practitioner acceptance and availability, and financing.

Teledentistry in the diagnosis of oral lesions: A systematic review of the literature

OBJECTIVE

The purpose of this systematic review is to summarize information on the use of teledentistry in the diagnosis of oral lesions.

MATERIALS AND METHODS

A systematic literature search conducted in August 2018 included articles published until December 2018 in 4 databases. Two reviewers evaluated the search results separately. If they were uncertain as to whether to include an article, a third reviewer made the final decision. Studies related to the diagnosis of oral lesions using teledentistry were included. The methodological quality of the studies was analyzed using the Quality Assessment of Studies of Diagnostic Accuracy.

RESULTS

Eleven articles were included in the study. The selected articles were published between 1999 and 2018, predominantly in developing countries. The professionals acting as patient examiners are dental students and dentists, as well as other health professionals. Most of the patients evaluated in the studies were from rural populations or locations distant from large centers. The tools used to obtain patient data were smartphones, videoconference, email, questionnaires, histopathological exams, and telemedicine applications and systems. Most studies concluded that there is a high level of agreement between teledentistry and clinical consultation and that the use of this resource for diagnostic purposes can reduce costs and the travel time to consult a specialist personally. Nine of the 11 studies were of good quality.

CONCLUSIONS

Teledentistry has the potential to improve the care quality related to diagnosis and management of oral lesions, shortening distances between patients who need specialized diagnoses and specialists.

Factors influencing healthcare providers' attitude and willingness to use information technology in diabetes management

BACKGROUND

The use of information technologies could help to improve communications between patients and care providers, might improve overall patient management practice. However, the potential for implementing these patient management options in Ethiopia has not been well documented. This institution-based survey aimed to describe the attitude and willingness of care providers towards the use of information technologies for managing diabetes patients, and factors influencing their interest.

METHODS

A cross-sectional quantitative survey was conducted on 423 study participants from February to March 2020 at two teaching hospitals in Northwest Ethiopia, where remote monitoring patients had not been implemented. A pretested self-administered questionnaire was used to collect the required data. Other than descriptive statistics, the binary logistic regression analysis method was used to identify factors associated with attitude. Also, the negative binomial regression method was used to identify factors associated with willingness to use information technologies.

RESULT

A total of 406 participants (69.7%, n = 283 nurses and 30.3%, n = 123 physicians) were completed survey. Overall, 64% of respondents had a favorable attitude towards remote monitoring, and the majority of them were willing to use voice call (74.4%), text message (62.1%), video conference (61.3%), e-mail (60.6%), and social media (57.4%) as a source of communication to support patients. The result of regression analysis shows that having a computer (AOR = 2.3, 95% CI: [1.3, 3.8]), innovativeness (AOR = 2.8, 95% CI: [1.8, 4.3]), and practice of supporting patient by electronic technologies (AOR = 1.7, 95% CI: [1.1, 2.6]) were significantly associated with attitude to remote monitoring. Attitude towards remote monitoring (IRR = 2.3, 95% CI: 1.1-4.7), computer use (IRR = 1.3, 95% CI: 1.162-3.023), frequently searching health-related information (IRR = 1.7, 95% CI: 1.459-6.570), gender (IRR = 1.2, 95% CI: 1.0-5.1), awareness towards remote monitoring (IRR = 1.4, 95% CI: 1.1-2.7) were significantly associated with willingness to use information technologies.

CONCLUSION

Improving the intention and skill of using computers should be a major point of attention for teaching hospitals who wish to improve their care providers' attitudes to remote monitoring and willingness in using information technologies. Besides, the awareness of professionals is crucial for improving willingness.

Are Austrian practitioners ready to use medical apps? Results of a validation study

Background

As part of the mobile revolution, smartphone-based applications (apps) have become almost indispensable in today’s information society. Consequently, the use of medical apps among healthcare professionals has increased heavily over the past years. As little is known on medical app use in day-to-day clinical practice in Austria, the present study aims at closing this knowledge gap by assessing respective prevalence, readiness, and concerns among Austrian practitioners.

Methods

We conducted a cross-sectional online survey among a sample of 151 Austrian doctors (mean age 45.0, SD 12.0, 55.0% females). We developed a German study questionnaire on the basis of the Practitioner Telehealth Readiness Assessment Tool (PRAT) to assess medical app use-related readiness and attitudes, and validated it using principal component analysis.

Results

In our study, 74% of participants used medical apps on a daily basis, with clarity, ease of use, speed, and support in clinical routine mentioned as most important app features. However, the majority of participants perceived certain barriers to use medical apps. Younger participants used more medical apps, were more likely to use them during work, and yielded higher readiness scores. The most often used medical apps were Diagnosia and Embryotox (both 28.5%).

Conclusions

Nowadays, medical apps serve as an important source of information for many doctors and are especially popular among younger physicians. The omnipresence of smartphones in the smocks of healthcare workers raised awareness for potential shortcomings regarding disruption of traditional face-to-face doctor-patient interaction among all healthcare stakeholders. This study’s finding thus highlight the need for initiating a public discussion on legal and social frameworks to successfully integrate mobile apps into everyday clinical.

Readiness to use telemonitoring in diabetes care: a cross-sectional study among Austrian practitioners

Background

Telemonitoring services could dramatically improve the care of diabetes patients by enhancing their quality of life while decreasing healthcare expenditures. However, the potential for implementing innovative treatment options in the Austrian public and private health system is not known yet. Thus, we analyzed the readiness to use telemonitoring in diabetes care among Austrian practitioners.

Methods

We conducted an online survey among a purposive sample of Austrian practitioners (n = 41) using an adapted German version of the practitioner telehealth readiness assessment tool. We assessed three readiness domains for telemonitoring in the context of diabetes care, i.e. core readiness, engagement readiness, and structural readiness, and validated the German tool using principal components analysis.

Results

Study subjects perceived themselves as open to innovations and also expressed optimistic attitudes towards telemonitoring in general and offering telemonitoring-based services for their patients. Participants achieved a medium average readiness level for telemonitoring (58.2, 95% CI 53.9–62.5) and were thus in a good position to use telemonitoring, although some arguments may adversely affected its use. The top three perceived benefits of telemonitoring were enhanced quality of treatment, better therapy adjustment, and reduced travel and waiting times for patients. The top three barriers were reduced personal communication, practitioner time expenditure and equally placed poor financial compensation as well as data security and privacy issues.

Conclusion

Our data revealed that Austrian practitioners showed a quite moderate readiness to use telemonitoring in diabetes care. To further advance telemonitoring readiness among all pillars of diabetes care in Austria, joint efforts among healthcare stakeholders are required to overcome existing financial, organizational, and technical obstacles.