|Year : 2020 | Volume
| Issue : 4 | Page : 258-262
Feasibility assessment for using telehealth technology among dentists and general population in Satara district, Maharashtra
Ankita N Mane1, KM Shivakumar1, Vidya Kadashetti2
1 Department of Public Health Dentistry, School of Dental Sciences, Krishna Institute of Medical Sciences Deemed University, Satara, Maharashtra, India
2 Department of Oral Pathology and Microbiology, School of Dental Sciences, Krishna Institute of Medical Sciences Deemed University, Satara, Maharashtra, India
|Date of Submission||28-Jan-2020|
|Date of Decision||15-Mar-2020|
|Date of Acceptance||25-Aug-2020|
|Date of Web Publication||13-Oct-2020|
K M Shivakumar
Public Health Dentistry, School of Dental Sciences, Krishna Institute of Medical Sciences Deemed University, Malkapur, Karad, Satara - 415 110, Maharashtra
Source of Support: None, Conflict of Interest: None
Background: In this era of modern medicine, teledentistry has been constantly changing with the advent of information and technology. Teledentistry is a part of telemedicine. Teledentistry has many branches such as telestomatology, teleradiology, telepathology, tele oral surgery, and teleorthodontics. Teledentistry uses information technologies and communication system to deliver health-care services to people. Materials and Methods: A cross-sectional analytical study was conducted among the all dental specialist and people related to dental health service of Satara district. Respondents were given a brief introduction to the purpose of survey in an electronic format (dentist) and physical format (general population). Bulk of questions were focused on two domains (1) need for telehealth technology (2) interest in using telehealth technology for dental care delivery. The Collected information is subjected to descriptive statistical analysis. The Chi-square test was used to test the association of variables for dentists and general population. Results: Results showed great need of telehealth technology to overcome the obstacle in providing sufficient oral health services to the rural and underserved population as well as positive response from the dentist toward teledentistry. Out of 196 general population and 60 dentists, it is not easy for 67% general population to visit dentist due to difficulty of basic transportation services. Moreover, 56% people have no access to dentist only. 80% of dentist is willing to participate in teledentistry program if it ever comes and 83.33% dentists think it can improve overall efficiency of dental health-care services. Conclusion: Unwillingness and attitude among local dental practitioners can be changed through increasing scope of education regarding teledentistry at the central government level through preparing legislation.
Keywords: Dentists, rural population, teledentistry, telemedicine
|How to cite this article:|
Mane AN, Shivakumar K M, Kadashetti V. Feasibility assessment for using telehealth technology among dentists and general population in Satara district, Maharashtra. Indian J Dent Sci 2020;12:258-62
|How to cite this URL:|
Mane AN, Shivakumar K M, Kadashetti V. Feasibility assessment for using telehealth technology among dentists and general population in Satara district, Maharashtra. Indian J Dent Sci [serial online] 2020 [cited 2022 Jul 2];12:258-62. Available from: http://www.ijds.in/text.asp?2020/12/4/258/298028
| Introduction|| |
Around 30,570 dental graduates and post graduates practice in various sectors of country according to the article published by NCBI in 2016. The current status of dental graduates in India by S Yadav in 2016, despite the number of professionals the rural population and the vulnerable sections still suffer from lack of availability of basic oral health care facilities. Reasons for available dentist population ratio in the rural areas are mainly migration of qualified professionals to urban areas. The world health statistics 2012 released by the WHO stated that India has <1 dentist per 10,000 people in the urban area and this ratio falls to one dentist per 150,000 people in the rural area. This leaves the rural and vulnerable groups like the elderly with limited access to oral care. It has been observed that the number of visits to the dentists of such groups is minimal and is need based. The available oral health services at primary health care level are inadequate to cater to the needs of the population.
Recently, dental care is transformed into technology and telehealth care. The initial concept of teledentistry developed as a part of blueprint for dental informatics in 1989 conference funded by Westinghouse electronic system group in Baltimore. Teledentistry is a combination of telecommunication and dentistry, which involves the exchange of information and treatment planning over the remote distance. Technologies currently available are beginning to change the concept of dental care delivery through various ways such as, real-time consultation or store and forward method. In real-time consultation as the name suggests, this type of consultation occurs live where the dentist can directly communicate with the patient or another care-giver located at the remote location. Real-time consultation requires advanced digital set up at both ends, another alternate type of teledentistry is store and forward method in which stored data of patient's history, photographs of relevant areas and X-ray radiographs, tomography scans, magnetic resonance images can be stored and transferred to consulting clinician or beneficiary locations.
It would increase the accessibility of specialists, besides decreasing time and cost associated with specialty consultations. This can also help to decrease the isolation of practitioners by providing peer contact, specialist support, and postgraduate education. Teledentistry can be successfully implemented in different oral health settings to deliver improved health outcomes and positive dentist-patient experience. It has the potential to reduce the number of inappropriate referrals by screening patients to ensure that only those who need to see a specialist go on waiting lists. This ensures the efficient use of scares health resources, improving specialist productivity and supporting enhanced oral health across society.
Very few studies had done in India for teledentistry implementation and some of them assessed knowledge and attitude among patients and dentists. Teledentisrty, knowledge and attitude among dentists in Udaipur, India by Ramesh et al. where they stated positive attitude of dentists toward the use of this technology.
The health university in Western Maharashtra where the current study was designed has telemedicine consultations for medical field in place. This study has been conducted to assess the feasibility and interest of the patients and the dental practitioners alike in teledentistry as a viable option to enhance the accessibility of the rural population to oral health care consultations.
To evaluate the feasibility assessment for using telehealth technology among dentist and general population in Satara district.
| Materials and Methods|| |
Study design and population
A descriptive cross-sectional study was conducted among general population (n = 196) and individuals of all dental speciality (n = 60) in Satara, India, in the month of August 2018. This study protocol was reviewed by the ethical committee of Krishna Institute of Medical Sciences and Hospital and was granted ethical clearance (protocol number 0310/2017-2018), and informed consent of participants was taken.
A pilot study was conducted before the main study, and based on the results of the pilot study, the sample size calculation was done by using the following formula.
(Z: Standard variate at 95% Confidence level = 2; p: prevalence = 5; q: 100-5 = 95; d: allowable error = 10% of 'p').
The sample size was found to be 50 and additional sample (10%) was considered due to the variation in prevalence with age and geographical area which gives rise to 55 and the sample size was rounded to 60 for dentist. Similarly, it was 196 for general populations.
- Dental health-care providers (MDS, BDS with more than 2 years of clinical experience
- General population who have visited dentist ever in their life or regular dental check-up and were able to read English and Marathi, aware of smartphones or internet).
People who did not consent to be the part of study were excluded from the study.
Ethical approval and official permission
This study protocol was reviewed by the ethical committee of Krishna Institute Of Medical Sciences and Hospital and was granted ethical clearance.
The reliability of the questionnaires was assessed by using Test-retest, internal reliability, and the validity of the questionnaires was also determined. Overall, internal reliability (Cronbach's alpha = 0.92) and test-retest reliability (0.92) were found to be high. Significant differences (P < 0.01) between the scores of the two groups of study population indicated that the questionnaire had satisfactory construct validity and reliability. The survey included mixture of open-ended and closed-ended questions (total number of questions for general population-16 and total number of questions for dental health-care providers-12).
- Need for telehealth technology (9 questions from both questionnaire)
- Interest in using telehealth technology for dental care delivery (7 questions from both questionnaire) both questionnaires are focused on these two main domains.
The respondents from the general population were asked to consider their willingness to seek telehealth consultants and their willingness to use services. Mixed type of questionnaire with both open and closed ended questions was translated in Marathi and then was back translated to English to assess the face and content validity.
A convenience sample of participants was recruited from the local public areas (main street, general hospitals, markets and bus stops) form overall Satara district mainly where local general dentist practice. To collect the samples from the general population, participants were required to speak in Marathi which is the common language in this area, be able to communicate properly through two way communication and through digital communication ways such as WhatsApp, email, and SMS (major involvement of public in social media even in rural areas actually was useful to simplify sampling method and to reach maximum people to get involved in the survey), for participants below the age of 18 their guardians were asked about all the information required.
The Statistical Package for Social Sciences software (version 21.0; SPSS, Chicago, Illinois), and descriptive variables were tabulated. The Chi-square test is used to test the association of variables for dentists and general population.
| Results|| |
Results from the date collected from the survey questionnaire for general population.
Basic transport services available – 51% people use private transport services and rest use government transport services to see health-care services.
[Figure 1] showed advice to visit specialist most frequently, i.e., 35% in for orthodontics followed by prosthodontics, pedodontics, periodontics, and the other specialists.
Ease of access to specialists. Not easy to visit specialists for 67% of people. 56% people claim about unavailability of dental health-care services in nearby areas, 58% need speciality consultation and 67% people are not able to access proper oral health-care services. Following above all the general characteristics of public, we also investigated a use of online pathways of consultation and health information transfer by the dentist and people, where 95% people never used it and 5% people claimed of using it before, likewise, we found out about the knowledge of telehealth among general population that is just 3% which means 97% people in this area have no clue about telehealth.
Summarizing a result from the survey of general population and after acknowledging them about telehealth, 96% people think it's a better and useful option.
Results from the data collected from the survey questionnaire for dentists.: 46.66% dentists are working as a faculty in dental colleges in this area, whereas other 53.33% dentists are practicing as a dental practitioners but not as a faculty in any dental college. Dental speciality 60% general dentists- 40%.
[Figure 2] shows the frequency of needing specialist consultant per year where dentist also say orthodontics, i.e., 34.1% is the most needing consulation speciality followed by oral surgery, con-endo, prosthodontics, and pedodontics. Awareness of telemedicine or teledetistry – Majority of dentists are aware of teledemedicine and teledentisrty programs around the globe, but only 39% dentists are aware of any of those programs in India.
Willingness to participate in teledentistry program. 80% dentists are willing to participate in teledentistry program and rest are not willing. [Figure 3] shows common reasons for not participating in teledentistry program, 83.33% dentists say the most common reason is unavailability of technological equipment followed by the lack of training among general dentists in rural area.
|Figure 3: Reasons of not willing to participate in teledentistry program|
Click here to view
[Figure 4] shows what are the most common ways by which teledentistry can improve overall dental health-care services. 78.33% dentists say it can improve over efficiency of oral health care service; other most common ways are improved cost efficiency, improved patient satisfaction, and higher patient retention.
|Figure 4: Ways in which teledentistry can improve dental health services in rural and underserved area|
Click here to view
The limitations include difference in understanding and interpretation among the general population and unconscientious responses.
| Discussion|| |
Most studies investigating perceptions of telehealth have focussed on patients or clinicians who have had experience with telehealth consultations., In this study, we sought to understand the broader community awareness and perceptions of telehealth in a rural town of Satara district. As compared to this number vulnerable sections of our country, both urban and rural population, under basic oral health-care facilities are much less with expected reasons such as lack of access, migration of educated and qualified professionals away from the rural area, lack of public transport services, lack of awareness, and poverty.
Krishna institute of medical sciences located in small town like karad is comparatively accessible multi-speciality hospital in Satara district, where people from all over the districts visit to seek advanced speciality health-care services. Medical authorities of this institute had also tried to use telehealth technology for higher speciality consultation from international consultants through video conferencing for educational and treatment plan purpose. Along with general health of underserved population in this area, oral health should equally be a priority, but unfortunately, lack of awareness and access to basic oral health-care services are huge obstacles. Patients in small villages in this district with particular needs of oral health services have to travel miles of distance without sufficient availability of transport services for speciality consultation in Krishna school of dental sciences and hospital. Teledentistry can be the feasible option to improve this overall condition. As an effort to make use of potential application of teledentistry in rural areas, first, we have to assess knowledge and interest to use this technology. Considering this, we conducted a survey in Satara district to assess the feasibility that included the identification of potential consulting specialists, regulatory issues, lack of knowledge., Our goal was to understand the interest and need for the usage of telehealth technology by dental health-care professionals and general population, especially underserved population in Satara district.
When general population and dentists were asked about need of other specialist consultants, more than 65% responded positively showing need of advance health-care services which is according to study article 'Utilization of dental care: An Indian outlook' more than the need of specialist in urban areas of India. This scenario mainly due to more concentration of dentists in urban areas since the cost-benefits and technological development is high as compared to rural area. Literacy regarding oral health is partially or completely absent in rural areas leads to serious oral diseases (92% general population agreed of having oral health issues), which need to be treated through advance health-care services, and according to survey, it is not easy for 67% of population to visit specialist located in distant areas adding other factors such as lack of government transport services. Teledentistry is a better option to overcome these factors at certain level. 99% respondents from the general population were completely unaware of telehealth or teledentistry if it compared to knowledge of teledentistry among the general population of South Carolina, United States, is 69.3% according to the survey of feasibility assessment. This difference shows the lack of basic knowledge about oral health as well as general health in Satara district which is one of the rural areas of India, and predictably, this is the scenario of every rural areas of India.
Fortunately, almost every dental practitioner is aware of teledentistry, but among them, only 39% dentists have knowledge about telehealth programs conducted in India which is acceptable because there hardly any studies are conducted or any organization and government have implemented telehealth model. The frequency of needing consultant for orthodontics is more than any other speciality consultation, following oral surgery, cons-endo and pedodontics. 78.33% dentists are certainly willing to use telehealth if it ever gets implemented for their patients in case of need for other speciality consultation and 83.33% dentist are willing to serve as an outside consultant through teledentistry. 21.66% dentists are not willing to serve or participate in teledentistry program, the main concerns such as unavailability of technological equipment, high cost, lack of training which are actually major obstacles to achieve the objectives of telehealth.,
Dental practitioners who showed positivity toward telehealth asked about the ways telehealth can improve dental health services, maximum practitioners think that it can improve overall efficiency of dental practice and general as well as oral health services. In other ways they think its beneficial are improved cost efficiency, improved patient satisfaction, and higher patient retention.
Telehealth or teledentistry is very useful, primarily in spreading basic knowledge about general and oral health among rural and underserved population but considering unavailability of digital devices, high cost and lack of training, providing telehealth services through private dental practice is difficult., As state dental leaders explore teledentistry and examine the aforementioned questions, they should consider engaging government's national health care services into advanced telehealth and teledentistry services to improve access to health care in rural and underserved areas of India. It can be done by advancing the adaptation of telehealth technologies and supporting provider communities in their application.,,, Through government health strategies, maximum telehealth resource centers should be implemented at state or district levels which can then be adept at connecting local clinicians with telehealth networks, academic and consulting partners and resources to develop telehealth solutions.,,
| Conclusion|| |
Further research will also be required to analyse economy and modelling to determine the intervention's productivity. Unwillingness and attitude among local dental practitioners can be changed through increasing the scope of education regarding teledentistry at central government level through preparing legislation.
It is not farfetched to imagine that the near future teledentistry will be just another way to access an oral health-care provider. Dentists with knowledge in teledentistry can be appointed at the primary health centers and community health centers to discuss about the diagnosis and treatment plan of the difficult cases with the specialists. Dental colleges in underserved and rural areas could be main places to serve the population through teledentistry consultation as they include all the specialists under the same roof. A team of specialists could communicate for a few hours on a daily basis with the dentists/hygienists/patients at the remote clinics.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Mallick R., Perwez E, Noor R, Sachdeva S, Tamrakar AK. Teledentistry: Proposal of implementation model in India. Ann dent spec 2016;4:33-7.
Martin AB, Nelson JD, Bhavsar GP, McElligott J, Garr DR, Leite RS. Feasibility assessment for using telehealth technology to improve access to dental care in rural and underserved populations, South Carolina. J Evidence Based Dent Prac 2016;16:228-35.
Marino R, Tonmukayakul U, Marwah P, Collmann R, Hopcraft MS. Teledentistry/telediagnosis using teledentistry technology: a pilot feasibility study, IntJ Adv Life Sci 2014;6:291-99.
Bauer JC, Brown WT. The digital transformation of oral health care. Teledentistry and electronic commerce. J Am Dent Assoc 2001;132:204-9.
Marino R, Ghanim A. A systemic review of the literature review article, J Telemed telecare 2013;19:179-83.
Singh V, Bhaskar DJ, Chandan Agali R, Kishore M, Bumb S, Safalya S. Kadtane. Teledentistry: Its all about access to care TMU J Dent 2014;1:64-6.
Walmsley AD, White DA, Eynon R, Somefield L. Use of the internet within a dental school. Euro J Dent Edu 2003;7:27-33.
Chen H, Fricton J. Teledentistry: Seeing the doctor from a distance. Northwest Dent 2007;86:27-8, 68.
Ramesh N, Pankaj A, Archana J S, Kailash A, Mridula T, Piyush P, et al
. Teledentistry: knowledge and attitudes among dentists in Udaipur, India. Oral Health Dent Manag 2013;12:138-44.
Kopycka-Kedzierawski DT, Billings RJ, McConnochie KM. Dental screening of preschool children using teledentistry: a feasibility study. Pediatr Dent 2007;29:209-13.
Blignault I, Kennedy C. Training for telemedicine. J Telemed Telecare 1999;5 Suppl 1:S112-4.
Hopcraft MS, Morgan MV, Satur JG, Wright FA. Dental service provision in Victorian residential aged care facilities. Aust Dent J 2008;53:239-45.
Reddy KV. Using teledentistry for providing the specialist access to rural Indians. Indian J Dent Res 2011;22:189.
] [Full text]
Chhabra N, Chhabra A, Jain RL, Kaur H, Bansal S. Role of teledentistry in dental education: Need of the era. J Clin Diag Res 2011;5:1486-8.
Mahdi SS, Mancini M, Nadim R, Amenta F. Teldentistry: A review on its present status and future perspective. JDO 2015;11:45-51.
Brüllmann D, Schmidtmann I, Warzecha K, d'Hoedt B. Recognition of root canal orifices at a distance-A preliminary study of teledentistry. J Telemed Telecare 2011;17:154-7.
Estrela C, Holland R, Estrela CR, Alencar AH, Sousa-Neto MD, Pécora JD. Characterization of successful root canal treatment. Braz Dent J 2014;25:3-11.
Eaton KA, Francis CA, Odell EW, Reynolds PA, Mason RD. Participating dentists' assessment of the pilot regional online videoconferencing in dentistry (PROVIDENT) project. Br Dent J 2001;191:330-5.
Mallick R, Tamrakar AK, Sachdeva S, Perwez E. Immediate overdenture: taking advantage of two specialized procedures. Ann Dent Spec 2014;2;148-51.
Ignatius E, Perälä S, Mäkelä K. Use of videoconferencing for consultation in dental prosthetics and oral rehabilitation. J Telemed Telecare 2010;16:467-70.
Reddy KV. Using teledentistry for providing the specialist access to rural Indians. Indian J Dent Res 2011;22:189.
] [Full text]
World Health Organization, Calibration of Examiners for Oral Health Epidemiological Survey, Publication ORH/EIS/EPID.93.1. Geneve: World Health Organization; 1993.
Sharma U, Clarke M. Nurses' and community support workers' experience of telehealth: a longitudinal case study. BMC Health Serv Res 2014;14:164.
Shigekawa E, Fix M, Corbett G, Roby DH, Coffman J. The current state of telehealth evidence: A rapid review. Health Afairs 2018;37:1975-82.
Tuckson RV, Edmunds M, Hodgkins ML. Telehealth. N
Engl J Med 2017;377:1585-92.
Ray KN, Shi Z, Gidengil CA, Poon SJ, Uscher-Pines L, Mehrotra A, et al
. Antibiotic prescribing during pediatric direct to consumer telemedicine visits. J pediatrics. May 2019, 143 (5) e20182491; DOI: https://doi.org/10.1542/peds.2018-2491s
Kharbanda O, Priya H, Balachandran R, Khurana C. et al
. Current scenario of teledentistry in public health care in India. J Int Soc Telemed eHealth 2019;7:e10.
[Figure 1], [Figure 2], [Figure 3], [Figure 4]