Bhamra, I. B., Gallagher, J. E., Patel, R. (2023) ‘Telehealth technologies in care homes: a gap for dentistry?’, Journal of Public Health, fdad258
Introduction
Care home residents are often individuals who require additional care and are dependent on others for carrying out activities of daily living. Studies have found that nursing homes do not prioritise oral care and residents’ teeth are not brushed even once a day. Consequently, these individuals face various barriers to accessing dental and oral care. These barriers include limited mobility, travel (times and costs) for the resident or healthcare professional, difficulty making suitable appointments, long wait times, inability to access specialist care, and healthcare professionals lacking familiarity with the resident. Teleconsultations are a type of telehealth technology that could help reduce these barriers through remote consultations using either real-time consultations or store-and-forward (the information and images are stored and sent to the physician). Since the COVID-19 pandemic, the use of teleconsultations in dental services has increased and this has opened opportunities for implementation in care home settings.
The aim of this study was to identify and appraise the literature relating to telehealth technologies in care homes with a specific focus on dental care.
Methods
The review was conducted following the Khangura et al 2012 method and quality assessment was carried out using the Mixed Methods Assessment Tool (MMAT) 2018. An electronic database search was carried out on four databases: PubMed, Embase, Web of Science and OpenGrey. The search was on technologies used in care homes for medical consultations and specific dental technologies.
Results
A total of 1,525 records were identified and as shown in Fig 1, 1108 abstracts and 75 full texts screened resulting in an inclusion of 47 papers (40 studies). Studies were conducted between 1997-2021, four of which related to teledentistry. The remaining studies were from other disciplines as seen in Table I which also shows the key characteristics of the studies. Altogether, the main outcomes of the studies were acceptability, economic analysis, diagnostic accuracy, and efficacy. The risk assessment found that 16 studies were high quality, 18 medium and 16 low quality.
Fig 1. PRISMA flow chart
Table 1: Characteristics of 40 included studies
| Characteristics | All studies |
|---|---|
| Year of publication | 1997–2021 |
| Country, n USA Australia Singapore Canada UK France Germany Hong Kong Portugal South Korea Multiple countries | 18 5 5 3 2 2 1 1 1 1 1 |
| Type of study design, n Mixed Randomized controlled trial Non-randomized controlled trial Cross-sectional Descriptive Cohort Observational Case–control Other | 9 5 5 3 2 2 2 1 10 |
| Discipline, n Geriatrics Psychiatry Dentistry Dermatology Mixed Other | 16 7 4 2 2 9 |
| Outcomes, n Acceptability Hospitalization rate Economic analysis Diagnostic accuracy Length of time for consultation Quality of care Clinical condition | 21 14 8 7 7 6 3 |
The seven studies on diagnostic accuracy found mixed results but overall neurological disorders and psychiatry found high consistency in assessment using real-time consultations, and dentistry and dermatology found statistically significant results for accuracy, sensitivity and specificity. The teledentistry studies utilised both real-time and store-and-forward consultations and found positive results. Teleconsultations were found to have high levels of satisfaction however, stakeholders preferred in-person consultations. The use of intra-oral cameras was generally well accepted but this was assessed subjectively. Multiple studies found that teleconsultations improved quality of care, reduced the rate of hospital admissions, and were cost saving. For teledentistry, improved quality of care was due to improved awareness of oral health needs, increase in the number of residents with oral health care plans, and improved support. Some studies also found difficulties in the use of teleconsultations in care homes due to poor technology/ equipment, digital literacy, and residents with low cognitive function.
Conclusion
Whilst there was limited research on teledentistry, the findings suggest the use of telehealth technologies in care homes could be beneficial due to their cost-saving, acceptability, efficacy and potential diagnostic accuracy. The findings suggest better potential for follow-up rather than diagnosis but more research is needed on the use of teledentistry in care homes.
Re