Lee, Joshua (2023) Teledentistry in a Clinical Setting: Advantages and Barriers of Implementation. Research Master thesis, Victoria University.

Abstract

The use of teledentistry by dental practitioners in Australia is on the rise, largely due to the COVID-19 pandemic. Previous studies have been conducted analysing the opinions of dental practitioners. These studies demonstrated that practitioners were optimistic about the technology, however they still identified flaws that made them hesitant to adopt it into their own practice. These studies were conducted prior to the COVID-19 pandemic. Since then, there have been large changes within teledentistry including the introduction of new item codes into the Australian Schedule of Dental Services and Glossary to allow clinicians to appropriately bill their patients and the technology behind teledentistry have improved. With these changes, opinions regarding the advantages, disadvantages and barriers to implementing teledentistry may have changed. Additionally, there have been no studies conducted to identify barriers to implementing teledentistry in Australia. This thesis involved research to address this gap. The overall aim of this mixed methods study was to determine the advantages and disadvantages of teledentistry as well as identify barriers of implementing teledentistry from the clinicians’ perspective and develop interventions to overcome these barriers. We aimed to complete this through 2 objectives. 1. To determine the advantages and disadvantages of teledentistry in a clinical setting from the perspectives of healthcare professionals using an e-questionnaire. 2. To explore the advantages and disadvantages of teledentistry while also determining the barriers of implementing teledentistry in a clinical setting and identifying interventions to overcome these barriers using focus groups. The quantitative study (objective 1) involved a cross-sectional study involving an anonymous electronic questionnaire with a sample of 152 participants. The questionnaire contained 28 questions with a 5-point Likert-scale to assess the perceptions of general dentists about teledentistry regarding diagnosis, accessibility, patient care, technology and finances. Chi-squared test and analysis of variance (ANOVA) were used to analyse the results. The focus group (objective 2) involved 2 focus groups of 6 and 7 people each. The focus group discussions were transcribed and de-identified, after which a thematic analysis was conducted. A word cloud was also generated to analyse for themes and subthemes. Quotes were then selected to create a narrative regarding the themes and subthemes. Part 1: The participants of the questionnaire believed that teledentistry was effective for consultations and diagnosing simple cases. They saw large benefits of teledentistry in improving access, delivering post-operative care, and triaging patients. They found it particularly useful during the COVID-19 pandemic. However, the participants felt that teledentistry was ineffective at diagnosing complex cases such as pathology. Concerns were also raised regarding the interventional capacity of teledentistry, the reliability of the technology, data security and medicolegal issues. In general, the participants preferred in-person compared to teledentistry. They were neutral regarding finances. Additionally, younger dentists perceived patients to be more accepting compared to the other age groups [20-64 years vs >65 years] (P = 0.0430). Part 2: The themes identified were technology utilisation, patient accessibility, clinical applications, patient centred care, difficulties for clinicians to adopt teledentistry, and finances. The participants of the qualitative focus group believed that teledentistry was able to improve accessibility and efficiency of their clinics. However, issues were raised regarding the technology, interventional capacity, communication issues as well as the difficulty in using the technology for clinicians and for patients. Some possible strategies to improve the implementation of teledentistry were increased funding and training to be able to purchase higher quality equipment and be effectively trained to use it and development of a streamlined process to be able to adopt and use teledentistry more easily. Patient convenience was believed to play a pivotal role in the success of implementation of teledentistry as well. Clear benefits were observed by dental practitioners in Australia regarding teledentistry. However, there was still hesitancy to adopt it due to the limitations noted. This study identified potential strategies to improve the implementation of teledentistry. Streamlining the process of delivering teledentistry could encourage more dentists to adopt teledentistry into their own routine practice. It is important to continue research into teledentistry to benefit people who have difficulties accessing dental health services.

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