SCIENTIFIC
FACTORS INFLUENCING ORTHODONTISTS’ INTEREST IN UTILIZING TELEHEALTH POST-COVID Dr. Brennan R. Alford a, Dr. Bhavna Shroff b, Dr. Caroline K. Carrico c
Objectives: 1) To investigate orthodontists’ interest in providing care via telehealth and 2) to investigate which aspects of care orthodontists are willing to perform via telehealth technologies. Methods: An original electronic, crosssectional survey was sent to members of the American Association of Orthodontists (AAO) in June of 2020 during the reopening phase after widespread state lockdowns. Responses were summarized using descriptive statistics. Differences in interest relative to provider and treatment characteristics were assessed with chisquare tests. Results: Respondents indicated an overall average agreement and awareness of telehealth for orthodontic practice. Current use of telehealth was significantly associated with self-reported percent of cases treated with aligners (p-value=0.0043). The most agreement with incorporating telehealth technologies in practice was for monitoring treatment progress in clear aligner patients (0.95 on a scale from -2.0 to +2.0) followed by retention (0.79) and elastic wear (0.88). The strongest disagreement was for monitoring a patient who underwent extraction (-0.32). Conclusions: Overall interest in utilizing telehealth in orthodontics remains low. Providers who treat higher percentages of patients with in-office aligners report more interest in utilizing telehealth technologies. Providers are most interested in using telehealth to monitor aligner treatment progress, retention, and elastic wear.
INTRODUCTION
As a key step in limiting the spread of COVID-19 following widespread
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lockdowns in the spring of 2020, the Centers for Disease Control and Prevention (CDC) advised oral health care professionals to implement teledentistry and triage protocols. The CDC stated that tele-dentistry options should be used as alternatives to in-office care when possible.1 Some orthodontists referred to this necessary shift to teledentistry as the “new ergonomics,” describing the increasing need to utilize technology to limit in-office visits, and to select appliances that require fewer activations or adjustments.2 These “new ergonomics” required an adjustment to provider’s attitudes, habits, and preferences.2 Tele-medicine encompasses the use of telecommunication technology to aid healthcare professionals in diagnosis and treatment from a remote location. Two main methods are distinguished by a real-time interaction between patient and professional. Real-time telemedicine utilizes video conferencing, or simply a phone call, to provide live patient interaction with a physician. Store-andforward, or asynchronous tele-medicine, involves patient information that is uploaded to a secure data-base and accessed by a healthcare professional at a later time.3 The terms tele-medicine and tele-dentistry, as they apply to orthodontics, can also be called teleorthodontics or simply “telehealth”. This purpose of this study was to examine the attitudes of orthodontists toward telehealth technologies in June of 2020, during the reopening phase in the United States after many states implemented lockdowns of various severities and durations. The aims of this study were to investigate orthodontists’ interest in providing care via telehealth and which aspects of care orthodontists were willing
to perform via telehealth technologies. Secondarily, provider characteristics that influenced differences in preference and perceived utilization of telehealth were evaluated.
MATERIALS AND METHODS
An original electronic, cross-sectional survey was created and sent to 2,199 members of the American Association of Orthodontists (AAO) in June of 2020. The Research Electronic Data Capture (REDCap), self-report survey consisted of 32 questions regarding the use of telehealth technologies as they apply to orthodontics. The project was deemed exempt of Institutional Review Board (IRB) approval by the Virginia Commonwealth University Office of Research and Innovation. Individual completion and submission of the survey was considered consent to participate in the study. The survey consisted of 5 sections. The first was a section on demographics. The second section was an Awareness and Application section containing questions regarding awareness, current use, and plans to implement telehealth technologies with answers on a 5-point Likert scale from -2 (Strongly Disagree) to 2 (Strongly Agree), yes and no, and multiple choice. The third section was focused on interest in using telehealth while monitoring treatment with responses on the same 5-point Likert scale and multiple choice. The fourth section was focused on interest in using telehealth during active treatment with responses on the same 5-point Likert scale, and multiple choice. The fifth section was focused on interest in using telehealth to manage emergencies, with responses on 5-point Likert scale. A comments box was included at the conclusion of the survey. Responses were summarized using
