Oral Medicine and Pharmacology Teleconsulting Sessions of the Telehealth Program in one Southeastern State of Brazil

ABSTRACT Objective: To evaluate questions concerning oral medicineand pharmacology-related specialties of asynchronous dental teleconsulting sessions of the Telehealth Brazil Networks Program. Material and Methods: Data were collected from secondary databases of asynchronous dental teleconsulting sessions of the telehealth centers of Minas Gerais from July 2015 to July 2017. The variables for dental underlying fields and the types of questions were evaluated. Descriptive analysis was performed with the SPSS v.22.0 program. Results: 3,920 teleconsulting sessions were referred to the telehealth centers of Minas Gerais during the study period. Regarding oral medicine-related questions (n=745), most (n=469; 62.95%) addressed diagnosis, whereas the underlying field questions mostly regarded fungal, viral, and bacterial infections (17.3%), biopsies (16.4%), developmental defects and dental abnormalities (9.9%), and soft tissue tumors (9.4%). Pharmacology-related questions (n=738) mostly addressed general approaches (n=672; 91.06%), and the most common questions were about underlying fields' prescriptions (44.7%), anesthetics (17.6%), adverse effects of medications and anesthetics (10.2%), and selection of anesthetics for patients with systemic conditions (9.8%). Conclusion: Most teleconsulting sessions regarded conditions or procedures common in primary health care and essential for diagnosis and treatment planning at all care levels, which suggests a need for more academic learning processes for healthcare professionals, especially in dentistry primary fields.

Endodontic teleconsulting by Telehealth in Minas Gerais state, Brazil / Teleconsultorias endodônticas do Telessaúde no estado de Minas Gerais, Brasil

Abstract Background The Telehealth Brazil Program aims to improve the quality of Primary Health Care. Objective This cross-sectional study evaluated the Telehealth Brazil Networks Program's dental teleconsulting in Minas Gerais state to elucidate the prevalent questions in endodontics. Method Secondary databases of offline dental teleconsulting from the Clinical Hospital and Medical School of the Universidade Federal de Minas Gerais from July 2015 to July 2017 were used. The variables analyzed were telehealth center, dental specialty and sub-area, and question type. The results were descriptively analyzed using the SPSS v.22.0 program. Results A total of 3,920 teleconsulting sessions were carried out. Endodontics was the field with the sixth-highest demand for questions (7.4%). The most prevalent endodontic questions were related to pulpal and periapical alterations (32.3%), being more related to diagnosis, followed by dental trauma (15.6%), endodontic emergencies (11.4%), and intracanal medication (7.3%), all of them with most questions related to clinical conduct. Conclusion The endodontic field questions were related to prevalent conditions in the daily activities of the primary health care professionals. It is crucial to continuously update the professionals through continuing education programs and the search for new knowledge to reinforce these competencies.

Resumo Introdução O Programa de Telessaúde tem o objetivo de aprimorar a qualidade da Atenção Primária em Saúde. Objetivo Este estudo transversal avaliou as teleconsultorias odontológicas do Programa Telessaúde Brasil Redes em Minas Gerais para elucidar as dúvidas prevalentes em endodontia. Método Bancos de dados das teleconsultorias offline de odontologia do Hospital das Clínicas e Faculdade de Medicina da Universidade Federal de Minas Gerais de Julho de 2015 a Julho de 2017 foram utilizados. As variáveis analisadas foram: núcleo de telessaúde, especialidade odontológica e subárea, e tipo de dúvida. Resultados Os resultados foram analisados descritivamente utilizando o programa SPSS v.22.0. Um total de 3920 teleconsultorias foi realizada. A Endodontia foi a área com a sexta maior demanda por dúvidas (7,4%). As dúvidas endodônticas mais prevalentes foram relacionadas às alterações pulpares e perirradiculares (32,3%), sendo mais relacionadas ao diagnóstico, seguidas por trauma dentário (15,6%), emergências endodônticas (11,4%) e medicação intracanal (7,3%), sendo a maioria das dúvidas relacionadas à conduta clínica. Conclusão As dúvidas na área endodôntica foram relacionadas a condições prevalentes nas atividades diárias dos profissionais da atenção primária a saúde. É crucial a atualização constante dos profissionais, por programas de educação continuada e pela busca por novos conhecimentos, reforçando essas competências.

National analysis of dental teleconsulting of the Brazilian Telehealth Program.

This cross-sectional study nationally evaluated asynchronous dental teleconsulting services offered by the Telehealth Brazil Networks Program, using the 2019 Telehealth Results Monitoring and Evaluation System database and considering Brazilian regional differences. The following teleconsulting variables were collected: dentist's sex and specialty, date/time of question and answer, response time; dental specialty, professional satisfaction, and patient referral. Five Brazilian regions were socioeconomically characterized according to the Human Development Index, estimated population, Gini coefficient, coverage of dental specialty centers, oral health teams in Family Health Strategy, and oral health teams in primary health care (PHC). In total, 2,703 teleconsulting sessions occurred in Brazil in the analyzed period. The Southeast exhibited the highest demand (49.1%). Most dentists were female (60.6%) and were dental surgeons from the Family Health Strategy (61.3%). Most teleconsulting sessions occurred during working hours (85.5%) and questions were answered within 72 hours (66.7%). Level of satisfaction and avoidance of referral yielded rates of 90.9% and 66.8%, respectively, among dentists who answered about these topics. Semiology was the most frequently demanded area in teleconsulting (33.9%). The different demands from the regions reflected regional differences. The most frequently demanded specialties represent the Brazilian PHC scenario. Professionals incorporated teleconsulting into their work routine and most teleconsultants responded within the stipulated timeframe. Professional feedback should be encouraged.

Professional Factors Associated with Case Resolution without Referrals of Orofacial Pain Cases to Secondary Dental Care by Telehealth in Brazil: A Cross-Sectional Study in 2019 and 2020.

This study aimed to identify professional factors associated with case resolution without a referral of orofacial pain to secondary health care by Brazilian Primary Health Care (PHC) practitioners who demanded asynchronous teleconsulting, stratified by year, in 2019 and 2020 (the COVID-19 Pandemic burst). A cross-sectional study employed secondary databases from asynchronous teleconsulting Telehealth Brazil Networks from January 2019 to December 2020. The outcome was the dichotomous variable "If referral to secondary care was avoided." As covariates: sex, healthcare professions, and category of orofacial pain doubts. A negative binomial regression model estimated each covariate's unadjusted and adjusted PR (95%CI) and p values, stratified for 2019 and 2020. There was a difference in descriptive factors associated with case resolution without a referral from 2019 to 2020. Females prevailed in both years, and the total demand decreased to a third from 2019 to 2020. The rate of resoluteness decreased by 19.1%. In 2019, nurses (PR = 0.69 CI 95% 0.57-0.83) and other professionals (PR = 0.84 CI 95% 0.73-0.97) showed less frequency of case resolution without a referral than did general dentists. In 2020, oral-cavity-related doubts (PR = 1.18 CI 95% 1.06-1.32) and temporomandibular disorders (PR = 1.33 95% 1.15-1.54) surpassed other causes of orofacial pain in case resolution without a referral, and female professionals avoided referrals more frequently than men (PR = 1.24 CI 95% 1.21-1.38). In conclusion, in 2019, oral cavity doubts and the PHC profession influenced the case resolution. Female professionals and oral cavity doubts scored the higher case resolution without a referral for the service in 2020.

National analysis of dental teleconsulting of the Brazilian Telehealth Program

Abstract This cross-sectional study nationally evaluated asynchronous dental teleconsulting services offered by the Telehealth Brazil Networks Program, using the 2019 Telehealth Results Monitoring and Evaluation System database and considering Brazilian regional differences. The following teleconsulting variables were collected: dentist's sex and specialty, date/time of question and answer, response time; dental specialty, professional satisfaction, and patient referral. Five Brazilian regions were socioeconomically characterized according to the Human Development Index, estimated population, Gini coefficient, coverage of dental specialty centers, oral health teams in Family Health Strategy, and oral health teams in primary health care (PHC). In total, 2,703 teleconsulting sessions occurred in Brazil in the analyzed period. The Southeast exhibited the highest demand (49.1%). Most dentists were female (60.6%) and were dental surgeons from the Family Health Strategy (61.3%). Most teleconsulting sessions occurred during working hours (85.5%) and questions were answered within 72 hours (66.7%). Level of satisfaction and avoidance of referral yielded rates of 90.9% and 66.8%, respectively, among dentists who answered about these topics. Semiology was the most frequently demanded area in teleconsulting (33.9%). The different demands from the regions reflected regional differences. The most frequently demanded specialties represent the Brazilian PHC scenario. Professionals incorporated teleconsulting into their work routine and most teleconsultants responded within the stipulated timeframe. Professional feedback should be encouraged.

Analysis of Dental Teleconsulting in the Pediatric Dentistry Field of Telehealth Minas Gerais: A Cross-Sectional Study

ABSTRACT Objective: To analyze the profile of the dental teleconsulting in the Pediatric Dentistry field of Telehealth Brazil Networks Program, in Minas Gerais centers, Brazil. Material and Methods: Asynchronous dental teleconsulting was evaluated in the Pediatric Dentistry specialty, extracted from secondary databases of the telehealth centers: the Clinical Hospital of the Universidade Federal de Minas Gerais and UFMG Medical School, from July 2015 to July 2017. The variables collected were: type of issues and area and sub-area of Pediatric Dentistry. The results were descriptively analyzed using the SPSS v.22,0 program by frequencies. Results: Most of the issues in the Pediatric Dentistry specialty were about clinical conduct (81.4%). There was a predominance of issues regarding prevention (16.6%), surgery (15.3%), tooth eruption (15.1%), endodontics (12.1%), harmful oral habits (9.7%), patient cooperation (8.7%), primary teeth trauma (7.2%) and dentistry (6.7%). Regarding sub-areas, most issues were related to child oral hygiene (68.5%), tooth extraction (92%), tooth eruption chronology (65.6%), pulp diagnosis (49.0%), bruxism (64%), patient management (74.3%), post-trauma treatment (79.3%), and restoration (88.9%). Conclusion: Pediatric Dentistry teleconsulting suggested a difficulty of the professionals in the pediatric patient approach. Continuing education programs and training courses for professionals working in primary health care are crucial for the comprehensive care of pediatric patients.

Analysis of the asynchronous dental teleconsulting of Telehealth Brazil Networks in Minas Gerais.

This cross-sectional study aimed to evaluate the asynchronous dental teleconsulting of Telehealth Brazil Networks Program in Minas Gerais. Data were collected from secondary databases of the Clinical Hospital of the Universidade Federal de Minas Gerais (CH/UFMG) and Medical School of UFMG (MS/UFMG), from July 2015 to July 2017. The variables analyzed were telehealth center, sex and profession, date and time questions and answers, response time in days, whether the issue was duly addressed, whether the teleconsulting was attended, post status, professional's satisfaction, conduct adopted after teleconsulting, dental specialty area, and type of issues. Sociodemographic data from the Intermediate Geographical Regions (IGR) of Minas Gerais, including the Municipal Human Development Index (MHDI) and Gini Index were also collected. The results were analyzed using SPSS v.22.0. In total, 3,920 teleconsulting were recorded, with increasing demand in the study period. Most were requested by dentists (93.3%) and female professionals (78.6%), during office hours (78.6%), and related to general conducts (72.1%). Almost all were attended (99.7%), with a maximum response time of two days (75.0%). A low feedback on satisfaction and resolution of issues (missing data of 57.2% and 70.2%, respectively) was recorded. Only 5.2% had information on whether patients were referred. The most common inquires were of issues about Pathology/Stomatology specialties (19.0%) and Pharmacology/Anesthesiology (18.8%). The response occurred within the expected time, with prevalent issues in basic dental areas and general conducts. Feedback from professionals must be encouraged to allow a better analysis and improvements of the program.

Análise das teleconsultorias odontológicas do Telessaúde Núcleos Minas Gerais / Análise das teleconsultorias odontológicas do Telessaúde Núcleos Minas Gerais com ênfase em Endodontia / Analysis of the dental teleconsulting of Telehealth in Minas Gerais state, with emphasis in Endodontics

O objetivo desse estudo transversal foi avaliar as Teleconsultorias Odontológicas offline do Programa Telessaúde Brasil Redes Núcleos Minas Gerais, com ênfase em Endodontia. Foram coletadas informações dos bancos de dados secundários dos núcleos: Hospital das Clínicas da Universidade Federal de Minas Gerais (HC-UFMG) e Faculdade de Medicina da UFMG (FM-UFMG), de jul/2015 a jul/2017. Foram analisadas as variáveis: núcleo de telessaúde, sexo e profissão do solicitante da teleconsultoria; data e horário da pergunta e resposta; tempo até a resposta em dias; se a dúvida foi devidamente respondida; se a teleconsultoria foi atendida; status de postagem; satisfação do profissional; conduta após a teleconsultoria; área e subárea da especialidade odontológica e tipo de dúvida da teleconsultoria. Dados sóciodemográficos das Regiões Geográficas Intermediárias de Minas Gerais, Índice de Desenvolvimento Humano Municipal (IDHM) e Índice de Gini também foram coletados. Os resultados foram analisados descritivamente usando o programa SPSS v.22.0. Foram realizadas 3920 teleconsultorias com uma procura crescente no período (n=187 de Julho a Dezembro de 2015; n=2.214 em 2016; n=1.519 de Janeiro a Julho de 2017), com maior demanda feita por dentistas (93,3%) e sexo feminino (66,7%), dentro do horário de trabalho (78,6%), sendo sobre conduta geral, englobando dúvidas sobre o tratamento, prevenção e proservação das condições bucais (72,1%). Quase a totalidade foi atendida (99,7%), com uma devolutiva de até dois dias em 75% dos casos. Houve baixo feedback dos profissionais em relação a satisfação e resolução das dúvidas (57,2% e 70,2% sem informação, respectivamente). Apenas 5,2% apresentavam informações sobre o encaminhamento dos pacientes. A maior prevalência de dúvidas relacionou-se às áreas de Patologia/Estomatologia (19,0%), seguidas por Farmacologia/Anestesiologia (18,8%), Odontopediatria (10,3%), Cirurgia (10,2%), Dentística/Prótese (8,6%) e Endodontia (7,4%). A devolutiva das dúvidas ocorreu dentro do tempo esperado, com maior prevalência em áreas básicas e condutas gerais. As dúvidas Endodônticas mais prevalentes foram sobre alterações pulpares e periapicais (32,3%), traumatismos dentários (15,6%), urgências endodônticas (11,4%) e medicação intracanal (7,3%). As áreas básicas devem receber uma maior ênfase nos cursos de graduação, para formar profissionais mais preparados para a prática clínica, que realizem um adequado diagnóstico e tratamento integral ao paciente. As dúvidas endodônticas mais prevalentes estiveram relacionadas com os desafios no dia-a-dia dos profissionais da Atenção Primária à Saúde (APS). É de fundamental importância a atualização contínua dos profissionais, tanto por meio de programas de educação continuada, como pela própria busca por novos conhecimentos, promovendo um reforço dessas competências. Além disso, é preciso estimular o feedback dos solicitantes para permitir melhor análise e melhorias para o programa.(AU)

This cross-sectional study aimed to evaluate the off-line dental teleconsulting of Telehealth Brazil Networks Program in Minas Gerais state Telehealth centers, with emphasis in Endodontics. Data were collected from secondary databases of the Clinical Hospital of the Federal University of Minas Gerais (CH/UFMG) and Medical School of UFMG (MS/UFMG), from July 2015 to July 2017. The variables analyzed were telehealth center; applicant's gender and profession; date and time of question and answer; response time in days; if the issue was duly answered; if teleconsulting was attended; posting status; professional's satisfaction; conduct adopted after teleconsulting; dental specialty area and subarea and type of issues. Sociodemographic data from the Intermediate Geographical Regions (IGR) of Minas Gerais, the Municipal Human Development Index (MHDI) and Gini Index were also collected. The results were descriptively analyzed using SPSS v.22.0. In total, 3,920 teleconsulting sessions were recorded, with increasing demand in the period (n=187 from July to December 2015; n=2,214 in 2016 and; n=1,519 from January to July 2017). Most were demanded by dentists (93.3%) and female (78.6%) professionals, during office hours (78.6%) and related to general conducts, with doubts related to treatment, prevention and preservation of oral conditions (72.1%). Almost all were attended (99.7%), with a maximum response time of two days (75.0%). There was low feedback regarding satisfaction and resolution of issues (57.2% and 70.2%, respectively, without information). Only 5.2% had information on whether patients were referred. The higher prevalence of issues related to Pathology/Stomatology specialties (19.0%), followed by Pharmacology/Anesthesiology (18.8%), Pediatric Dentistry (10.3%), Surgery (10.2%), Dentistry/Prosthesis (8.6%) and Endodontics (7.4%). The response occurred within the expected time, with the prevalence of issues in primary dental areas and general conducts. The most prevalent Endodontic doubts were related to pulp and periapical alterations (32.3%), dental trauma (15.6%), endodontic urgencies (11.4%) and intracanal medication (7.3%). The basic areas should receive a greater emphasis on undergraduate courses, to better prepare professionals for clinical practice and determine the adequate diagnosis and integral treatment to the patient. The most prevalent endodontic doubts were related to the daily challenges of Primary Health Care (PHC) professionals. It is of fundamental importance the continuous updating of the professionals, both through continuing education programs and through the search for new knowledge, promoting a reinforcement of these competences. In addition, applicant's feedback needs to be encouraged to allow better analysis and improvements to the program. Keywords: Primary health care. Telemedicine. Dentistry. Public health. Endodontics.(AU)