Oral Pathology Department, School of Dentistry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
Telehealth, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
Oral Dis. 2018 Sep;24(6):1012-1019. doi: 10.1111/odi.12851. Epub 2018 Jun 7.
The diagnosis of oral lesions is often challenging for primary healthcare providers, which explains the high number of referrals to specialist care. This favors increases in waiting lines and delays in diagnosis, contributing to high mortality rates from oral cancer. This study aimed to summarize the experience of the EstomatoNet, a telediagnosis program catering to primary care dentists and physicians from southern Brazil.
This exploratory study included all queries received by EstomatoNet from June 2015 to December 2016. Health providers (71 dentists and 18 physicians from primary care) submitted requests including clinical information and photographs of oral lesions by means of a cloud-based platform. Specialized oral medicine teleconsultants received the data, conveyed a diagnostic hypothesis, and conveyed management recommendations.
Actinic cheilitis (n = 41, 15.8%), squamous cell carcinoma (n = 22, 8.5%), and inflammatory hyperplasia (21, 8.1%) were the most frequent diagnoses. Teleconsultants recommended referral to specialists in 42.9% of the cases, total biopsy in 23.6%, and follow-up in 16.2%. After the EstomatoNet use, the intention to refer the patients to face-to-face consultation reduced from 96.9% to 35.1%.
Telediagnosis for oral lesions is feasible and has potential to improve the quality of primary health care by bridging the gap between primary and specialized health care.
初级保健提供者通常难以诊断口腔病变，这就是为什么有那么多患者需要转诊至专科治疗。这导致候诊时间延长和诊断延误，从而导致口腔癌死亡率居高不下。本研究旨在总结 EstomatoNet 的经验，该网络是一个远程诊断计划，服务于巴西南部的初级保健牙医和医生。
本探索性研究包括 2015 年 6 月至 2016 年 12 月期间 EstomatoNet 收到的所有查询。医疗服务提供者（来自初级保健的 71 名牙医和 18 名医生）通过基于云的平台提交了包括临床信息和口腔病变照片的请求。专门的口腔医学远程咨询顾问接收数据，提出诊断假设，并提供管理建议。
光化性唇炎（41 例，15.8%）、鳞状细胞癌（22 例，8.5%）和炎症性增生（21 例，8.1%）是最常见的诊断。远程咨询顾问建议在 42.9%的病例中转诊给专家，在 23.6%的病例中进行全部活检，在 16.2%的病例中进行随访。使用 EstomatoNet 后，将患者转介至面对面咨询的意愿从 96.9%降至 35.1%。
口腔病变的远程诊断是可行的，通过弥合初级和专科医疗保健之间的差距，有潜力改善初级卫生保健的质量。
