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远程牙科改善口腔医疗服务可及性和质量:系统评价与荟萃分析综述

Teledentistry for Improving Access To, and Quality of Oral Health Care: Overview of Systematic Reviews and Meta-Analyses.

作者信息

Kengne Talla Pascaline, Allison Paul, Bussières André, Rodrigues Anisha, Bergeron Frédéric, Giraudeau Nicolas, Emami Elham

机构信息

Faculty of Dental Medicine and Oral Health Sciences, McGill University, 2001 McGill College Ave, Montreal, QC, H3A 1G1, Canada, 1 (514) 398-7203.

Faculty of Medicine and Health Sciences, School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada.

出版信息

J Med Internet Res. 2025 Jul 30;27:e65211. doi: 10.2196/65211.


DOI:10.2196/65211
PMID:40737673
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12334114/
Abstract

BACKGROUND: Digital interventions including teledentistry are promising approaches to address some of the inadequacies of health care systems. Despite existing systematic reviews (SRs) on the benefits, implementation challenges, accuracy, and effectiveness of teledentistry, a comprehensive synthesis of evidence on its impacts requires further analysis. OBJECTIVE: The purpose of this overview of SRs is to summarize evidence on the impacts of teledentistry in promoting access to and enhancing the quality of oral health care. METHODS: We searched electronic databases in MEDLINE (Ovid), Embase (Embase.com), CINAHL (EBSCO), Web of Science, Cochrane Library, and Epistemonikos from inception to March 2024, without date and language restrictions, to identify SRs and meta-analyses. Two independent reviewers performed data selection following the PICOSS (population, intervention, comparison, outcome, and study design) format, as well as the data extraction. We conducted quality assessments using both (A MeaSurement Tool to Assess Systematic Reviews-2) AMSTAR 2 and ROBIS (Risk Of Bias In Systematic reviews) tools. The certainty of evidence and the overlap of the primary studies included in the SRs were assessed. Results were presented in tables and graphs. A narrative synthesis was performed. RESULTS: The search yielded 1020 articles, of which 30 SRs were included in the overview. The number of participants across these reviews ranged from 130 to 7913 people. All dimensions of the quality of care were addressed to varying extents, with the domains of effectiveness (22/30, 73%), patient-centered care (14/30, 47%), and efficiency (11/30, 37%) being the most extensively studied. Teledentistry addressed public health challenges by improving access to oral health care and reducing inequities (9/30, 30%) for vulnerable people. The major teledentistry applications were teleconsultation (13/30, 43%), and telediagnosis (9/30, 33%). Teledentistry enhanced patient-clinician communication, quality of life, and care experiences for both patients and providers. However, multilevel barriers must be addressed to ensure its successful implementation (7/30, 23%). Meanwhile, patient safety (8/30, 27%) and equity (1/30, 10%) were the least explored domains, with few reviews addressing adverse outcomes, as well as concerns related to data privacy (3/30, 10%) and confidentiality (2/30, 6%). Several SRs exhibited a critically low to low methodological quality (25/30, 83%) and a high risk of bias (8/30, 27%). The overlap (corrected covered area) of the primary studies in all the SRs was slight (30/30, 2.3%), while it was moderate (11/30, 5.7%) for SRs with meta-analyses. CONCLUSIONS: The findings of this overview suggest that teledentistry is an effective and efficient alternative to in-person oral health care. However, significant concerns regarding the quality of the reviews highlight an urgent need for more methodologically rigorous studies to generate robust and reliable evidence. This is particularly essential to better understand teledentistry's potential to enhance overall health outcomes and ensure equitable access to care, thereby providing a stronger foundation to guide clinical practices and inform policy decisions.

摘要

背景:包括远程牙科在内的数字干预措施是解决医疗保健系统某些不足的有前景的方法。尽管已有关于远程牙科的益处、实施挑战、准确性和有效性的系统评价(SRs),但对其影响的证据进行全面综合仍需要进一步分析。 目的:本系统评价概述的目的是总结关于远程牙科在促进口腔保健可及性和提高口腔保健质量方面影响的证据。 方法:我们检索了MEDLINE(Ovid)、Embase(Embase.com)、CINAHL(EBSCO)、Web of Science、Cochrane图书馆和Epistemonikos等电子数据库,检索时间从建库至2024年3月,无日期和语言限制,以识别系统评价和荟萃分析。两名独立评审员按照PICOSS(人群、干预措施、对照、结局和研究设计)格式进行数据筛选以及数据提取。我们使用AMSTAR 2(一种评估系统评价的测量工具-2)和ROBIS(系统评价中的偏倚风险)工具进行质量评估。评估了系统评价中纳入的证据的确定性以及原始研究的重叠情况。结果以表格和图表形式呈现。进行了叙述性综合分析。 结果:检索共获得1020篇文章,其中30篇系统评价纳入本概述。这些评价中的参与者人数从130人到7913人不等。护理质量的各个维度均有不同程度涉及,其中有效性(22/30,73%)、以患者为中心的护理(14/30,47%)和效率(11/30,37%)领域研究最为广泛。远程牙科通过改善口腔保健可及性和减少弱势群体的不公平现象(9/30,30%)应对了公共卫生挑战。主要的远程牙科应用是远程会诊(13/30,43%)和远程诊断(9/30,33%)。远程牙科增强了患者与临床医生之间的沟通、生活质量以及患者和提供者双方的护理体验。然而,必须解决多层次障碍以确保其成功实施(7/30,23%)。同时,患者安全(8/30,27%)和公平性(1/30,10%)是研究最少的领域,很少有评价涉及不良结局以及与数据隐私(3/30,10%)和保密性(2/30,6%)相关的问题。一些系统评价显示方法学质量极低至低(25/30,83%)且偏倚风险高(8/30,27%)。所有系统评价中原始研究的重叠(校正覆盖面积)轻微(30/30,2.3%),而有荟萃分析的系统评价重叠程度为中等(11/30,5.7%)。 结论:本概述的结果表明,远程牙科是面对面口腔保健的一种有效且高效的替代方式。然而,对这些评价质量的重大担忧凸显出迫切需要开展更多方法学严谨的研究以产生有力且可靠的证据。这对于更好地理解远程牙科在改善整体健康结局和确保公平获得护理方面的潜力尤其重要,从而为指导临床实践和为政策决策提供更坚实的基础。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/543e/12334114/ed20d592b69b/jmir-v27-e65211-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/543e/12334114/e14bcdb22c40/jmir-v27-e65211-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/543e/12334114/ed20d592b69b/jmir-v27-e65211-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/543e/12334114/e14bcdb22c40/jmir-v27-e65211-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/543e/12334114/ed20d592b69b/jmir-v27-e65211-g002.jpg

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本文引用的文献

[1]
What does teledentistry mean? Mapping of current definitions.

Digit Health. 2024-11-25

[2]
Assessing the Carbon Footprint of Telemedicine: A Systematic Review.

Health Serv Insights. 2024-8-11

[3]
A Systematic Umbrella Review of the Effects of Teledentistry on Costs and Oral-Health Outcomes.

Int J Environ Res Public Health. 2024-3-28

[4]
Teledentistry for improving access to, and quality of oral health care: A protocol for an overview of systematic reviews and meta-analyses.

PLoS One. 2024

[5]
Telehealth technologies in care homes: a gap for dentistry?

J Public Health (Oxf). 2024-2-23

[6]
Teledentistry: A bibliometric analysis of the scientific publication's trend.

Digit Health. 2023-10-12

[7]
Is teledentistry effective to monitor the evolution of orthodontic treatment? A systematic review and meta-analysis.

Dental Press J Orthod. 2023

[8]
Accuracy of Remote Examination for Detecting Potentially Malignant Oral Lesions: A Systematic Review and Meta-Analysis.

Telemed J E Health. 2024-2

[9]
Comparative Evaluation of Dental Caries Score Between Teledentistry Examination and Clinical Examination: A Systematic Review and Meta-Analysis.

Cureus. 2023-7-25

[10]
A Systematic Review of the Use of mHealth in Oral Health Education among Older Adults.

Dent J (Basel). 2023-8-8

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