Medico-economical Evaluation on Buccodental Teleexpertise in Nursing Home

Study Overview
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Brief Summary
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Oral care in medical and social institutions is a real public health problem. The impact of poor oral health on the general state of residents but also on their overall quality of life is significant. The development of a precise regulatory framework for telemedicine in France aims to transform experiments into sustainable medical activities. Odontology often set aside in this reflection, must be reintegrated. The use of tele-expertise for the oral care of nursing home residents should make it possible to replace oral health in medico-social institutions. The investigators will assess in a cluster randomized controlled study whether the buccodental telemedicine has a viable economic model and a significant impact on the overall health of facility for dependent elderly persons residents. The medico-economic impact of the buccodental telexpertise is fundamental for the development of this innovative activity.

Official Title
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Medico-economical Evaluation on Buccodental Teleexpertise in Nursing Home

Conditions
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Tooth Diseases

Intervention / Treatment
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* Other: bucco-dental teleexpertise


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Be resident of a facility for dependent elderly persons involved in the study Have given their Free, informed and signed consent Beneficiary or member of a social security scheme Exclusion Criteria: incapacity to open the mouth contrary opinion of the medical team (end of life) Change of nursing home planned within 6 months Subject in a period of relative exclusion from another protocol Subject's participation in another study Subject deprived of liberty by judicial or administrative decision

Ages Eligible for Study
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Minimum Age: 60 Years
Maximum Age: 120 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Diagnostic
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: telemedecine nursing home<br>One buccodental teleexpertise at the completion day and a second buccodental teleexpertise at the end of study | Other: bucco-dental teleexpertise<br>* A bucco-dental consultation remotely using telemedicine system<br>|
| No Intervention: control nursing home<br>Only one buccodental teleexpertise at the end of study | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Cost-Utility ratio of buccodental telemedicine in nursing home as compared to usual care | Costs include telemedicine and medical costs related to oral health care. Utility correspond to the Quality Adjusted Life-Years (QALY) score measured using the EQ5D-3L questionnaire (EuroQol 3 levels of 5 dimensions). | At month 6 | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Cost/Efficacity ratio of buccodental telemedicine in nursing home as compared to usual care | Costs include telemedicine and medical costs related to oral health care. The clinical efficacy criteria correspond to the proportion of patients with a zero dental emergency score. The score of Emergency is measured according to WHO classification: Score 0 correspond to unnecessary care Score 1 correspond to descaling required Score 2 correspond to Low urgency: need for restoration and/or crown but not immediately (superficial damage to the tooth). Includes patients requiring fixed and/or removable prostheses. Score 3 correspond to: Advanced emergency: need for restorations and/or crowns quickly (within 7 to 14 days) to avoid pulp damage and/or infection Score 4 correspond to: High urgency: urgent need for care due to pain and/or infection. Includes patients requiring endodontic treatment or extraction | At month 6 | 
| Quality of life comparison: EQ5D-3L questionnaire | The Quality of Life measured using the EQ5D-3L (EuroQol 3 levels of 5 dimensions) questionnaire. EQ-5D-3L questionnaire comprises the following 5 dimensions: mobility, self-care, usual activities, pain/discomfort and anxiety/depression. Each dimension has 3 levels: no problems, some problems, extreme problems. Levels of perceived problems are coded as follows: Level 1 (no problems) is coded as a '1' - Level 2 (some problems) is coded as a '2' - Level 3 (extreme problems) is coded as a '3'. The best score for the 5 dimensions is coded by '11111' and the worst state is coded by '33333'. In addition a EQ visual analogue scale (EQ VAS) help people say how good or bad a health state is, on which the best state is marked 100 and the worst state is marked 0. | At month 6 | 
| Economic impact of teleexpertise on dental treatment | Budgetary impact of the new coverage expressed in annual cash flows | At month 6 | 
| Evaluate satisfaction rate of use of teleexpertise of nursing home staff | Satisfaction of nursing home staff measured by an ad hoc Likert scale | At month 6 | 
| Compare the emergency score | The emergency score measured by the Oral Health Assessment Tool (OHAT) questionnaire. The OHAT comprises eight categories of screening tool to assess oral health : Lips, Tongue, Gums and tissues, Saliva, Natural teeth, Dentures, Oral cleanliness, Dental pain. After a dental examination by telemedicine, the dentist will evaluate each category as following : Score 0 correspond to healthy, score 1 corresponds to changes or score 3 correspond to unhealthy. | At month 0 and at month 6 | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Telemedicine, dentistry, long-term-care-home