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Difficulty recruiting and follow-up due to the epidemic context of COVID19
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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.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| telemedecine nursing home | Active Comparator | One buccodental teleexpertise at the completion day and a second buccodental teleexpertise at the end of study |
|
| control nursing home | No Intervention | Only one buccodental teleexpertise at the end of study |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| bucco-dental teleexpertise | Other | A bucco-dental consultation remotely using telemedicine system |
|
| 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 |
| 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" |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Nicolas Giraudeau, DDS, MSc | CHU de Montpellier | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| EHPAD Le Sherpa | Belmont-sur-Rance | 12370 | France | |||
| EHPAD Via Domitia |
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| ID | Term |
|---|---|
| D014076 | Tooth Diseases |
| ID | Term |
|---|---|
| D009057 | Stomatognathic Diseases |
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| 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 |
| Castelnau-le-Lez |
| 34170 |
| France |
| EHPAD Korian La Colombe | Gigean | 34770 | France |
| EHPAD Korian Perier | Marseille | 13000 | France |
| EHPAD La Roselière | Marsillargues | 34590 | France |
| EHPAD Françoise Gauffier | Montpellier | 34000 | France |
| EHPAD Korian La Pompignane | Montpellier | 34000 | France |
| EHPAD La Carriera | Montpellier | 34000 | France |
| EHPAD Montpellieret | Montpellier | 34000 | France |
| EHPAD Pierre Laroque | Montpellier | 34000 | France |
| Résidence mutualiste de Pezilla | Pezilla La Rivière | 66370 | France |
| EHPAD Saint Jean | Saint-Amans-des-Cots | 12460 | France |
| EHPAD Saint Jean Pla de Corts | St. Jean-Pla-de-Corts | 66490 | France |