The current situation surrounding COVID-19 has created a number of challenges, many of which relate to self-isolation and social distancing. As the guidance for dental practitioners continues to evolve regarding what circumstances consultations / treatment can be provided, we, as a profession, are faced with having to consider limiting the majority of patient interactions to remote consultations.
Dental Protection has received calls from members regarding the safety and suitability of remote consulting – i.e. teledentistry – and this article outlines our advice and guidance.
We recognise this is an extremely challenging time for all healthcare professionals and Dental Protection is here to support you. The treatment of patients is of paramount importance and we want you to be able to deliver this in a safe and effective way.
If you are undertaking a remote consultation
When considering a remote consultation, you should weigh up whether you can adequately assess the patient remotely. If you have doubts then you should recommend the most appropriate route for the patient to seek dental care, in accordance with local public health/government guidance.
In circumstances where a face-to-face consultation is not a viable option, you need to be satisfied you can adequately assess the patient remotely. You should document that you have undertaken this consideration in the clinical records. Unless there are exceptional circumstances, it is preferable that remote consultations will relate to patients already known to you, with access to their clinical records. During any remote consultation, both the dental practitioner and patient should be able to reliably identify each other. Naturally, video consultations may enable this. They may also assist in assessing any facial swelling or other symptomology but the practitioner needs to be satisfied that the video is sufficient to fully assess the condition and may be dependent upon the quality of the image and lighting.
After the patient’s identity has been confirmed, it is prudent to move forwards and retake their medical history.
In cases of emergency, patients should be encouraged to seek assistance via the recommended route, in accordance with the most recent government and/or public health guidance.
Remote consultation with an existing patient in another country
If you are contacted by an existing patient and you hold their dental records, but they are out of the country and unable to return for quarantine or restricted travel reasons, you should recommend to the patient that they follow the most appropriate alternative route for assistance, which may involve seeking local dental care or advice
If the patient is contacting you in relation to a known dental problem, and you feel able to provide advice, you should make a reasoned decision as to whether this is the safest course of action for the patient before doing so. Any advice may be very limited and there should be a low threshold for advising patients to seek advice from local dental services.
Remote consultation with a new patient in the same country as you
If you are asked to undertake a remote consultation with a new patient, you need to consider whether you can obtain sufficient clinical and medical information in order to assess the patient and provide any advice remotely. If you cannot adequately assess the patient, then you should recommend the most appropriate route for the patient to seek dental care, in accordance with local public health/government guidance.
Remote prescribing should only be considered if local regulation guidance / laws permit this and it is clinically justified. In Australia, the lead clinical guidance comes from the Oral and Dental Therapeutic Guidelines, version 3. The prescription must be the most appropriate treatment option and before any prescription is considered, you must be satisfied that you have full information about the patient’s medical history and have been able to fully assess the patient’s dental problem. Evidence to support this must be recorded in the patient’s dental records.
In all remote consultation situations, it is your responsibility to ensure you continue to practise in accordance with any applicable laws, guidance and regulations around the diagnosis, treatment, prescription and provision of medication to patients – both within the country in which you practise and, if applicable, within the country in which an existing patient is based at the time of the consultation. Where members depart from their usual practice, they will remain accountable for their actions.
Consideration also needs to be given regarding the use of ADA glossary codes, as it is not appropriate to utilise a code that does not describe the actual treatment provided/activity undertaken. Be mindful that Health Insurers may not offer a rebate under these circumstances.
The overarching principles of consent, privacy and duty of care remain, regardless of how you consult with you patient.
It is imperative that the patient understands that teledentistry is not a like for like substitute for a chairside assessment.
If the patient is not able to access local dental care due to quarantine protocols, and you are satisfied that this is the case and documented this rationale – then you will be able to request assistance from Dental Protection for incidents that arise from the consultation, where the complaints or claims are brought in the jurisdiction in which you hold your membership.