Survey vis-à-vis “Information Acquirement Systems” Available for Indian Dentists in the Wake of COVID-19 Crisis
1Department of Dentistry, All India Institute of Medical Sciences, Mangalagiri, Andhra Pradesh, India
2Department of Pedodontics and Preventive Dentistry, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
3Department of Pedodontics and Preventive Dentistry, New Horizon Dental College and Research Institute, Bilaspur, Chhattisgarh, India
4Department of Public Health Dentistry, Swami Devi Dyal Hospital and Dental College, Panchkula, Haryana, India
5Department of Community and Family Medicine, All India Institute of Medical Sciences, Mangalagiri, Andhra Pradesh, India
6Department of Conservative Dentistry and Endodontics, Patna Dental College and Hospital, Patna, Bihar, India
Corresponding Author: Cheranjeevi Jayam, Department of Dentistry, All India Institute of Medical Sciences, Mangalagiri, Andhra Pradesh, India, Phone: +91 8894337313, e-mail: firstname.lastname@example.org
How to cite this article Jayam C, Lokade A, Agrawal A, et al. Survey vis-à-vis “Information Acquirement Systems” Available for Indian Dentists in the Wake of COVID-19 Crisis. J South Asian Assoc Pediatr Dent 2021;4(2):90–95.
Source of support: Nil
Conflict of interest: None
A “well-informed dentist” = “best functioning dental care system”. In this context, it is imperative to see how good the information disseminating systems are present for the dentists in times of coronavirus disease-2019 (COVID-19). The following article is in no way related to clinical guidelines for dentists/care of patients/setting up best practices, rather a mirror on how effectively and efficiently dentists are being provided critical information during this confounding time.
Materials and methods: A cross-sectional survey utilizing Google forms was conducted to evaluate “Information Acquirement Systems” available for Indian dentists in the wake of the COVID-19 crisis through a structured questionnaire. Six hundred and sixty-four responses obtained just within a week were obtained for which comparison of participants’ response based on qualification, type of practice, and the experience was computed utilizing Pearson Chi-square and Fisher’s exact tests.
Results: Significant results were obtained on who should dispense the information regarding COVID guidelines for dental practice.
Conclusion: Quantity, quality, and authenticity of the information received confused due to the absence of a single source of information dispensation and uncertainty of the hierarchical system. In the current study, it was found that among the options present, dentists depended mostly on DCI for guidelines and proposed that they should continue to dispense the working guideline. Quantity of guidelines obtained, quality of guidelines was satisfactory, and has enabled to take right decisions currently. They have sometimes actively sought further information and lastly, they are confident to start practices after lifting COVID sanctions.
Keywords: Coronavirus disease-2019, Electronic media, Government regulations for COVID-19, Indian dentist, Information dispensing system, SARS-CoV-2, Social media.
Information is wealth, especially in the dynamic times of an epidemic; knowledge present should be made available and be adaptive to changing predicaments. A “well-informed dentist” = “best functioning dental care system”. In this context, it is imperative to see how good the information disseminating systems are present for the dentists to dynamically change accordingly to suit one’s practice in times of coronavirus disease-2019 (COVID-19).1
The following article is in no way related to clinical guidelines for dentists/care of patients/setting up best practices, rather a mirror on how effectively and efficiently dentists are being provided critical information during these confounding times.1 This pandemic has created some unique governance challenges. Coronavirus disease-2019 has shed light on our basic organizational problems and the inability of our healthcare system to cope with the demand of disseminating fast and correct information to the dentist.2
In terms of patient care, fundamental questions regarding patient care have arisen in the minds of clinicians like—(1.1) What are the standard operating procedures to be followed in the wake of COVID-19? (1.2) What are the rightful information sources one can bank on? (1.3) How much is the credibility of the available information in this age of WhatsApp universities? (1.4) When divergent opinions are present between state-union government guidelines, which guideline should the clinician bank on?
Apart from patient care, clinicians are also pondering for answers regarding—(2.1) Authenticity and legalities of teledentistry, (2.2) Role of dentists in community care, (2.3) financial aspects-Government economic packages for dentists to circumvent financial distresses, government exemptions from contracting trade licenses, tax benefits, a moratorium on loans, (2.4) Insurance and health packages in case of adversity.
MATERIALS AND METHODS
A cross-sectional survey utilizing Google forms was conducted to evaluate “Information Acquirement Systems” available for Indian dentists in the wake of the COVID-19 crisis through a structured questionnaire https://docs.google.com/forms/d/e/1FAIpQLSeqLklRTfF95O2OzwCSfZBs6cIOf3SlKQWfk364-eMvP939ug/viewform?usp=sf_link and https://docs.google.com/forms/d/e/1FAIpQLSftkP4xvA_-uInflH8vFgWk74Ec9c8xO5U_jlf-vovUH3krPA/viewform?usp=sf_link. The sample size (n) was calculated by using OpenEpi, Version for sample size estimation at a 95% significance level and a 5% error margin, the representative sample size is 452. Professionals from all states of India (Fig. 1) participated in the online study conducted for just a week in the month of May 2020 amidst the COVID-19 pandemic.
Total of 664 professionals’ response was later scrutinized leaving behind partially filled forms. Duplicate responses were discarded it included 320 females and the rest were 344 males; 274 graduates (BDS) and 390 were postgraduates. Among the total 280 were general practitioners and the rest were specialists. According to years of experience, 375 had %3C;5 years of experience, 151 had 5–10 years of experience, and 138 had %3E;10 years of experience (Fig. 2–Demographic characteristics). Pearson Chi-square tests and Fisher’s exact tests were used for statistical analysis. 44.7% of subjects reported relying on DCI for COVID guidelines for dental practice, whereas 28.6% rely on the government and the rest relied on others. Table 1 shows a comparison of responses to various questions by graduates, postgraduate students, and specialists. The dental council of India was the most trusted source of information for 44.7% of the subjects but the difference was not significant. 58.9% of subjects believed that DCI should dispense the information regarding COVID guidelines for dental practice and the difference was significant (p %3C; 0.05). 61.4% of subjects find the information received from the selected source to be adequate and the difference was not significant. The quality of information was found to be satisfactory by 82.7% of subjects and the difference was not significant. 67.2% of subjects find the information to be adequate to take the right decisions and 80.3% of subjects are confident to handle the patients after lockdown but the difference was found to be not significant.
|Question number||Subgroups||BDS N (%)||PG N (%)||MDS N (%)||Total N (%)||p value|
|9||Govt.||85 (31)||39 (28)||66 (26)||190 (28.6)||0.463|
|DCI||115 (42)||64 (47.1)||118 (46.5)||297 (44.7)|
|Association||52 (19)||17 (12.5)||45 (17.7)||114 (17.2)|
|Others||22 (8)||16 (11.8)||25 (9.8)||63 (9.5)|
|10||Govt.||63 (23)||27 (19.9)||48 (18.9)||138 (20.8)||0.058|
|DCI||114 (52.6)||89 (65.4)||158 (62.2)||391 (58.9)|
|Association||67 (24.5)||20 (14.7)||48 (18.9)||135 (20.3)|
|11||Overburden||23 (8.4)||11 (8.1)||29 (11.4)||63 (9.5)||0.607|
|Adequate||165 (60.2)||87 (64)||156 (61.4)||408 (61.4)|
|Inadequate||86 (31.4)||38 (27.9)||69 (27.2)||193 (29.1)|
|12||Good||32 (11.7)||15 (11)||31 (12.2)||78 (11.7)||0.708|
|Satisfactory||228 (83.2)||110 (80.9)||211 (83.1)||549 (82.7)|
|Poor||14 (5.1)||11 (8.1)||12 (4.7)||37 (5.6)|
|14||No||94 (34.3)||47 (34.6)||77 (30.3)||218 (32.8)||0.553|
|Yes||180 (65.7)||89 (65.4)||177 (69.7)||446 (67.2)|
|15||Very actively||108 (39.4)||45 (33.1)||106 (41.7)||259 (39.0)||0.172|
|Sometimes||148 (54)||75 (55.1)||133 (52.4)||356 (53.6)|
|Never||18 (6.6)||16 (11.8)||15 (5.9)||49 (7.4)|
|16||Confident||221 (80.7)||103 (75.7)||209 (82.3)||533 (80.3)|
|Not confident||53 (19.3)||33 (21.3)||45 (17.7)||131 (19.7)|
|Question number||Subgroups||General N (%)||Specialty N (%)||Total N (%)||p value|
|9||Govt.||92 (32.9)||98 (25.5)||190 (28.6)||0.022|
|DCI||117 (41.8)||180 (46.9)||297 (44.7)|
|Association||53 (18.9)||61 (15.9)||114 (17.2)|
|Others||18 (6.4)||45 (11.7)||63 (9.5)|
|10||Govt.||68 (24.3)||70 (18.2)||138 (20.8)||0.017|
|DCI||147 (52.5)||244 (63.5)||391 (58.9)|
|Association||65 (23.2)||70 (18.2)||135 (20.3)|
|11||Overburden||26 (9.3)||37 (9.6)||63 (9.5)||0.986|
|Adequate||172 (61.4)||236 (61.5)||408 (61.4)|
|Inadequate||82 (29.3)||111 (28.9)||193 (29.1)|
|12||Good||36 (12.9)||42 (10.9)||78 (11.9)||0.734|
|Satisfactory||228 (81.4)||321 (83.6)||549 (82.7)|
|Poor||16 (5.7)||21 (5.5)||37 (5.6)|
|14||No||90 (32.1)||128 (33.3)||218 (32.8)||0.747|
|Yes||190 (67.9)||256 (66.7)||446 (67.2)|
|15||Very actively||108 (38.6)||151 (39.3)||259 (39)||0.839|
|Sometimes||153 (54.6)||203 (52.9)||356 (53.6)|
|Never||19 (6.8)||30 (7.8)||49 (7.4)|
|16||Confident||230 (82.1)||303 (78.9)||533 (80.3)||0.301|
|Not confident||50 (17.9)||81 (21.1)||131 (19.7)|
Table 2 shows a comparison between general practitioners and specialists for various items in the questionnaire. Specialists (46.9%) found the information disseminated by DCI to be most dependable and it was significantly higher for specialists compared to general practitioners. Also, specialists (63.5%) believed that DCI should be the body to dispense the information related to guidelines regarding dental practice during COVID-19 situations and it was significantly higher for specialists compared with general practitioners. Rests of the comparisons were not found to be significant.
|Question number||Subgroups||<5 years N (%)||5–10 years N (%)||%3E;10 years N (%)||Total N (%)||p value|
|9||Govt.||119 (31.7)||30 (19.9)||41 (29.7)||190 (28.6)||0.113|
|DCI||152 (40.5)||81 (53.6)||64 (46.4)||297 (44.7)|
|Association||66 (17.6)||26 (17.2)||22 (15.9)||114 (17.2)|
|Others||38 (10.1)||14 (9.3)||11 (8)||63 (9.5)|
|10||Govt.||84 (22.4)||27 (17.9)||27 (19.6)||138 (20.8)||0.798|
|DCI||216 (57.6)||91 (60.3)||84 (60.9)||391 (58.9)|
|Association||75 (20)||33 (21.9)||27 (19.6)||135 (20.3)|
|11||Overburden||27 (7.2)||22 (14.6)||14 (10.1)||63 (9.5)||0.043|
|Adequate||229 (61.1)||87 (57.6)||92 (66.7)||408 (61.4)|
|Inadequate||119 (31.7)||42 (27.8)||32 (23.2)||193 (29.1)|
|12||Good||36 (9.6)||25 (16.6)||17 (12.3)||78 (11.7)||0.124|
|Satisfactory||318 (84.8)||115 (76.2)||116 (84.1)||549 (82.7)|
|Poor||21 (5.6)||11 (7.3)||5 (3.6)||37 (5.6)|
|14||No||129 (34.4)||45 (29.8)||44 (31.9)||218 (32.8)||0.576|
|Yes||246 (65.6)||106 (70.2)||94 (68.1)||446 (67.2)|
|15||Very actively||143 (38.1)||55 (36.4)||61 (44.2)||259 (39.0)||0.148|
|Sometimes||198 (52.8)||90 (59.6)||68 (49.3)||356 (53.6)|
|Never||34 (9.1)||6 (4.0)||9 (6.5)||49 (7.4)|
|16||Confident||306 (81.6)||120 (79.5)||107 (77.5)||533 (80.3)||0.568|
|Not confident||69 (18.4)||31 (20.5)||31 (22.5)||131 (19.7)|
Table 3 shows a comparison of the number of years of experience with various items in the questionnaire. It shows 61.4% of subjects find the information received to be adequate and was found to be significantly higher for subjects with >10 years of experience. The difference in responses of subjects with different years of experience was not significant for other questions.
The intended article was not meant to compare guidelines but to seek information about reliable sources which dentists sought during the pandemic, whether the information was quantitatively and qualitatively adequate, whether the information was timely available and the mode used to gain the information produced by agencies.
Amidst the ocean of information available on various websites and social media, it is very difficult for dental professionals to identify reliable protocols and research data. Questions in dentists’ minds on whom to follow, which to follow, quantity, quality, and authenticity of the information received caused confusion due to the absence of a single source of information dispensation and uncertainty of the hierarchical system.3 First, the question was postulated—Whether there is the availability of an organizational system by which dental professionals are informed? A search was conducted across search engines like PubMed, EMBASE, SCOPUS, Google Scholar, DOAJ, Cochrane, etc., on which dentists were relying as information sources; however, the search was futile, thus prompting to conduct a quick survey across India under present circumstances.
The first question was asked regarding all the sources of information that the dentist was using. The present system is made in such a way that a dentist will take the onus of the ultimate care of the patient. A well-informed physician can do wonders in comparison to an uninformed. So present scenario should allow the dental workforce in India to be supported with an organized information system that protects the workforce, ensures financial sustainability; for this, an accessible information system needs to be facilitated. During a prior major global pandemic, e.g., 1918–1919 “Spanish Flu”, the information landscape was very different from today due to scanty scientific advancement systems. The most authentic guidelines followed were provided by Central Government agencies (Ministry of Health and Family Welfare). But with growing knowledge, databases added with greater numbers of dental/healthcare professionals, several information sources are available at the dispense of the dentist. In our study dentists, information sources sought were innumerable and a multitude of combinations was seen.5,6
In similar terms, when there are groups of dentists practicing as an institution, an impetus is to be made to ensure that hospital boards are organized and systems are put in place to keep them informed in comparison to a contemporaneous approach being practiced.
The role of webinars was in sync with an evolving concept in contrast to the traditional dental school-student approach. Teachers’ role is an eminent part of these imparting best practices. On 28/06/2020, DCI announced arranging an array of weekly webinars with QandA (Questions and Answers) sessions incorporated weekly to support the dentist.7
The next question (Question 9) was regarding the most sought out agency for deriving the best information. This question preceded question 8 as the latter question asked for multiple sources. The single source that updated regularly and provided dynamic support is need of the hour—a must need for fighting an epidemic. Statistically significant results showed a tendency that DCI is the most reliable source of COVID guidelines for a dental practice. Importantly, we need to remember that there are limits to how swiftly the government agency can react, what it can do, and there is a bigger premium as to how it can react independently in absence of a comprehensive crisis management strategy. Hence, other large organizations like DCI, IDA, or specialty associations can potentiate their scientific proficiency and laborious clinical workforce to generate a consensus by working in close partnership with state and local public health leaders.5–7
The next question (Question 10) was who would choose as a provider of guidelines. Our study showed that the participants expect DCI to dispense the information regarding COVID guidelines for the dental practice.7 In a perfect world, the government mechanism should be well prepared for an organized response to safeguard the integrity of the dentists and their dependents. Given the stimulus, it was virtuous to see that there was very good coordination between the policy formulating and enforcing agencies working in tandem.8,9 There was a coordinated effort between relevant agencies—Ministry of Health and Family Welfare, State Health Ministries, Dental Council of India, and State Dental Council that supplemented and supported enhancements to policies. MOHFW called for a unified guideline on 19/05/20205–7
The next question (Question 11) was regarding the quantity of instruction provided by suitable agencies.
The right quantity of information at harmonious intervals is the necessity of the hour. Questions arise on not just formulating SOPs but dispensing them equitably. Information sometimes gets entangled in the web and sometimes does not reach the end-provider appropriately. On one hand, there is a tsunami of information that is loaded on dentists daily by national and local agencies on certain topics while, on the other hand, there was sometimes scanty information as governmental agencies were not accustomed to switching gears and operating in crisis mode.10
The next question (Question 12) was about the appropriateness of the content received. In this regard, our study showed 82.7% of subjects considered the information to be of satisfactory quality. Not just information building systems but dispensing systems need to be put. Thanks to the modern advancements in computational techniques and Information and communication technologies (ICTs), artificial intelligence (AI), and Big Data management systems have helped in handling, real-time monitoring, and updating quality information.4,8
The next question (Question 13) focused on the mode of information dispensation. Earlier, most information spread largely by word-of-mouth or in form of press releases by governmental agencies. However, with digital technologies, information is dispensed faster and to the right seats.4 There were even hotline operators set in to tackle questions and provide instructions to dentists; one-to-one information was given in personal capacities. However, a need for an interactive system that provides real-time trusted information can be built on their websites to deal with future situations.8,11,12
The next question (Question 14) was regarding the clinician’s ability to function with present information. The study revealed 67.2% of subjects find the information to be adequate for the right decision-making. It is seen that small practices especially are very vulnerable to handle this situation and have continuously scrambled to implement fixes. Though there are guidelines provided, practitioners are not accustomed to this. In long-term, a renewed effort needs to be equipped to enhance clinicians to face similar future challenges–respond quickly and make appropriate decisions.13,14
The next question (Question 15) probed whether the clinician sought active information in case of non-availability of information. Our study showed that only 39% of subjects tried to actively find information related to COVID. It is always imperative to place hotlines that respond proactively and quickly to deal with a problem. For example, AIIMS, New Delhi, is running a 24 × 7 helpline to provide support to the treating physicians on clinical management. The helpline number is 9971876591. Several nodal officers were also appointed by states to help to treat clinicians.15,16
There was an interesting finding in the present study. About 80.3% of subjects are confident to handle the patients after lockdown even when only 19.7% of subjects find the information to be adequate for right decision-making, hence suggesting the pressure to start practicing dentistry.17,18
Conclusions from current study—Quantity of guidelines obtained, quality of guidelines was satisfactory, and has enabled to take right decisions currently. They have sometimes actively sought further information and lastly, they are confident to start practices after lifting COVID sanctions.
General conclusions—Initially, there was a dearth of knowledge, but suddenly there was a barrage of knowledge. Both acted as two ends of swords cutting the practicing dentist to bereavement. Certain conflicting statements on the nature of practice were agonizing. Dental care is experiencing a severe breakdown and would even continue to do so for months together after the opening of lockdown. Accordingly, practices will keep scrambling to keep patients and staff safe, while facing financial collapse. In such conditions, agencies should provide good support to dentists in terms of regular situation briefing, trend now-casting/forecasting. In the current study, it was found that among options present, dentists depended mostly on DCI for guidelines and proposed that they should continue to dispense the working guideline.
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6. CDC, Coronavirus Disease 2019 (COVID-19) [Internet]. Centers for Disease Control and Prevention. 2020 [cited 2020 Sep 21]. Available from: https://www.cdc.gov/coronavirus/2019-ncov/hcp/dental-settings.html.
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17. Prinja S, Pandav CS. Economics of COVID-19: challenges and the way forward for health policy during and after the pandemic. Indian J Public Health 2020;64(Supplement):S231–S233. DOI: 10.4103/ijph.IJPH_524_20.
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