Hostname: page-component-797576ffbb-jhnrh Total loading time: 0 Render date: 2023-12-08T12:56:07.861Z Has data issue: false Feature Flags: { "corePageComponentGetUserInfoFromSharedSession": true, "coreDisableEcommerce": false, "useRatesEcommerce": true } hasContentIssue false


Published online by Cambridge University Press:  30 May 2017

Roland Petcu
University of Montpellier
Chris Kimble
KEDGE Business
Roxana Ologeanu-Taddei
University of Montpellier
Isabelle Bourdon
University of Montpellier
Nicolas Giraudeau
University of Montpellier


Objectives: The evaluation of telemedicine from the patient's point of view has focused on the patient pathway and patient satisfaction. However, research in this field does not provide us with the means to assess a patient's perception of the procedure if their reasoning ability is impaired. In this study, we use direct observation of a patient's behavior and mood to assess their perception of an oral teleconsultation procedure.

Methods: This study has been conducted in the context of a pilot project using an asynchronous teleconsultation to improve access to dental care for the dependent elderly, disabled people, and prisoners, some of whom may be cognitively impaired. We use a direct observation form consisting of five behavioral variables and eight affect variables to reflect the patient's experience of the oral teleconsultation procedure.

Results: A total of 135 patients were evaluated; 10 refused the procedure. Psychotic patients (n = 33) had a somewhat negative experience during the oral teleconsultation procedure. Patients who were not psychotic had a positive experience; this decreased as we moved from the autonomous to the semi-autonomous and then to the dependent sub-group. Some gender differences were also noted.

Conclusions: Improving evidence on evaluating the acceptance of the cognitively impaired is required to improve the technology development process so that it can be translated into an improved patient experience and adherence. Although the study was specifically focused on teledentistry, the approach described in this study could be adapted to other forms of teleconsultation.

Copyright © Cambridge University Press 2017 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)



1. Mathers, CD, Loncar, D. Updated projections of global mortality and burden of disease, 2002-2030: Data sources, methods and results. Geneva: World Health Organization. [Online] 2005. (accessed March 12, 2015).Google Scholar
2. WHO. WHO | Facts about ageing. [Online]. Geneva: WHO. (accessed January 11, 2015).Google Scholar
3. Kimble, C. Business models for e-health: Evidence from ten case studies. Global Business and Organizational Excellence. 2015;34:18-30.Google Scholar
4. Sanchez Dils, E, Lefebvre, C, Abeyta, K. Teledentistry in the United States: A new horizon of dental care. Int J Dent Hyg. 2004;2: 161-164.Google Scholar
5. Zenthoefer, A, Cabrera, T, Hassel, A, Rammelsberg, P. Increasing dependency of older people in nursing homes is associated with need for dental treatments. Neuropsychiatr Dis Treat. 2014;10:2285-2290.Google Scholar
6. Giraudeau, N, Valcarcel, J, Tassery, H, et al. Projet e-DENT: téléconsultation bucco-dentaire en EHPAD. Eur Res Telemed. 2014;3:51-56.Google Scholar
7. Broens, TH, Huis in't Veld, RM, Vollenbroek-Hutten, MM, Hermens, HJ, van Halteren, AT, Nieuwenhuis, LJ. Determinants of successful telemedicine implementations: A literature study. J Telemed Telecare. 2007;13:303-309.Google Scholar
8. Delamater, AM. Improving patient adherence. Clin Diabetes. 2006;24:71-77.Google Scholar
9. Osterberg, L, Blaschke, T. Adherence to medication. N Engl J Med. 2005;353:487-497.Google Scholar
10. Chen, K, Chan, AHS. A review of technology acceptance by older adults. Gerontechnology. 2011;10:1-12.Google Scholar
11. Inouye, SK, Foreman, MD, Mion, LC, Katz, KH, Cooney, LM. Nurses’ recognition of delirium and its symptoms: Comparison of nurse and researcher ratings. Arch Intern Med. 2001;161:2467-2473.Google Scholar
12. Gerritsen, DL, Steverink, N, Ooms, ME, de Vet, HC, Ribbe, MW. Measurement of overall quality of life in nursing homes through self-report: The role of cognitive impairment. Qual Life Res. 2007;16:1029-1037.Google Scholar
13. Aubin, M, Verreault, R, Savoie, M, et al. Validité et utilité clinique d'une grille d'observation (PACSLAC-F) pour évaluer la douleur chez des aînés atteints de démence vivant en milieu de soins de longue durée. Can J Aging. 2008;27:45-55.Google Scholar
14. Aubin, M, Giguère, A, Hadjistavropoulos, T, Verreault, R. L’évaluation systématique des instruments pour mesurer la douleur chez les personnes âgées ayant des capacités réduites à communiquer. Pain Res Manag. 2007;12:195-203.Google Scholar
15. Watson, D, Clark, LA. Measurement and mismeasurement of mood: Recurrent and emergent issues. J Pers Assess. 1997;68:267-296.Google Scholar
16. Morello, R, Jean, A, Alix, M, Sellin-Peres, D, Fermanian, J. A scale to measure pain in non-verbally communicating older patients: The EPCA-2: Study of its psychometric properties. Pain. 2007;133:87-98.Google Scholar
17. Watson, D, Clark, LA, Tellegen, A. Development and validation of brief measures of positive and negative affect: The PANAS scales. J Pers Soc Psychol. 1988;54:1063-1070.Google Scholar
18. Watson, D, Clark, LA. The PANAS-X: Manual for the positive and negative affect schedule-expanded form. Iowa City, Iowa: University of Iowa; 1999.Google Scholar
19. Venkatesh, V. Determinants of perceived ease of use: Integrating perceived behavioral control, computer anxiety and enjoyment into the technology acceptance model. Inf Syst Res. 2000;11:342-365.Google Scholar
20. Guo, X, Sun, Y, Wang, N, Peng, Z, Yan, Z. The dark side of elderly acceptance of preventive mobile health services in China. Electron Mark. 2013;23:49-61.Google Scholar
21. Stefan, Bracha, Vega, E, Vega, C. Posttraumatic dental-care anxiety: Is ‘dental phobia’ a misnomer? Hawaii Dent J. 206;37:17-19.Google Scholar
22. De Jong, A, Baartmans, M, Bremer, M, et al. Reliability, validity and clinical utility of three types of pain behavioural observation scales for young children with burns aged 0–5 years. Pain. 2010;150:561-567.Google Scholar
23. Manne, SL, Jacobsen, PB, Redd, WH. Assessment of acute pediatric pain: Do child self-report, parent and nurse ratings measure the same phenomenon? Pain. 1992;48:45-52.Google Scholar
24. Ely, EW, Inouye, SK, Gordon, S, et al. Delirium in mechanically ventilated patients: Validity and reliability of the confusion assessment method for the intensive care unit (CAM-IC). JAMA. 2001;286: 2703-2710.Google Scholar
25. Burrows, AB, Morris, JN, Simon, SE, Hirdes, JP, Phillips, C. Development of a minimum data set-based depression rating scale for use in nursing homes. Age Ageing. 2000;29:165-172.Google Scholar
Supplementary material: File

Petcu supplementary material

Supplementary Figure

Download Petcu supplementary material(File)
File 2 MB