CHAPTER I: STATEMENT OF THE PROBLEM

1.1 Description of the problem

The global pandemic of Covid-19 has left a severe health crisis, after several months of mandatory quarantine in the vast majority of the 188 countries where the new coronavirus is present (World Health Organization WHO, 2020). This health crisis is affecting the attention and care that has been given to other pathologies that are still present and that have been relegated to the background due to the urgency that has become global this year.

Several researchers have already been speaking on the subject. A medical team admitted that the crisis generated by the expansion of the new SARS-CoV-2 pandemic, has affected hospital services in the European nation and has precipitated the adoption of its procedures to direct them to the outpatient.

In the Iberian nation, the procedures for external consultation of pharmaceutical care have had to be modified, adopting measures recommended by national and international health organizations to minimize the chances of contagion. This has to do with social and spatial distancing practices, as well as hygienic biosecurity measures. For non-face-to-face outpatient consultations for Pharmaceutical Care, they have had to implement the repowering of teleconsultation platforms with dispensing of treatments based on basic procedures. 

In the medical field, the concern of how to approach patients becomes more complex as the need for contact between the doctor and the person receiving care deepens. Such is the case of surgeons who must perform highly invasive treatments and operations. Therefore, expert doctors suggest reorganizing human and material resources more efficiently, having as the first challenge to protect medical personnel and protect patients from possible coronavirus infections. 

In the field of dentistry, the challenges have also multiplied as a result of the pandemic. The first challenge has been to manage the information. Experts argue that the studies that exist on the impact that Covid-19 has had on dental medicine lack homogeneity, randomness and repetition. For these experts, these shortcomings hinder the possibility of finding a concrete guideline to proceed with treatment and medical care in this context of a pandemic.

The most respected studies indicate that Covid-19 can be spread by direct means, through coughing, sneezing and inhalation of small drops of salivary or mucosal secretions and direct contact with the nasal, ocular and oral mucosa . Within the dental office, the most important risk factor is the possibility and inhalation of small drops of saliva that can remain suspended in the air and be inhaled by both the patient and the dental doctor.

These risk factors have motivated changes in the practice of dentistry since the pandemic began to spread in different countries of the world. Experts published a work in which they warned that the production of oral health care made by dentists had undergone a transformation in the context of the pandemic. They affirm in the letter that this transformation that has been staged in the field of dentistry from confinement is framed in structural transformations of the entire dental practice. 

They concluded after a study carried out by specialists and professional researchers, that there is great concern among dental doctors about the level of infections that had been registered on behalf of Covid-19 and because they are the first line of contact with patients. Thus, they predicted that dental services were going to have to transform to meet the new protocols and hygiene guidelines. 

Part of these transformations in the practice of dentistry is the underpinning of telematic modalities for the care of outpatient patients or, in any case, for the elective care of users of services that require dental care.

Teleconsultation of patients or virtual dental consultation as it is also often called, has not arisen as a result of the Covid-19 crisis; Although the pandemic has forced many professionals to include it in their service offering. Again, the experts explain that the development of technology has permeated almost all human activities, including the practice of medicine.

This is thanks to the fact that over time people have been able to become more familiar with the interfaces of the different computer programs to obtain services of all kinds, without the need to move from one place to another.

Thus, we see that these experts made a diagnosis of the potentialities of Information and Communication Technologies (ICT) in applications related to the dental medical service. They analyzed the alternatives that exist both at the level of dental teaching and in clinical practice in their different specialties, in order to optimize them, facilitate them and make it reach more patients in different places. It is worth noting that most of the studies carried out so far this year are aimed at providing solutions for dental practice at the teaching level. However, this has not prevented healthcare centers, especially those of a private nature, from investing their own resources in the design of platforms that allow them to maintain care with their users. 

Some private medical institutes began to implement the increasing use of ICT in the provision of their services.

It is at this point that virtual dental care services become of paramount importance for major dental clinics. During the months of the quarantine, this meant the only viable alternative so that patients did not lose contact with their doctors and dentists, they could continue with their external consultations and recommend treatments by virtue of the evolution of their patients. 

Due to the haste with which the applications of the virtual platform for dental patient care had to be expanded, dental clinics have perceived that there may be gaps within the platform that could be affecting the perception that patients have of this service.

Due to the multiplicity of variables that intervene within the provision of a digital service (internet coverage, band capacity, computer equipment, knowledge of the platform, digital capabilities of the actors involved), it is necessary to carry out a diagnosis of which is the situation of each of these variables.

In dental clinics, there is concern about how their patients are evaluating virtual dental care, since, by knowing their concerns, a diagnosis can be made that will allow formulating recommendations to improve the service, consolidating their strengths and modifying those aspects that are considered weak. 

By virtue of the above described, the following problem formulation question is asked.

1.2 Problem Formulation 

What is the level of satisfaction of the service in the virtual dental consultation of the patients of the dental clinics?

•  Objectives

The objectives of this research are circumscribed to the need to know the current perception that patients have of dental clinics to know their strengths and weaknesses and to undertake the necessary corrections.

1.3.1 General Objective

Determine the level of satisfaction of patients seen virtually in 2020, in dental clinics according to dimensions of sex and age.

1.3.2 Specific objectives

• Know the profile of patients who are using ICT resources to access virtual dental care. 
• To investigate the most recurrent observations made by patients about virtual dental care services. 
• Identify the dental services that can be incorporated into the virtual care platform of the dental clinic.
• Design a procedure manual for medical personnel to attend to the concerns of patients who come to the virtual dental care service.

1.4 Justification of the problem

Regardless of whether the Covid-19 pandemic can be controlled in the medium and long term, there is an irreversible fact that is the penetration of Information and Communication Technologies (ICT) in almost all areas of human life and very particularly in the field of health service provision. The important has pointed out that two crucial elements are joining to mark this trend: The concern of the States to offer better health services to the population and the desire to improve that the members of the communities have themselves has led to the development of alternatives. He later describes that health services are being improved with the possibility of remote consultations, using the tools of ICT. 

Through these technologies, he affirms that health professionals and assistants who work in places far from the specialists and the most developed laboratories have found telecommunications a reliable alternative to access better advisory and consultation services. 

1.4.1 Importance of the Research project. 

Seven years ago experts asserted that the use of ICTs in the health area constitutes a tool to improve the impact of interventions in communities and they recommended, after conducting a study, that new information and communication technologies represent a tool effective in reducing access limitations and improving the effectiveness of treatments.

All this indicates that beyond the serious health emergency that is being experienced by Covid-19, it is indisputable that the advancement of the health service towards virtual or telematic models is an irreversible trend and that it will become more pronounced with the pass of the time. 

This irreversible trend serves as a basis for the relevance of the need for dental clinics to evaluate the performance of their virtual dental care services on time, since as the years go by, this modality will gain greater weight within the whole services provided by dental clinics.

In other words, the scope of the usefulness of the information that is collected goes much further than the Covid emergency. It is about creating new forms of care and relationships between the medical staff of dental clinics and their patients. It is about automating processes and supervising their development, generating the capacity of the company to implement the necessary corrections to improve aspects such as empathy in patient care, patient waiting times, direct contact with patients. specialists requested, extension and flexibility of the schedules and the main thing: The possibility for both the patient and the doctor, of not having to travel to generate a good dental care service. 

In case measures are not taken in order to adapt to what seems to be the evolution of our societies, the business model of dental clinics runs the risk of stagnating and not walking in the same direction as the needs of their patients . A relatively new, important and growing market niche is being left open for other entrepreneurs to exploit and take advantage of the situation.

Regarding the present time, if the processes are not subjected to continuous supervision by the dental clinic directives, there is a risk that the efforts of professional improvement, process reengineering and increasing the effectiveness of the information flow between the different departments, they are lost, even though they have been policies that have been implemented in recent years to streamline processes and increase the quality of service. All this to get a better rating from patients every time. 

A good satisfaction on the part of the patients of the virtual dental services of the dental clinics, generates feelings in the mutual relationship of:

A. Reliability is the feeling that the patient has when establishing contact with the dentists of the dental clinics, in which they will receive professional, safe and accurate care. 

B. Validity, which is the impression by the patient that the information they will receive from their doctor will be effective in curing their ailments or improving their health parameters. And finally 

C. Loyalty. A patient who identifies favorably with the care he receives in a hospital center will surely be the permanent site for her consultation and treatment.

1.4.2 Project feasibility 

There is within the management of dental clinics, fully aware of the need for constant evolution and renewal of their services. That is why it is from this instance that the initiative to carry out this study has started, with which it is intended to obtain lights for a roadmap that will be applied in the time that the study stipulates, in order to maintain or improve the levels of patient satisfaction regarding the virtual dental services provided by this network of clinics. 

In this sense, the directive has arranged to propose the use of the necessary logistical resources, taking advantage of the computing, records and communications infrastructure that exist between the 38 physical offices and their headquarters, to establish the base of operations for the investigation. 

Another resource of capital importance is the medical and auxiliary team of the dental clinics, which has received instructions from the directive to collaborate by providing all the information necessary to categorize and classify the services that are being provided, as well as relate the experiences of communication with patients that have arisen in the framework of the Covid-19 pandemic. 

From the economic point of view, the management of the dental clinics will have a financial amount in accordance with the initial budget, so it is estimated that there will be the necessary monetary muscle to carry out the study applying the tools and methods of collection of data that had been established from the beginning.

In this order of ideas, this research project can be considered viable since it is based on the favorable knowledge and support from the board of the dental clinics, which has had the necessary logistical and financial resources to carry out good term this investigation. The CEO’s board of directors has been committed to the idea of knowing the results of the investigation and implementing the recommendations that arise from the conclusions that are reached through the results of the surveys. 

• Limitations

The estimated limitations for carrying out this research are given by the conjunctural circumstances that are experienced in the final part of this year 2020. As a consequence of the Covid-19 pandemic, and the long confinement that closed the dental care services for months On a face-to-face basis, we find part of the staff dispersed in obligations and commitments outside of their normal routine, or at least, what was taken as routine before confinement.

Thus, a good part of the staff and even more of the auxiliary staff that will be vital for the location of possible respondents, facilitator of patient history and their dental and socioeconomic profile, is oversaturated with tasks as a result of recent reengineering processes in the field of staff functions. In this context, we have located a staff that, although they are willing to collaborate with this investigation, is solving primary problems of adaptation to new responsibilities and even working in new scenarios as a result of the relocation of their functions.

These new occupations have limited the possibility of collaboration, to the extent that many of them are in different settings than those at the time the research proposal was formulated and the study application process was agreed with the directives.

Another limitation that has been visualized is that the survey execution season, which is the mechanism that will be used to obtain detailed information on the perception of services, will coincide with the Christmas holidays, days in which many families temporarily change their address or withdraw from health care.

When dealing with patients who use a virtual or remote dental service, their geographical location is much more dispersed than when it comes to captive patients within a dental practice. This will imply a logistical effort and an investment of additional time that will be proportional to the number of people who are decisive for the study sample.

These two events may directly affect compliance with the initial schedule that had been established for this study, specifically in relation to data collection and conducting the survey through direct interviews with patients. Therefore, they constitute elements to be taken into account for the final design of the activities schedule. To counteract possible delays, it is proposed to adjust the times of the other activities related to the investigation, especially the previous ones, in order to advance the field work and make the times coincide with dates of normal work activity in the country.