Pain has been deemed the fifth vital sign and many describe it as an adverse event. The adequate management of pain is the bane of the dental profession and its continuous assessment is crucial to minimizing patients' pain experiences. Due to the duration of action of most commonly-used local anesthetic agents, dental patients are unable to predict their pain following dental procedures until many hours later, when they have already returned home and dental offices are closed. This has led to an over-reliance on pre-emptively prescribed opioids by dental providers because they have no means to actively track their patients' pain after hours. Innovative mobile applications and connected health technologies that allow real-time tracking of patients' symptoms, functional status and quality of life, provide healthcare professionals with data that were previously unavailable, and have fostered patient engagement, shared decision-making and adherence to treatment plans. We propose an innovative solution to optimize the quality of dental pain monitoring and management by implementing mobile phone technology to monitor patients' pain during the critical acute post-operative phase. Our hypothesis is that by actively tracking these symptoms using mobile phones, we will promptly identify the patients with sub-optimal pain experiences and offer providers an opportunity to intervene (e.g. modify analgesic prescriptions), thereby eliminating needless suffering, reducing the occurrence and/or severity of post-op complications, and enhancing the overall care experience. Our ultimate goal is to achieve the quadruple aim: improve patient experience, improve patient outcomes, improve physician experience and reduce per capita costs. We will test this hypothesis using a cluster-randomized experimental study design with: (1) an intervention arm where patients receive push notifications through SMS text messages on their mobile phones (FollowApp) at designated time intervals on Days 1, 3, 5 and 7; and (2) a control arm where patients receive the usual care. This project will be conducted at two dental institutions: Willamette Dental Group (WDG) and University of California San Francisco (UCSF).
In Aim 1 we will customize the design features of the existing Followapp at two dental institutions (Willamette Dental Group and University of California San Francisco) and assess its capacity to accurately capture patient-reported outcomes.
In Aim 2 we evaluate the impact of using Followapp on patient post-op experiences and oral health outcomes. And in Aim 3, we evaluate provider acceptance of Followapp and its impact on provider performance. By collecting patient reported outcomes in a timely and usable way, we expect to help dentists enhance their practice performance and reduce the burden of unnecessary opioid prescriptions on society.
We seek to implement a dental patient reported outcomes system using mobile phone and SMS text messaging to target the over-reliance on pre-emptively prescribed opioids by dental providers. If successful, our project will help dentists actively track and manage their patients' pain after hours and enhance the overall care experience.
