CAPUNI is a national survey carried out by the GIS Marsouin which aims to measure what digital technology brings (or does not bring) to individuals in terms of power to act.
It is particularly interested in the uses of digital technology within isolated rural areas (ZRI) and in priority city districts (QPV).
It is a telephone survey conducted in March 2019 among 7500 people over 18 years old (a national sample and four oversamples).
FOCUS In 2019, 40% of French people use online medical appointment platforms. Age and income are discriminating factors. Residents of isolated rural areas are less likely to use these platforms. 10% of French people have already used digital technologies to monitor their health. Half of the French are convinced by the benefits of integrating digital technology into health practices, a quarter are reluctant and the remaining quarter are undecided.Some of the individuals targeted by these possibilities (seniors and people with reduced mobility) are more undecided than the French as a whole about their benefits. Moreover, the quality of the perceived flow plays a role: a poor quality flow at home favors pessimism. Professionals in the health and social sector are less optimistic overall than the national average about some of the promises of digitization of health. However, those in the ZRIs, faced with the remoteness of major urban centers and therefore major medical centers, have a more clear-cut opinion and are more optimistic than their colleagues in more urban areas. On March 17, 2020, the French population was placed under reinforced confinement to limit the spread of the Covid virus as much as possible19 . The CAPUNI survey shows that there is still a long way to go for patients and caregivers to make the most of the possibilities of digital health care. An epidemic like the one we are experiencing will transform the uses and representations we all have of e-health. Let's hope that this transformation will allow us to move from promises to achievements.
The development of digital technologies seems to offer new perspectives in terms of personal care. The development of the Shared Medical Record (DMP), the deployment of telemedicine and online medical appointments are in full expansion. By 2022, in parallel with administrative dematerialization, the government plans to implement a program called "My Health 2022[1]". This program aims to encourage cooperation between healthcare professionals and to optimize patient care and referral according to their needs, in particular by improving the distribution of medical resources across the country. One of the fundamental levers emphasized in the implementation of this major project is the use of digital technologies.
These advances are transforming the relationship between patients and healthcare professionals. The CAPUNI survey examines various dimensions (territorial and social in particular) of French people's digital medical practices in 2019, as well as their feelings about the possibilities offered by the contribution of digital technology in this sector.
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Online medical appointments: a first step towards the digitization of the sector
Appeared in 2013, online appointment booking platforms are now preferred by 20% of French Internet users, while 20% of them say they make their appointments "as much via digital as without". Thus 4 out of 10 French Internet users are used to going through digital to make a medical appointment, even if they do not use it directly, two thirds of the French consider it easier to perform the task via the Internet.It appears that the place where one lives influences whether or not one favors digital medical appointments. There is a gradual effect linked to the degree of polarization[1]of the territory. Indeed, people living in the Paris region and in urban areas with more than 200,000 inhabitants are more likely to favor digital technology (30% compared to 20% nationally). In isolated rural areas (ZRI), the population is less likely to use digital technology to book medical appointments than in other more urbanized areas (10% versus 20% nationally). As for the share of the population that never uses digital technology to book an appointment online, it is 50% nationally and 60% in the ZRIs. It should be noted that this difference cannot be linked to the fact that ZRI residents consider it more difficult to make medical appointments online: the results concerning the perception of difficulty are similar to the national figures (14% mention the difficulty of making a medical appointment online in ZRIs compared to 13% in France).
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At the individual level, in addition to the generational divide that remains, the level of education plays a role in whether or not a medical appointment is made online. This effect is revealed more specifically in the opposition between the most highly educated (level higher than Bac +2) for whom 52% use digital technology ("favor" or "as much with as without") and those without a bachelor's degree (25% of them use digital technology).
The Shared Medical Record: a promising device?
Initiated some fifteen years ago and then generalized throughout the country in November 2018 by the government[1]Référence :
, the Shared Medical Record (DMP) compiles in a single dematerialized space the history of information that is directly or indirectly related to the health of a patient. The aim of the DMP is to enable patients to share their medical information with healthcare professionals in order to improve the quality and effectiveness of the care they receive, particularly for those who frequently seek care (chronically ill patients or pregnant women). The CAPUNI survey reveals that in 2019, 60% of French people are aware of the DMP, and 10% have created it. This proportion rises to 30% for respondents declaring a disability at the time of the survey. All of those who have created their DMP are Internet users. Three quarters of people who have created their DMP are optimistic about the benefits of digital technology in terms of coordinating the care provided. This figure is 18 points higher than that of the French population as a whole (56%).Digital health: uses and expectations
According to the official definition, telemedicine is "a form of remote medical practice using information and communication technologies."[1] Since 2018, the act of teleconsultation is part of the common law of medical practices (tele-expertise since February 2019). The Ministry of Solidarity and Health indicates that telemedicine has been thought and designed to offset the aging of the population, ensure better monitoring of chronic diseases or improve access to care in certain areas[2] via tools such as teleconsultation[3 ] or remote monitoring[4]. The CAPUNI survey seeks to quantify the use of digital health technologies by the French population. In some cases, these means are similar to uses inherent to telemedicine (connected objects, teleconsultation, etc.). In addition, the survey measures the feelings of the French people regarding the possibilities offered by telemedicine.Références :
10% of French people have already monitored their health using digital technologies. On the very specific topic of health, we find the usual generational divide: the youngest use digital technology more (38% of 18 to 29 year olds) than the oldest (less than 6% of those over 75). Digital technology users are more convinced of the benefits of remote medical diagnosis than the French as a whole (54% vs. 47%, i.e. 7 points more). There are fewer pessimists than in the French population as a whole (27% vs. 33%, i.e. 6 points less). It should be noted that the proportion of those who do not express an opinion on the benefits of digital technology for remote medical diagnosis is similar among users as it is for the French population as a whole (19% and 20%).
The CAPUNI survey focuses on two perspectives opened up by the development of remote medical diagnostics: firstly, keeping the elderly and disabled at home, and secondly, hospitalization at home. The survey reveals that nearly 50% of French people believe that the contribution of digital technology favors home care for the elderly and disabled, as well as home hospitalization. 25% are pessimistic about these same prospects and 25% remain undecided.
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French Internet users who are dissatisfied with their Internet connection at home are more pessimistic than the average French person about the possibilities offered by digital uses in health. For example, 36% of people who are dissatisfied with their home connection for minimum speed uses[1] are pessimistic about the possibility of using digital technology to help elderly and disabled people stay at home (+7 points compared to the French population as a whole). This figure rises to 39% (+10 points) if median speed usage is taken into account. This observation links, on the one hand, the objective of generalizing practices intrinsic to telemedicine in the territories and, on the other hand, the quality of the Internet speed and more specifically the deployment of very high speed.
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A salient fact is that the people directly concerned by the benefits of deploying digital health technologies in the region (particularly through telemedicine) are significantly more likely to have no clear opinion ("Don't know") on these questions. Indeed, seniors (40% of those over 75 years old, compared to 26% in France) and people with reduced mobility (36%, compared to 26% in France) - whether they have an officially recognized disability or have answered that they have difficulty getting around on a daily basis - are more undecided than the French as a whole on the subject of promoting home hospitalization or keeping elderly and disabled people at home thanks to digital technology.
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The growing presence of digital technology in the health and social sector is leading to a transformation of professions and practices.
The CAPUNI survey shows that health and social care professionals[1Référence :
] are more pessimistic than the general population about the prospects for digital health technologies. Indeed, 35% of them believe that digital technology will not promote home hospitalization or the maintenance of elderly and disabled people at home: this represents 11 points more than the national average. This finding raises questions: does the reason for this greater pessimism stem from a deterioration in their working conditions, a real perception of a negative impact on patients in their remote monitoring, or a fear that digital technology will transform their human-centered professions into technical ones (or a combination of all three)?Although this greater pessimism among HCPs regarding the promises offered by digital health is visible throughout France, there is an imbalance between HCPs who say they are optimistic and those who are undecided about the degree of polarization in their area of residence. In fact, among the PSS, those in isolated rural areas (IRZ) are more optimistic (+9 points) and less undecided (-9 points) than all PSS. They are thus on a par with the average for all French people in terms of optimism. It should be added that the opinion of ZRI residents in general overlaps with that of the French as a whole.
Thus, to some extent, within the ZRIs - areas highly concerned with some of the promises of digital health related to facilitating access to care in medical "deserts" - the perceptions of HCPs resonate with the promises of public policy in the development of digital health.
